Maternal Survival and the Crisis in Human Resources for Health in Africa: Impact of the Brain Drain

  • Staffan Bergström


This chapter focuses on what might be the ultimate challenge in human resources for health: currently there are more pregnancy-associated deaths than all deaths from AIDS, malaria and tuberculosis combined. Every year more than half a million women and girls die during pregnancy or childbirth (WHO, 2007). Of all health indicators, maternal mortality shows the starkest disparity between rich and poor countries; 99 per cent of maternal mortality occurs in low- and middle-income countries (WHO, 2007). The staggering number of maternal deaths still represents a small minority of deaths due to pregnancy complications; approximately seven per cent. We tend to forget the ‘passenger deaths’ of babies when we focus on the ‘carrier deaths’ of mothers. There are, annually, around four million stillborn babies in the world and three million early neonatal deaths (deaths very soon after birth), amounting to seven million deaths (Stanton et al., 2006; Lawn et al., 2006). In comparison, AIDS causes around 2.1 million deaths, tuberculosis around 1.6 million and malaria around 1.3 million, or, combined, around five million deaths per year.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Bergström S. (2005a), ‘Who Will Do the Caesareans When There is No Doctor? Finding Creative Solutions to the Human Resource Crisis’, BJOG, 112, 1168–9.CrossRefGoogle Scholar
  2. Bergström S. (2005b), ‘Obstetric Ectoscopy — An Eye-Opener for Hospital-Based Clinicians’, Acta Obstetricia et Gynecologica Scandinavica, 84, 105–7.CrossRefGoogle Scholar
  3. Bodart, C., Servais, G., Mohamed, Y. L., Schmidt-Ehry, B. (2001), ‘The Influence of Health Sector Reform and External Assistants in Burkina Faso’, Health Policy and Planning, 16, 74–86.CrossRefGoogle Scholar
  4. Borghi, J., Hanson, K., Acquah, C. A., Ekanmian, G., Filippi, V., Ronsmans, C. (2003), ‘Costs of Near-Miss Obstetric Complications for Women and their Families in Benin and Ghana’, Health Policy and Planning, 18, 383–90.CrossRefGoogle Scholar
  5. Briasco, C., Floate, H., Tate, A. (2004), Feeding the System, unpublished MPH dissertation, Brisbane: University of Queensland.Google Scholar
  6. Broadhead R. L., Muula A. S. (2002), ‘Creating a Medical School for Malawi: Problems and Achievements’, British Medical Journal, 325, 384–7.CrossRefGoogle Scholar
  7. Chen, L., Evans, T., Anand, S., Boufford, J. I., Brown, H., Chowdhury, M., Cueto, M., Dare, L., Dussault, G., Elzinga, G., Fee, E., Habte, D., Hanvoravongchai, P., Jacobs, M., Kurowski, C., Michael, S., Pablos-Mendez, A., Sewankambo, N., Solimano, G., Stilwell, B., de Waal, A. and Wibulpolprasert, S. (2004), ‘Human Resources for Health: Overcoming the Crisis’, Lancet, 364, 1984–90.CrossRefGoogle Scholar
  8. Chilopora, G. C., Pereira, C., Kamwendo, F., Chimbiri, A., Malunga, E., Malewezi, J. and Bergström, S. (2007) ‘Postoperative Outcome of Caesarean Sections and Other Major Emergency Obstetric Surgery by Clinical Officers and Medical Officers in Malawi’, Human Resources for Health, 5, 17–23.CrossRefGoogle Scholar
  9. Connel, J. (Ed.) (2007), The International Migration of Health Workers, Oxford: Routledge.Google Scholar
  10. Cumbi, A., Pereira, C., Vaz, F., McCord, C., Bacci, A., Bergström, S. (2007), ‘Major Surgery Delegation to Mid-Level Health Practitioners in Mozambique: Health Professionals’ Perception’, Human Resources for Health, 7, 27–35.CrossRefGoogle Scholar
  11. Dovlo, D. (2003), ‘The Brain Drain and Retention of Health Professionals in Africa: A Case Study’, paper presented at Regional Training Conference on Improving Tertiary Education in sub-Saharan Africa: The Things That Work! 23–25 September 2003, Accra.Google Scholar
  12. Fathalla, M. F. (1991), ‘How Much are Mothers Worth?’ Proceedings of the XIII World Congress of Gynecology and Obstetrics, 15–20 September, Singapore, Carnforth, UK: Parthenon.Google Scholar
  13. Fofana, P., Samaj, O., Kebbie, A. and Sengeh, P. (1997), ‘Promoting the Use of Obstetric Services through Community Loan Funds, Bo, Sierra Leone’, International Journal of Gynecology and Obstetrics, 59, S225–30.CrossRefGoogle Scholar
  14. Joint Learning Initiative (JLI) (2004), Human Resources for Health: Overcoming the Crisis, [accessed 22 December 2009].
