Global Health Watch 1 in one file
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Global Health Watch 1 in one file

Global Health Watch 1 in one file Global Health Watch 1 in one file

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31.10.2014 Views

Severe shortage Low density Moderate density Unusual density High density Figure B3.2 Health worker density (Source: JLI 2004)

30 20 Rands million 10 0 -10 -20 -30 Athlone Blaauwberg Central Helderberg Khayelitsha Mitchels plain Nyanga Oostenberg South Peninsula Tygerberg East Tygerberg West Figure B3.3 Inequity in public primary care expenditure, Cape Town (zero line represents an average equitable expenditure) (Source: Sanders et al. 2004) are also often poorly distributed. Typically, rural and remote communities are served by fewer doctors and nurses than urban communities; this may be associated with a disproportionate concentration of health workers at the secondary and tertiary levels of the health system. Attracting skilled professionals to rural areas has long been a challenge, including in developed countries such as Canada, Australia and the US, which have become reliant on foreignqualified doctors and nurses to staff facilities in rural and remote areas. As increasing numbers of people move to urban conglomerations, there is growing evidence of acute disparities between different parts of the same city, with health services relatively understaffed in slums. Figure B3.3 shows the wide variation in public sector health care expenditure in Cape Town, with black townships hugely under-resourced compared to suburban areas (Sanders et al. 2004). The lower the funding allocation, the more likely it is that fewer staff will be employed, and with fewer qualifications. There are also differences in the availability of health personnel in different segments of a health care system. Private health care services, particularly those tailored to the rich, are typically better staffed than services for the poor. In some countries there is also a growing divide between public sector services and better staffed nongovernment health care providers serving the poor. The channelling of large sums into HIV/AIDS programmes in relatively stand-alone structures and systems, many delivered through donor agencies and NGOs that offer higher salaries than the public sector, drains staff from the public Global health worker crisis 123

Severe shortage<br />

Low density<br />

Moderate density<br />

Unusual density<br />

High density<br />

Figure B3.2 <strong>Health</strong> worker density (Source: JLI 2004)

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