ABSTRACT
The provision of health care in developing countries, particularly those in sub-Saharan Africa, is grossly inadequate. Inadequacies exist in all aspects of the health system: the workforce, infrastructure (hospitals, clinics, equipment, and supplies), and in health system financing and administration. The combination of inadequate production of health care workers and brain drain has resulted in critical shortages of doctors and nurses throughout all the resource-poor countries (Anyangwe and Mtonga 2007; Sheldon 2006; UNESCO 2009). The World Health Organization (WHO) defines a critical shortage of doctors, nurses, and midwives as less than 2.3 per 100,000 of population. Of the 57 countries with critical health workforce shortages worldwide, 37 are in sub-Saharan Africa. Countries below this level fail to achieve an 80 per cent coverage rate for measles immunisation or for deliveries by skilled birth attendants (Chen et al. 2004). They are also unlikely to reach the Millennium Development Goals (MDGs) prescribed by the United Nations for completion by 2015 (WHO 2006). Lack of adequate investment in health and in higher education has resulted in dilapidated universities and teaching hospitals in many sub-Saharan African countries (Ishengoma 2003; Kariuki 2009; Polgreen 2007; Sawyerr 2004). In this chapter, we will focus on the problem of shortages of doctors, nurses, pharmacists, and dentists, and on the need to improve the quality of their training and the environment in which they train and work as one strategy to reinvigorate these universities and stem the brain drain.
