Health Systems and the "Brain Drain" A significant and oft-invoked barrier to effective health care in resourcepoor settings is the lack of medical personnel. In what is termed the brain drain, many physicians and nurses emigrate from their home countries to pursue opportunities abroad, leaving behind health systems that are understaffed and illequipped to deal with the epidemic diseases that ravage local populations. The WHO recommends a minimum of 20 physicians and 100 nurses per 100,000 persons, but recent reports from that organization and others confirm that many countries, especially in sub-Saharan Africa, fall far short of those target numbers | Chapter 002. Global Issues in Medicine Part 12 Health Systems and the Brain Drain A significant and oft-invoked barrier to effective health care in resourcepoor settings is the lack of medical personnel. In what is termed the brain drain many physicians and nurses emigrate from their home countries to pursue opportunities abroad leaving behind health systems that are understaffed and ill-equipped to deal with the epidemic diseases that ravage local populations. The WHO recommends a minimum of 20 physicians and 100 nurses per 100 000 persons but recent reports from that organization and others confirm that many countries especially in sub-Saharan Africa fall far short of those target numbers. More than half of these countries register fewer than 10 physicians per 100 000 population. In contrast the United States and Cuba register 279 and 596 doctors per 100 000 population respectively. Similarly the majority of sub-Saharan African countries do not have even half of the WHO-recommended minimum number of nurses. In addition to these appalling national aggregates further inequalities in health care staffing exist within countries. Rural-urban disparities in health care personnel mirror disparities of both wealth and health. In 1992 the poorest districts in southern Africa reported doctors nurses and pharmacists per 100 000 population. The same survey found in the richest districts doctors nurses and pharmacists per 100 000 population. Nearly 90 of Malawi s population is rural but 95 of clinical officers were at urban facilities and 47 of nurses were at tertiary care facilities. Even community health workers trained to provide first-line services to rural populations often transfer to urban districts. In 1989 in Kenya for example there were only 138 health workers per 100 000 persons in the rural North Eastern Province whereas there were 688 per 100 000 in Nairobi. In addition to inter- and intranational transfer of personnel the AIDS .
