4 - 2 - Video 3.2 Maldistribution & Migration (6 07), Childbirth A Global Perspective
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Let's talk further about maldistribution.In addition to an overall shortage,there is also the problem ofmaldistribution of health workers.Like many people, skilled healthworkers tend to enjoy the advantages ofliving in urban areas wherethere are good schools fortheir children,educational opportunities for themselves,increased availability of jobs fortheir spouses, better housing, and so on.Thus, many rural areas may be underservedbecause they are hard to reach,poverty-stricken, andlack the amenities of cities.This graph indicates the scope ofthe problem of the urban-ruralmaldistribution.The y-axis indicates the percentof doctors, nurses andother healthcare workerswho work in urban areas.The dotted line along the x-axisindicates the percent ofthe world's populationthat lives in urban areas.You can see that a much largerpercent of healthcare workers live inurban areas compared with the population,and this is especially true for doctors.More than 75% of them are in urbanareas compared with less than55% of the population.Urban rural male distributionof healthcare workers isespecially a problem forpregnant women living in rural areas,who may live a long distance from medicalfacilities and skilled birth attendants.Although they may haveaccess to antenatal care,they may not have access toskilled healthcare should theyhave a life-threatening complicationduring labor and delivery.Delivering at home without a skilledbirth attendant is associated witha much higher rate of maternal andinfant mortality and morbidity.Let's take a look at the country ofKenya as an example of maldistribution.This map of Kenya is divided into the 47counties that make up the country.The colors indicate the distributionof nurses per 100,000 population inthe public and faith-based health sectors.The dark green areasrepresent the counties withthe most nurses per population,while the pink areas are those that havethe least number of nurses per population.As you can see, the distribution varieswidely and there are many remote areas,particularly in the eastern andnorthwestern parts of the country,here in Mandera, Wajir andTurkana counties, that are poorly served.Part of the reason formaldistribution is the fact thatnurse training schools are oftenlocated in more urban areas.Note this map of Kenya againnow that shows the location ofnurse training schools.Note the same counties withthe greatest shortage ofnurses have few training schools.Mendera and Wajir counties have notraining schools and Turkana has only one,while most training schools are locatedin the southern part of the country.The colors of the countiesindicate the number ofnewly trained nurses accordingto their county of residence.As you can see,Kenya trains very few nurses perpopulation from these remote counties.Special incentives andresources are needed to encourage andsupport young people from these remoteareas to attend nurse training andthen go on to serve in these remote areas.Another problem that contributes tomaldistributiion is the migration ofskilled health workers from developingcountries, that is, areas of the greatestshortage, to the more developed countriessuch as Europe and the United States.An Emory University study in Kenyain 2007 found that for every fournurses Kenya trains, one of them willapply to migrate out of the country.In addition, the nurses who chooseto migrate are often the most highlytrained nurses.Note the bar graph in this slide.The grey part of the bars represent thosenewly trained nurses that intend tomigrate out of the country.And the red part of the bar representsthose newly trained nurses who intend toremain in the country.You can see that 27% percentof bachelors trained and35% of registered nursesintend to migrate.So, why do healthcare workerstend to migrate to urban areas orto more developed countries?You can think of the reasons as push andpull factors.For example, if you were a highlytrained nurse midwife assigned toa remote area in rural Kenya,why might you want to leave?Take a moment to think about some reasons.Likewise, if you are a highlytrained nurse working in Kenya,why might you want tomigrate to the United States?Take a moment to think about some reasons.Note some of the reasons listed on thisslide as to why healthcare workers may notwant to go to rural areas or may wantto migrate to more developed countries.For example, poor nurse to populationratios means that nurses inthese areas are often overworked and alongwith low wages, they are often underpaid.Rural areas often lack social amenities,such as good housing and good schools.Lack of educationalopportunities also contributes,as many workers want toupgrade their education.A high HIV/AIDS prevalence andlack of resources such as gloves andprotective clothing can increasetheir risk of occupational exposure.In addition, many leave becauseof unstable political areas ingovernments that can increase violence.What are some of the pull factors?Shortages in developedcountries may result inaggressive recruitment practices thatmay encourage workers to migrate.Better educational opportunities,more resources forpatient care andbetter compensation also contribute.
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