There is a shortage of healthcare workers around the world, which is likely to increase in the upcoming years. Changing demographics and higher life expectancies are contributing factors to this trend. The research shows that qualified medical professionals are essential to patients’ access to quality healthcare, and their shortage may potentially lead to growing outbreaks of infectious diseases and treatment errors due to an overload on existing service providers (Agwu and Llewelyn, 2009; Kollar and Buyx, 2013). Countries in the South Caucasus also seem to struggle with the availability of medical professionals. However, a closer examination of the three states, namely Armenia, Azerbaijan and Georgia, suggests the deficit of healthcare workers is due to their uneven distribution rather than an actual shortage.
Armenia, Azerbaijan and Georgia train a large number of medical professionals. While not all graduates enter the labor market and all countries suffer from a considerable ‘brain drain’ or migration of specialists, the ratio of healthcare workers per population remains high. In fact, the average density of physicians and mid-level healthcare personnel (nurses, midwives) in all three states is much higher than the threshold recommended by the World Health Organization (WHO, 2016). Yet, unfilled vacancies in regional areas coexist with high rates of unemployment of specialists in larger cities (McPake et al., 2013). It is, in fact, this uneven geographic distribution of medical workers and their concentration in the capitals that causes a shortage of healthcare personnel in all three states, a situation that leaves rural patients in Armenia, Azerbaijan and Georgia facing unequal access to healthcare and increasing costs as they must to travel to the cities to access medical services.
Attracting medical professionals to rural areas requires additional incentives, including better salaries and access to continued education. The three states have different employment and remuneration policies. Healthcare workers in Armenia and Georgia are contracted by medical facilities, and their salaries are mainly determined by the directors of these facilities. In Azerbaijan, instead, healthcare professionals are employed by the state and their wages are defined by the unified tariff scale. Despite differences, medical professionals in all three states remain underpaid. Therefore, increasing the salaries of healthcare workers in rural areas is one of the priorities that governments should consider to rectify the shortage of healthcare workers outside the capitals.
Yet, remuneration is not the only factor leading to the shortage of healthcare workers outside the capitals in all three countries. Specialists migrate to the larger cities also to access better facilities, technology and methods that are essential to their professional growth. Medical facilities in rural areas are often outdated and their renovation requires substantial investment. A possible alternative to guarantee both the training of healthcare professional and their retention in the rural areas would be for the governments of the three states to finance exchange programs for specialists from rural areas to urban clinics.
Ideally, however, solving the problem of availability of healthcare professionals outside the capitals would require a strategy that envisages a combination of both financial and professional incentives. The share of the government health expenditure in Armenia, Azerbaijan and Georgia is relatively low. The role of the state in healthcare is decreasing, as also illustrated by the decentralization of service provision in Armenia and Georgia. In general, the share of private expenditure in all three states is significant, while the share of government funding is unlikely to increase in the upcoming years. For this reason, the governments may consider alternatives more feasible in the given situation, such as training mid-level healthcare professionals and community representatives (see Ghimire et al., 2009; Nair and Webster, 2013). This could ensure patients’ access to essential healthcare services and preventive measures, but not complex treatments.
Agwu, K. and Llewelyn, M. (2009). On behalf of undergraduates in International Health at UCL: Compensation for the brain drain from developing countries. The Lancet, 373, pp. 1665–1666
Ghimire, L. V., Malekpour, M., Fatehizadeh, M., Hashemian, R., Mohammad, S., Velayati, A.A. (2009). Retaining health manpower in developing countries. The Lancet, 374, p. 291.
Kollar, E. and Buyx, A. (2013). Ethics and policy of medical brain drain. A review. Swiss medical weekly, 143(w13845), pp. 1–8.
McPake, B., Maeda, A., Araújo, E. C., Lemiere, C., El Maghraby, A., Cometto, G. (2013). Why do health labour market forces matter? Bulletin of the World Health Organization, 91(11), pp. 841–846.
Nair, M. and Webster, P. (2013). Health professionals’ migration in emerging market economies. patterns, causes and possible solutions. Journal of public health, 35(1), pp. 157–163.
The World Health Organization, 2016. Global Health Observatory data repository. [online] Available at: http://apps.who.int/gho/data/node.main.A1444
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