Key factorprinciple

Human resources must be nurtured by long-term mentoring that offers follow-on opportunities to update and reinforce skills, attention to career development and working conditions, as well as professional and financial rewards.

The training and equipping of individuals with special skills is just the beginning of building workforce capacity in global health. The task of nurturing throughout a professional career is usually a larger and more complex challenge than the initial training program. Elements of success in this area include:

1. Long-term mentoring with ties to the original training program, together with updates and refresher activities, so that trainees stay connected to resources that will enhance their professional growth. This process has been greatly facilitated by advances in information technology, which allow distance learning and communication that were not possible in an earlier era.

2. Attention to career development and professional opportunities. Having attractive career paths and opportunities is prerequisite to building the global workforce. The low level of health-care funding in the world's poorest countries has severely limited the job opportunities for well-trained individuals at all levels.

3. Attention to professional and financial rewards, and working conditions. These are closely related factors. Poorly equipped and understaffed hospitals and laboratories, the danger of nosocomial infection with pathogens such as HIV or tuberculosis, infrastructure problems, low pay, and increasing demand for services all contribute to stress and dissatisfaction, and result in an acceleration of health-care professionals seeking a better life in other settings. These migrations both within and across borders exacerbate the already critical dearth of health-care workers in the poorest countries.

As the health labor market has become more global, high-income countries increasingly have recruited nurses and doctors to meet clinical demands, and have provided attractive opportunities for foreign scientists and public health workers as well. Efforts to address this "brain drain" include adoption of incentives to foster retention and to promote reverse migration by expatriates, economic and political barriers to out-migration, and creating limited training programs that yield credentials that are only recognized locally and are not valued internationally. Nevertheless, the shortages remain severe and acute. An interesting proposal of the Global Commission on International Migration is the creation of an Education Reinvestment Fund in which the brain-drain beneficiary countries would provide funds to build the educational capacity in the resource-poor countries that are losing substantial numbers of health-care workers to out-migration.

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