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by Jimmy Carter

The July 31 USA Today Forum article "U.S. savior: Foreign doctors" is very interesting but presents only one side of a tragic and selfish trend: the active recruitment of extremely scarce health workers from the poorer countries of the world. This is a crisis that The Carter Center faces every day in fighting malaria, lymphatic filariasis, Guinea worm, trachoma, river blindness, and schistosomiasis.

It is now estimated that there is a global shortage of 4 million health care workers, with Great Britain, the United States, and even some of the most generous private foundations rapidly recruiting health specialists who are trained in developing countries.

The number of medical doctors varies widely among nations, with Cuba having a doctor for every 169 citizens, the United States one for every 391 people, and Mozambique 2.6 for every 100,000. At the same time, of course, many of these countries are heavily afflicted by preventable diseases that are no longer known in the rich world.

In a recent article in Foreign Affairs magazine, Laurie Garrett reported that between 1993 and 2002, Ghana lost to foreign recruitment 604 of 871 medical officers trained there, and only 50 doctors remain of the 600 trained in Zambia in the past 40 years. Just 360 of the 1200 doctors trained in Zimbabwe still practice there, while in the large Zimbabwe town of Kadoma eight years ago there was a nurse for every 700 residents but now the ratio is 1:7500. Malawi has 930,000 people with HIV, but in the last five years it has lost 53% of health administrators, 64% of nurses, and 85% of physicians, mostly to wealthy nations and NGOs.

While this "brain drain" continues, foreign assistance for health care has increased four-fold, but these dollars often have strings attached and are "stove-piped" into needy societies for particular diseases, notably HIV/AIDS, tuberculosis, and malaria. These contributions are extremely valuable, but much of the funding is channeled through foreign contractors that sap away a large toll and bypass the local health delivery systems that struggle to deal with more basic medical needs. The top three killers in the poorest countries are maternal death from childbirth, childhood respiratory and intestinal infections, and uncontrolled diarrhea.

The result is a startling difference in life expectancy. A girl born in Japan today could expect to live 86 years, 44 years longer than one born in Zimbabwe!

In 2002, the United Kingdom passed legislation that encourages domestic training of health workers and prohibits the recruitment of doctors and nurses in poor countries without approval of the host governments. Instead of addressing this same problem, the U.S. Congress has moved to eliminate all immigration restraints on foreign nurses willing to move here to treat patients, with no consideration to their native country. At the same time, American nursing schools rejected more than 32,000 applicants in 2006 because of limited facilities and teachers. Without some corrective action, the United States is facing a shortage by 2020 of 200,000 physicians and 800,000 nurses.

More recruitment from poorer nations is not the best answer, nor is blocking foreigners from using their talents among wealthy patients, which might border on deprivation of human rights. The obvious solution is to increase the number of American health workers to meet our needs, and to provide assistance for poorer nations to train and retain their own citizens.

This problem is not insurmountable. Partially financed by USAID, The Carter Center has worked closely with the government of Ethiopia to improve its health care system. Our Ethiopian partners have produced professional level texts for 65 health topics and trained more than 700 medical faculty. 7135 health sciences students have graduated from seven regional universities (most of them with new curricula), and more than 20,000 health extension workers have been trained. During the next two years we will bring this total number of health workers to 30,000 (an extension worker for every 2500 people), and by 2010, 5000 health officers with training equivalent to registered nurses or physician assistants.

This global problem requires immediate attention, with rich and poor nations working together.

Jimmy Carter, 39th President of the United States, is founder of the not-for-profit Carter Center, advancing peace and health worldwide.