The world economic crisis. Part 2. Health manpower out of balance.

As outlined in the first part of this article in the last issue of the journal, many countries are facing severe constraints on health expenditure at the same time as they are trying to work towards Health for All by the Year 2000. Health manpower needs to be planned to secure maximum benefits from the limited resources available. Many medical schools train more doctors than are needed because quotas on medical places are either non-existent or set too high. Medical training may be oriented to high-technology, curative care and produce doctors ill equipped to fulfil the role demanded of them in the primary health care approach. Educational courses for paramedics and nurses are often insufficient and inappropriate. Countries which have previously lost trained doctors to attractive posts abroad now face the prospect of a flood of doctors looking for work in their home countries, now that opportunities for work abroad are being reduced. Such countries will find it difficult to reverse the bias in policy towards medical professionals, despite the waste caused by unemployment and inappropriate training among doctors. With limited budgets, there is a need for countries to plan ahead. To do this they must find ways of estimating future effective demand. The future balance of staff can then be planned on the basis of resources available and the relative costs of deploying various categories of health staff.