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66 Carlo Resti, Yohannes TadesseHRH will need to tie in to these reforms. Thus, coherent and well-formulatednational HRH policies and strategies are required for giving direction onHRH development and on how HRH relate to health sector reform issues(e.g. decentralization, public-private mix), the scaling-up of priority interventions,poverty reduction strategies, and training methodology approaches.In many countries the development of coherent HRH planning approachesis of low priority and respective planning departments are badly equipped,both, technically and personnel-wise. Recently it was pointed out that evencountries such as Australia, France, Germany, Sweden and the UnitedKingdom have a partial approach to planning of the health sector workforceand that the relationships between different categories of health professionsis ignored. More specifically, nurse workforce requirements for addressingdisease patterns of the population are neglected.The socio-political and economic situation of a country will largely determinehuman resource constraints for achieving the MillenniumDevelopment Goals. Many factors will influence in an important waywhether and where health professionals will practice: e.g. political stability,priority accorded to social sectors, the overall policy framework, governance,and accountability.Emigration of medical professional illustrates this. Recruitment policies, immigrationlaws and regulations in better off countries induce whether thereis a demand for health professionals in high-income countries. On the otherhand, living conditions in a low-income country will determine whetherhealth staff is encouraged to leave the country. With various high-incomecountries such as the USA, UK, France having a high demand for health professionalstrained outside their country, there is a growing concern that theyabsorb large numbers of health staff from low- and middle income countries.For example, it is reported that the US is short of several hundred thousandnurses and that the high demand for medically trained staff is not likely to bereversed in the coming years. In contrary, for Africa it is estimated thataround 23.000 qualified academic professionals emigrate annually or forGhana it is estimated that over 50% of doctors having graduated are livingand practicing outside the country.Unless there is no possibility to address at the same time pull factors of migrationin high income countries and push factors in low-income countries,investments in medical and nursing training are likely to be jeopardized. Itwill be crucial to elaborate and implement well balanced and sound nationalretention strategies.
5. Human resources for health (HRH): a crucial element for achieving international MDGs. 67The Ethiopian context and the nature of the crisisEthiopia has an estimated population of above 76 million and is the secondmost populous country in Sub-Saharan Africa. 85% of the population is ruraland earns its living from rain-fed subsistence agriculture which constitutesabout 42 % of GDP. The country is one of the poorest in the world with percapita income not exceeding 100 USD and about 44% of the populationlives below the poverty line. The population has been growing at a rate of 2,8% per year. Life expectancy is approximately 54 years for both sexes.Ethiopia’s poverty strategy, the guiding strategic framework for the five-yearperiod 2006-2010, is the PASDEP (Plan for Accelerated and SustainedDevelopment to End Poverty). The PASDEP carries forward importantstrategic directions related to human development, rural development, foodsecurity, and capacity-building. The document is also focusing on growth inthe coming five-year period – with a particular emphasis on greater commercializationof agriculture and the private sector - and a scaling-up of efforts toachieve the Millennium Development Goals.Up to now there is no formally endorsed HRH strategy at central level, buta “health sector human resource development framework (2006-2010)” as theonly reference guideline. Some of the Regional Health Bureaux in Ethiopiahave started to implement in autonomy some management strategies to curbthe migration of health professionals, especially medical doctors. The manifestationsof the crisis in Ethiopia are particularly acute. In 2006 a HRH nationalObservatory has been established to develop soon a comprehensivestrategy.Quantitative Shortage of All Forms of Health WorkersEthiopia is considered to have one of the lowest ratios of doctors to populationin the world. In particular, with the recent expansion of health facilitiesacross the country, severe shortages of health workers for staffing them havebeen witnessed. Furthermore, the threshold density below which high coverage(80%) of essential interventions, (including those necessary to meetMDGs) is estimated at 2.3 health workers per 1,000 people 1 , the definitionof Health workers being all people primarily engaged in actions with the primaryintent of enhancing health. However, with a total workforce of 45,8591 WHO. The world health report 2006: Working together for health. 2006. WHO,Geneva.
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