The first conference addressing the global shortage of health workers is opening in Kampala.
Africa is suffering from a critical shortage of health workers
The World Health Organization says a further four million doctors, nurses, midwives and other health care professionals are needed.
The WHO says the shortage is affecting basic services such as immunisation, child birth and treatment of diseases.
There is a critical shortage of health workers in 57 countries, most of which are in Africa.
Medical staff from Africa and Asia often migrate to richer countries where pay and conditions are better.
On average, one in four doctors trained in Africa is working in the developed world.
The conference, which is being attended by health ministers from some of the worst affected countries, aims to produce a global action plan.
No lack of money
The WHO says there is a need for more education and training to create a larger pool of health workers.
But there are also calls for improved management of the migration of health professionals.
The BBC's Sarah Grainger in Kampala says the issue seems to be more concerned with organisational problems rather than a lack of funds.
Some $12bn in international aid is devoted every year to health.
The WHO wants to see a quarter of that spent on the workforce, rather than drugs or treatments.
The brain drain, and the best way to retain talent, is a hot topic of debate across Africa.
Thousands of Africans move abroad each year to earn more money and attain a higher standard of living.
The UK and the US are the preferred destinations.
In 2003, 5,880 UK work permits were approved for medical personnel from South Africa, 2,825 from Zimbabwe, 1,510 from Nigeria and 850 from Ghana.
I am a physician, trained in Uganda but living and working in the US. The issue of brain-drain boils down to dictatorial governance on the continent, an aspect that is being ignored. Like most citizens of the world, I cherish working in an environment free of fear, political oppression, rampant corruption and tribalism. Opportunities for career advancement are only enjoyed by those originating from the president's tribe or village - such is the sorry state of affairs in Uganda.
Eugene Kalisa, New York, USA
I'm a psychologist, registered with the South African Health Professionals Council. There are a number of factors operating in the South African, 'brain drain': 1. Security - health professionals are concerned for the safety of their families, and so they go elsewhere. 2. The Global Labour Market - If I asked you to invest your money in government bonds earning 1% interest, for the good of the people, while you could earn 10% elsewhere, would you? No, because you're not an idiot. 3. HIV/AIDS - For anyone dealing with blood this is a serious consideration.4. Affirmative Action - The medical profession has not been spared the government's affirmative action legislation, and so for medical professionals in government service not from a previously disadvantaged group the prospects for promotion are lower. 5. Working Conditions - doctors in state hospitals have, on average, seven minutes per patient, and see about 60 patients a day. The politicians need to spend more time and money on making the country safe, and less time and money on multi-billion rand arms deals and covering them up.
William, Durban, South Africa
Shortage of Healthcare proffesionals is a global issue. Like a food or fuel shortage sweeping across the world,it is the developing countries that take the brunt of the effects. The task of keeping our healthcare workers at home is a very challenging task.The financial aspect of this population dynamics is a big factor but most important of all, is the Organisational aspect. Mid level practitioners equivalent to Physician Assistants or Nurse Practitioners should be considered. With a sound curriculum and high standards, mid level practitioners could alleviate some of the shortages in our healthcare systems. A database of every nations practitioners living outside the country should be readily accessible by every government.
Hassan Turay, Maryland, USA
I am a Zimbabwean trained radiographer, now resident in the UK, for the last six and a half years. It has not been a bed of roses to settle and integrate into the local community. Given choices, I would rather be back in Bulawayo serving my people. In the early nineties resources were a given, and we were seldom short of drugs for chemotherapy etc. It was a place of healing, or at least effective palliative care. But it all came to an end. Machine breakdowns grew from hours, to days to weeks and months. Going to work was just to sit, read newspapers and home by 3:30pm. The cycle became depressing, and patients' conditions deteriorated in your sight. As the conference takes place in Uganda, I urge the participants to analyse the root causes of the problem. Governments must first show commitment, backed up with actions that will inspire the confidence of the remaining workforce. It will be nearly impossible to attract back those that have left. With life experiences in the first world, the trauma of scraping a living in third world countries, unfortunately does not inspire one to go back. But the brain drain can be tamed. I wish the conference organisers and participants well.
Thabani Bafanah, Cambridge, UK
In the U.S., we have a program called the Public Health Service Corps. In essence, the government will pay for medical school if you commit to working for a number of years in medically underserved areas after graduation. It makes me wonder if a similar program could work in Africa - provide full tuition and living expenses for promising young students who are willing to make a commitment to staying in their home province for some number of years. The WHO is not in the scholarship business, but maybe it should be?
Neil Gray, New York, USA
I work for CURE International; CURE is one of the few organizations dedicated to training surgeons and surgical nurses throughout the developing world. While many governments and the WHO acknowledge brain-drain very few organizations are dedicated to the long-term change through medical education
Gerardine Luongo, Lemoyne, USA