This program is brought to you by Emory University. Hello my name is Dr. Martha Rogers and I'm a professor at the Emory University School of Nursing. Having a baby is a joyous experience for most women, but it can also be a very risky time. Over 275,000 women die each year from childbirth and over three million infants may not survive beyond the first month of life. Modern medicine has developed many interventions that can save women and infants' lives, but most of these interventions require two important things. First, well equipped health facilities that are accessible and affordable for women. And second, health professionals that are well trained and experienced in maternal and infant health. In most developed countries, such as the United States, over 99% of pregnant women deliver in a health facility. This is in contrast to many developing countries, where less than half of pregnant women are able to deliver their babies in a health facility. Most deliver at home, usually without a trained birth attendant. In the United States, 91% of women are attended by obstetricians or family physicians at the time of delivery, while 9% are attended by midwives. Less than 1% of women in the United States deliver without the help of a trained health provider. But in many developing countries there is an extreme shortage of doctors an, such as obstetricians, and nurses provide most of the health care, including delivering babies. The risk of maternal morbidity and mortality is much higher in women who deliver without a trained birth attendant, such as a nurse or doctor. The global shortage of both nurses and doctors is a key reason why many women and infants fail to survive the ordeal of childbirth. In our presentation this week, we'll talk about the importance of having a well trained, well equipped health workforce that can provide safe deliveries for pregnant women and their infants. How bad is the healthcare worker shortage? Globally it's estimated to be 4.3 million. This graph is from the World Health Report of 2006 and shows the distribution of health workers by burden of disease and health expenditure. The y-axis indicates the percent of the global burden of disease for a given region, while the x-axis shows the percent of the global workforce in that same region. I would like you to focus on the small dot that represents Africa. The size of the dot represents the health expenditures, and you can see that only a small percentage of the global expenditure occurs in Africa. In addition, Africa has a large percentage of the global disease burden, about 25%, but has less than 5% of the global workforce. Contrast that with the Americas, which has only about 10% of the global disease burden but over 35% of the health workforce. Thus, the health workers are not distributed equally across the globe, and areas that need them the most have the greatest shortages. Shortages of health workers means less service provision of vital health services, such as immunizations and skilled birth attendants. In this graph, the x-axis indicates the density of health workers, that is the number of workers per 1,000 people. And the y-axis indicates the level of service coverage. As you can see from the graph, the greater the density of health workers, the higher the service coverage. For pregnant women, this means that without enough nurses, doctors and midwives, fewer women can safely deliver with a trained birth attendant. This data from Kenya further illustrate the correlation between the availability of nurse midwives and deliveries in a health facility. This table shows provinces in Kenya, the number and rate of midwives per 100,000 population, and the percentage of women who deliver in a health facility. Take a moment to look at this table. Note that those provinces, such as Nairobi, with the highest rates of nurse midwives also tend to have the highest percentage of women delivering in a health facility. Those provinces with the lowest rates of nurse midwives, for example North Eastern province, tend to have the lowest percentage of women delivering in a health facility. Thus, the availability of trained birth attendants, such as midwives, is directly related to whether or not women can deliver their babies in a health facility, attended by a trained healthcare worker. So, why do we have a shortage of healthcare workers? The shortage of healthcare workers is both a function of increased need and decreased supply. Please take a few moments to think about what factors might result in an increased need, and what factors might result in a decreased supply. Here are some of the reasons why there is a global health workforce shortage. There is an increased need due to things, such as, aging populations, which require more healthcare services, expanding populations, increased incidence of chronic diseases, emerging epidemics, such as HIV/AIDS. And there is a decreased supply due to factors such as, underinvestment in healthcare worker pre-service education, lack of health system planning, lack of information about the need for healthcare workers, poor retention of healthcare workers in the workplace, and migration of workers and maldistribution.
