Maldistribution of health personnel

In many countries health personnel are not appropriately trained for the tasks they are expected to perform, or are not provided with the equipment and supplies they require. Health manpower varies greatly from country to country and includes a wide variety of different categories of people fulfilling different functions in different societies, depending on their social and economic conditions and cultural patterns. For this reason, intercountry comparisons are very difficult. Nevertheless, to illustrate the disparities among countries, in the least developed countries one health worker of all categories, including traditional practitioners, has to serve an average of 2400 people, in the other developing countries 500 people, and in the developed countries 130 people. As for medical personnel, in the least developed countries there is one doctor for an average of 17,000 people, in the other developing countries one for 2,700 people, and in the developed countries one for 520 people. The corresponding figures for nurses are one for an average of 6,500 people in the least developed countries, one for 1,500 in the other developing countries, and one for 220 people in the developed countries. To highlight the extremes: in the rural areas of some least developed countries there may be only one doctor to serve more than 200,000 people; whereas in the metropolitan areas of some developed countries there is one doctor for 300 people. None of these averages reveals the extremely inequitable distribution of health personnel often found within the same country. For example, in many countries there are ten times as many people for every doctor in rural areas as there are in metropolitan areas.

Compared with the developed countries, health care systems in the developing countries are supported by fewer middle-level cadres - technicians, clerks, administrators, etc. The staffing shortage is particularly acute at the level of village health posts and dispensaries where the recruitment and absorption of paraprofessional health workers has often been frustrated by laws and regulations governing training, licensing, and civil service status. Because of this shortage of suitable paraprofessional workers, together with inadequate methods of procuring and stocking drugs and other supplies, village health posts and dispensaries are often under-utilized and held in low esteem by villagers. In the absence of better public sector services at the community level, the rural poor for the most part seek out traditional healers, such as witchdoctors, herbalists, injectionists and traditional midwives.