Judging doctor supply--market or health criteria?
Roemer, M.I.
World Health Forum 9(4): 547
1988
ISSN/ISBN: 0251-2432 PMID: 3252854 Document Number: 360553
Large rural areas of developing countries show severe shortages of physicians, graduate nurses, and other trained health personnel. Countries have tried to alleviate this problem in several ways, including requiring all new medical graduates to 1st undertake periods of service in rural areas, the use of mobile clinic teams from small towns to visit outlying villages on a regular basis, and the use of air ambulances to transport seriously ill persons from isolated places to hospitals in cities. Perhaps the most significant strategy has been the use of trained community workers to provide primary health care for rural and low-income urban populations. Unfortunately, weak supervision of the community workers has often led to unsatisfactory performances. Surprisingly, a recent international congress claimed that many developing countries are training too many doctors, that some developing countries have, or will soon have, 1000s of unemployed physicians. However, comparison with developed countries shows that the "diagnosis" of a country's doctor supply situation may not depend on a universal standard, but on that job market's capacity for absorption of personnel. If specific public health goals are to be reached however, commercial criteria cannot be applied to the evaluation of a nation's health manpower; instead social need must be analyzed and strategies designed to meet them. Policy is shaped by the priority public authorities give to services. Of the 7 developing countries which reported a surplus of doctors, only Colombia and Mexico reported spending more on public health than on the military. In addition, in the other 5 countries, 40% or less of the overall public and private expenditures on health came from the government. When military expenditures absorb a high share of government funds, public support for health services is adversely affected, and individuals and families must depend on their own expenditures to obtain health services. Health services should be recognized as a basic human right, and, therefore, as an obligation of society. To meet this obligation necessary strategies are 1) increase public support, not only by increasing the health share of the general budget, but by other sources such as social security and community financing, 2) require 5-10 years of social service for all medical school graduates, 3) ensure that renumeration for doctors in public service is adequate to support a decent standard of living, 4) continue to train community health workers, but ensure physicians are qualified to supervise them, and, 5) health services and health manpower should be guided by principles of social justice, not by those of commercial market dynamics.