Objective An assessment of workforce issues in Pakistan following an appraisal of postgraduate training in 2006-2007

Design Universities, medical colleges and hospitals visited in 3 provinces.

Meetings with consultants, students and specialist trainees.

Results THE MEDICAL WORKFORCE

● Members of a committed workforce struggling to meet their expectations

● In a health system that is seriously underfunded —

● 70% of people are in rural areas

● population of 161 million (WHO 2008)

● 131,642 registered doctors (Pakistan Medical & Dental Council (PMDC) 2008)

● 79 doctors per 100,000 people

WORKFORCE ISSUES

1. Family / general practice in Pakistan

● 80% of people depend on family practitioners for health care

● 110,000 registered non-specialist doctors (PMDC 2008)

● almost no training for family practice

● evidence of poor clinical practice —

2 Staffing of the health system

● A well-structured system

Basic Health Units in villages,

Regional headquarters hospitals

Teaching hospitals

● Staffing in rural areas presents problems

● need for increased salaries, on-site housing, good security

● but money is short..

3 Trainee contributions to health care

● Specialist trainees have a major role in clinical care

● Few training programs outside major teaching hospitals

● Armed Forces specialist trainees have postings to distant military hospitals

4 Data and women doctors

● PMDC collects no information on work patterns or locations.

● Workforce planning is impeded, or impossible.

● About 60% of medical students are women

● Most are said to leave medicine soon after graduation.

● but there are no data

5 Medical migration and health funding

● Mullan 2005 found Pakistani doctors in 4 Western countries equated to 11.7%

of those registered in Pakistan —

Total government expenditure on health was 2.1% of GDP in 2005

Per-capita expenditure was 49 international dollars per year

(Source: WHO 2008)

Approach to hypertension. Jafar et al. 2005

Tuberculosis diagnosis & treatment. Khan et al. 2003

Injection practices. Janiua 2003

(See Biggs 2008)

Ways to reduce medical migration

1. Structured training programmes 2. New career structure

3. Improved clinical facilities and maintenance

4. Appropriate salaries and support

Conclusions ● There are too few practising doctors in Pakistan

● Extension of training programs outside main centres would help ● Absence of data makes workforce planning nearly impossible.

● Migration loss could be reduced with government action

● Higher priority for health is essential

References

Biggs JSG. Postgraduate medical training in Pakistan: observations and recommendations. J.College Physicians and Surgeons Pakistan 2008; 18:58-63. Pakistan Medical and Dental Council 2008. http://www.pmdc.org.pk/stat.htm Mullan F. The metrics of the physician brain drain. N Engl J Med.2005; 353:1810-8.

WHO 2008. http://www.who.int/countries/en/

Emigration Factor Emigration of medical graduates as a proportion of all

registered graduates in a country, Mullan 2005

0

5

10

15

20

Pak

ista

n

India

Phili

ppines

USA

Aust

ralia U

K

Emigration

Factor (%)

Medical staff of Liaquat University of

Medical & Health Sciences, Jashoro,

Sindh

Basic Health Unit, Hadayra, Punjab Dr. Samia Aitzaz, BHU, Padhana, Punjab

Medical staff, Kasur District Headquarters

Hospital

Teaching hospital, Hyderabad, Sindh

Medical students, Dow University of Health Sciences, Karachi

Medical Workforce in a Developing Country

John SG Biggs

Coast City Country Training, Australia

Acknowledgements The HEC, universities, medical colleges and hospitals are thanked for their support, as are the many students and trainees who helped in the task of appraisal.

Further information can be obtained from Dr John Biggs at

jsgb@homemail.com.au or at 21 Conyers St, Hughes ACT 2605, Australia