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Editorial A Global Workforce for Health Recently the G8 patted itself on the back for its pledge to double aid to Africa to US$50 billion annually while committing to universal access to HIV/AIDS treatment by 2010. Clearly, Africa needs this financial help and universal treatment is a heroic goal. But the $50 billion question remains: who is going to deliver that treatment? The answer is that no one is quite sure. Although medical science is at its zenith, the global crisis in human resources for health (HRH) means we cannot care for our own. Collapsing health systems, alarming burdens of disease, and immoral disparities in quality of life and access to care typify the shameful state of international health today. There are simply not enough health workers, not well enough trained or distributed, with sufficient equity, to staff the health systems of the world - particularly those of developing countries. Even most rich nations, which harbor poor communities that mimic health outcomes of the Third World, are not immune to the workforce crisis. This is thrown into sharp relief following natural disasters like Hurricane Katrina (see Cuba’s Response to Katrina Disaster). If the status quo prevails, there is little hope for reversing the trend, according to the WHO’s 5-year Millennium Development Goal (MDG) progress report in health released on August 22. “A failure of health systems, [has] failed to protect the poor from the consequences of ill health.” Significantly, the report points specifically to the HRH crisis: “much of the burden of disease can be prevented or cured…the problem is getting staff, medicine, vaccines and information…to those that need them. In too many countries, the health systems needed to achieve these objectives either do not exist or are on the point of collapse.”[1] The situation is most acute in Sub-Saharan Africa, which carries 25% of the world’s burden of disease, but has only 1.3% of the world’s health workforce.[2] But Latin America and the Caribbean also suffer a dearth of health professionals, with entire indigenous and marginalized populations without health care. In an effort to spur governments and other public health stakeholders to foster a sustainable solution to the complex HRH problem, the Joint Learning Initiative (JLI) in its seminal report Human Resources for Health, called for a “decade for human resources for health (2006-2015).” Leading the global charge, Cuba effectively inaugurated such a decade on August 20th with Havana graduation ceremonies for 1,610 new MDs for the Global South ( Top Story: Where There Were No Doctors: First MDs Graduate from Latin American Medical School). Part of a long-term, multi-faceted strategy designed to confront the crisis in health workforce capacity development ( Spotlight: Doctors for the (Developing) World; International Cooperation Report: Joining Forces to Develop Human Resources for Health), the new doctors, representing 28 nations, have pledged to return to their countries to work in underserved communities. Most of the graduates could only dream of becoming doctors before Cuba made full, six-year scholarships available. Indeed, this is true for new graduates like Dr. Luther Castillo from Honduras, who shares his experiences in MR Feature: Profiles in Commitment: Conversations with ELAM Students, as for Dr. Cedric Edwards ( MR Interview: Cedric Edwards, MD: First U.S. Graduate of the Latin American Medical School). Cuba’s extension of full medical scholarships to U.S. students from underserved communities also attempts to address health care disparities in the United States itself. According to the Sullivan Commission’s report Missing Persons: Minorities in the Health Professions, “African Americans, Hispanic Americans, and American Indians, only account for less than 9% of nurses…[and] 6% of physicians, mean[ing] these groups tend to receive less and lower quality health care than whites, resulting in higher mortality rates.”[3] Global health equity and the education of minority doctors are the focus of this month’s International Voices - a new section offered by MEDICC Review - which reprints articles by international experts concerning Cuban health and medicine. We are pleased to debut this section with “ Global Health Equity” from The Lancet and “ Affirmative Action, Cuban Style” from the New England Journal of Medicine. Cuba’s efforts to create a workforce to deliver quality, equitable health care in resource-scarce settings are the result of decades-long experience, as evidenced by the story of 1983 graduate Thabo Mnisi ( MR Feature: Profiles in Commitment: Thabo Mnisi, MD, Clinical Manager, Alexandra Health Centre and University Clinic, South Africa). The role of Cuban faculty in divergent international settings – where community and problem-based learning prevail – is addressed in our Professional Literature section ( Experience of Cuban Faculty in Establishing a Medical School in the Republic of The Gambia ; Community Health Diagnosis as a Curriculum Component:Experience of the Faculty of Health Sciences, Walter Sisulu University, Eastern Cape, South Africa). Cuba’s practical contribution to the global health workforce merits serious recognition by the international medical community. This year’s graduates should be taken at their word and placed promptly by health authorities in their home countries in the mountains, deserts, villages and favelas where their skills and commitment are urgently needed. And the world should take note: the decade for human resources for health has begun - the clock ticking in the short lives of the underserved who have no time to wait. References
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