The document summarizes a study that estimates health care professional shortages in sub-Saharan Africa in 2015. It finds that over 30 countries will face shortages of doctors totaling around 257,000. The full cost of eliminating these shortages, including wage bills, training costs, and supplies, is estimated to be around $28 billion annually. Possible policy solutions discussed include improving productivity, providing better incentives for health workers, expanding training capacity, and optimizing skill mix.

1. Brent D. Fulton, PhD Global Center for Health Economics and Policy Research* School of Public Health, University of California, Berkeley *A Pan American Health Organization/World Health Organization Collaborating Center on Health Workforce Economics Research 18 th Annual Global Health Education Consortium Conference & 7 th Annual Western Regional International Health Conference Transcending Global Health Barriers: Education & Action University of Washington April 4, 2009 Estimates of Sub-Saharan Africa Health Care Professional Shortages in 2015: What Can Be Done at What Cost

6. Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf

7. Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf

9. Health-worker shortage in 2015 (31 African countries) *Preliminary results. Do not cite.

10. Health worker shortage in 2015 (countries with largest projected shortage per 1,000 population) Note: Total is based on non-rounded numbers. Preliminary results. Do not cite. Need: 0.55 1.73 2.28

11. Health worker shortage in 2015 (cont.) (countries with largest projected shortage per 1,000 population) Note: *Negative number represents a surplus. Total is based on non-rounded numbers. Preliminary results. Do not cite. Need: 0.55 1.73 2.28

13. Monthly Wage Statistics in Africa ($US 2007) Source: Occupational Wages around the World (OWW) Database Doctors ($) Nurses ($) Doctor-to-Nurse Ratio Average 522 333 1.8 Median 423 272 1.7 Minimum 33 18 1.0 Maximum 1,779 1,129 5.0

14. Annual wage bill required to remove health worker shortage in Africa for 2015 Note: Numbers are based on rounded numbers. Preliminary results. Do not cite.

15. Annual wage bill required to remove health worker shortage in Africa for 2015 (millions $US 2007) Source: 2003 Government Health Budget, World Health Report 2006 Note: Total is based on non-rounded numbers. Preliminary results. Do not cite.

16. Annual wage bill required to remove health worker shortage in Africa for 2015 (millions $US 2007) ( cont.) Note: *Negative amount represents a surplus. Total is based on non-rounded numbers. Preliminary results. Do not cite.

19. Full Cost to Scale Up in Context Sources: Authors’ analysis, World Health Report 2006, and Effective Aid Better Heath (2008) *Preliminary results. Do not cite.

22. Skill Mix Analysis

23. Questions? End of Presentation

24. Conceptual Framework Demand Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf

29. Number of countries with projected shortages of doctors Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf Note: A country was defined to have a shortage if the projected supply of physicians met less than 80% of the projected demand or need.

31. Doctor Shortages in Africa in 2015 Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf

32. Doctor Shortages in Africa in 2015 (cont.) Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf Countries with no doctor shortages: Botswana, Congo, Namibia, Mauritius, South Africa and Algeria

33. Scenario A: wage bill savings from increasing nurse & midwife-to-doctor ratio by 50 percent *Preliminary results. Do not cite.*