Why we need to support the eye health workforce

Juliet Milgate, October 2013
A young boy wearing dark glasses, laughing.

“There's the equivalent of a global shortage of nearly 2.5 million doctors, nurses and midwives”

This World Sight Day, Sightsavers is focusing on the acute shortage of eye health and health workers. Let me explain why.

Here in the UK we take access to good doctors and nurses for granted. OK, so we grumble a little about the state of the NHS; longer waiting times or rising prescription fees. But as the opening ceremony of the Olympics showed us in 2012, the NHS is more than just a public health service; it’s a well-loved public icon, a service to trust and importantly, rely on.

But relying on a health worker being available – where we need them, when we need them – is suddenly becoming a problem in the UK. Just this week The College of Emergency Medicine has published a report highlighting potential shortage of staff in emergency departments. Could it be that for the first time the UK is experiencing the impact of the global health workforce crisis?

The global crisis
This is a debate that health and development professionals in developing countries are all too familiar with. It is estimated that there are over 50 countries with critical shortages in health workers. This is equivalent to a global shortage of nearly 2.5 million doctors, nurses and midwives, or 4.3 million[i] health workers.

The global shortage however is not uniform and these figures hide particular shortages in some countries and in certain specialities within countries. In Africa 36 countries are facing a health workforce crisis and in eye health where services depend primarily on specialist (eg ophthalmologists, optometrists) and non-specialist health workers such as primary care staff, it is estimated that a further 10,000 eye health workers are needed.

Globally this shortage of health workers presents one of the greatest barriers to meeting the existing Millennium Development Goals (MDGs) and will continue to threaten a post-2015 health development framework if action is not taken to support governments to develop and implement costed health workforce strategies, which must include eye health workers.

Influencing Change

That is why this World Sight Day, and in the months ahead, our attention is focused particularly on the need to ensure health workers are not a barrier to good eye care and general health care, but facilitators of good care.

In September Sightsavers attended the UN General Assembly at which the MDGs and the post-2015 development framework were discussed. If we are to achieve better health for all – particularly those living in poverty, including people with disabilities – it is critical that the new post-2015 agenda focuses on creating the right conditions for people to live healthy lives. For Sightsavers that means ensuring that the right health systems are in place to deliver critical interventions. At the heart of those systems are eye health and health workers.

Addressing the global shortfall isn’t a solution that health workers can address alone. It requires sustained investment in national health financing by national governments and the international donor community. We need investment in salaries for health workers, in good terms and conditions of service, in skills development and training – and all this should be available not just in urban cities but in rural communities so that people, regardless of where they live or who they are, can reach a health worker.

Role of health workers in achieving UHC
In November the third global forum on Human Resources for health will discuss the contribution of health workers to achieving Universal Health Coverage. UHC ensures that people can access the range of primary health care services they need, including comprehensive eye care services, near their homes; ensures the effective coverage of those services, so that the hardest to reach populations, often people with disabilities, are targeted; and, contributes to improving social protection – protecting people from these catastrophic health costs.

Sightsavers’ experience shows that many people, often the poorest and including people with visual impairments, blindness or other disabilities, are excluded from accessing the health care they need because they cannot afford it or incur medical expenses that lead to further poverty. Each year, for example, 100 million people are impoverished through health spending[ii].

Health workers play a critical role in delivering these essential health services. Countries with fewer than 23 doctors, nurses and midwives per 10,000 people generally fail to achieve adequate coverage rates at primary health care level to achieve the targets set by the MDGs. Ghana currently has fewer than 1 doctor and 10 nurses and midwives per 10,000 people. The UK in contrast has 27 and 94 respectively.

Our Call

The challenges faced by developing countries in recruiting and retaining health workers reverberate and are felt here by the NHS in the UK as countries both rich and poor face common challenges of how to finance their national health systems with limited resources.

But that’s where the commonalities end. There may well be staff shortages here, but at least the UK has the resource to address those shortages, if it so chooses, and make sure that we can rely on a doctor or nurse being available. In the countries in which Sightsavers works, I’m not sure many governments have that luxury.

We are calling on governments to take action to develop and implement costed health workforce strategies, which must include eye health workers and international donors to invest in strengthening health systems and in particular human resources. This is not for the sake of UHC or to meet the MDGs but more than that; to ensure that people can live healthy lives and rely on the care they need, when they need it.

[i] WHO (2007) Everybody’s Business: Strengthening health systems to improve health outcomes. WHO’s Framework for Action.

[ii] WHO (2006) Working Together for Health, World Health Report 2006 WHO Press, Geneva


Juliet Milgate is Sightsavers’ Director of Policy and Advocacy

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