A shortage of doctors, nurses and midwives around the globe is threatening health initiatives and could have dire political and economic consequences, public health experts said on Friday.

Without an estimated 4 million more healthcare workers, efforts to battle HIV/AIDS, malaria, tuberculosis and other diseases could fail.

“Millions of people around the world are trapped in a vicious spiral of sickness and death. For them there is no tomorrow without action today,” said Lincoln Chen, of Harvard University in Massachusetts, co-author of a report on health resources.

“At stake is nothing less than the course of global health and development in the 21st century,” he and his colleagues added in The Lancet medical journal in a summary of the study.

The report, “Human Resources for Health: Overcoming the Crisis,” identifies the causes of the problem and examines strategies to strengthen health systems teetering on collapse.

It was conducted under the auspices of the Joint Learning Initiative (JLI), an independent network of more than 100 world health leaders.

“This is the first global view of this huge challenge,” Chen told journalists during a conference call.

Poverty, political instability and uneven economic growth are the backdrop to the health crisis, according to the study.

It is exacerbated by rising infections of HIV/AIDS and other diseases, a brain drain of medical professionals from poor to wealthy countries and rural areas to cities, and a legacy of chronic under-investment in education and training.

“We estimate the global shortage at more than 4 million workers approximately,” he added.

There are more Malawian doctors working in Manchester, England than in Malawi. Only a fraction of doctors trained in Zambia remain there, according to the report.

Countries in sub-Saharan Africa must nearly triple their current healthcare workforce by adding about 1 million workers to deliver health services.

“Today’s dramatic health reversals risk more than human survival in the poorest countries; they threaten health, development, and security in an interdependent world,” Chen and his colleagues added.

The report urged governments to have a national workforce plan to address their health needs and to increase investment in human resources.

It also urged international organizations, such as the World Health Organization (WHO) and the World Bank, and donor countries, to designate $400 million annually to help countries educate, recruit and retain doctors, nurses and other healthcare workers.

An independent, non-governmental and short-term Action Alliance should also be launched to monitor progress in implementing the report’s recommendations.

“What we do - or what we fail to do - will shape the course of global health for the entire 21st century,” Chen and his colleagues said in the journal.

SOURCE: The Lancet, November 27, 2004.