  15. Jowett, M. (2000), ‘Safe Motherhood Interventions in Low-Income Countries: An Economic Justification and Evidence of Cost Effectiveness’, Health Policy, 53, 201–28.CrossRefGoogle Scholar
  16. Lawn, J. E., Wilczynska-Ketende, K., Cousens, S. N. (2006), ‘Estimating the Causes of 4 million Neonatal Deaths in the Year 2000’, International Journal of Epidemiology, 35, 706–18.CrossRefGoogle Scholar
  17. Lowell, G. and Findlay, A. (2001), Migration of Highly Skilled Persons from Developing Countries: Impact and Policy Responses, Geneva: International Labour Office.Google Scholar
  18. Mbaruku, G. and Bergström, S. (1995), ‘Reducing Maternal Mortality in Kigoma, Tanzania’, Health Policy and Planning, 10, 71–8.CrossRefGoogle Scholar
  19. Musgrove, P. (1999), ‘Public Spending on Health Care: How are Different Criteria Related?’ Health Policy, 47: 207–23.CrossRefGoogle Scholar
  20. Padmanathan, I., Liljestrand, J. and Martins, J. M. (2001), Investing in Maternal Health in Malaysia and Sri Lanka, Washington: World Bank.Google Scholar
  21. Pereira, C., Bugalho, A., Bergström, S., Vaz, F. and Cotiro, M. (1996), ‘A Comparative Study of Caesarean Deliveries by Assistant Medical Officers and Obstetricians in Mozambique’, BJOG, 103, 508–12.CrossRefGoogle Scholar
  22. Pereira, C., Cumbi, A., Malalane, R., Vaz, F., McCord, C., Bacci, A. and Bergstrom, S. (2007), ‘Meeting the Need for Emergency Obstetric Care in Mozambique: Work Performance and Histories of Medical Doctors and Assistant Medical Officers Trained for Surgery’, BJOG, 114, 1530–3.CrossRefGoogle Scholar
  23. Rao, K. B., Harrison, K. A. and Bergström, S. (2002), ‘Organization of Maternity Care in Developing Countries’, in J. B. Lawson, K. A. Harrison and S. Bergström (Eds), Maternity Care in Developing Countries, London: Royal College of Obstetricians and Gynaecologists.Google Scholar
  24. Songane, F. F. and Bergström, S. (2002), ‘Quality of Registration of Maternal Death in Mozambique: A Community Based Study in Rural and Urban Areas’, Social Science and Medicine, 54, 23–31.CrossRefGoogle Scholar
  25. Stanton, C., Lawn, J. E., Rahman, H., Wilczynska-Ketende, K. and Hill, K. (2006), ‘Stillbirth Rates: Delivering Estimates in 190 Countries’, Lancet, 367, 1487–94.CrossRefGoogle Scholar
  26. Tawfik, L. and Kinoti, S. N. (2001), The Impact of HIV/AIDS on the Health Sector is in Sub-Saharan Africa: The Issue of Human Resources, Washington, United States Agency for International Development, Bureau for Africa, Office of Sustainable Development.Google Scholar
  27. Thonneau, P. F. (2001), ‘Maternal Mortality and Unsafe Abortion: A Heavy Burden for Developing Countries’, in V. de Brouwere and W. van Leerberghe (Eds), Safe Motherhood Strategies: A Review of the Evidence, Antwerp: Studies in Health Services Organization and Policies.Google Scholar
  28. USAID (2003), The Health Sector Human Resources Crisis in Africa: An Issue Paper, Washington: United States Agency for International Development, Bureau of Africa, Office of Sustainable Development.Google Scholar
  29. Vaz, M. L. and Bergström, S. (1992), ‘Mozambique — Delegation of Responsibility in the Area of Maternal Care’, International Journal of Gynecology and Obstetrics, 38 (Suppl.), S37–9.CrossRefGoogle Scholar
  30. Vaz, F., Bergström S., Vaz, M. L., Langa, J. and Bugalho, A. (1999), ‘Training Medical Assistants for Surgery’, Bulletin of the World Health Organization, 77, 688–91.Google Scholar
  31. WHO (2002), Reducing Risks, Promoting Healthy Life, Geneva: World Health Organization.Google Scholar
  32. WHO (2005), The World Health Report 2005: Make Every Mother and Child Count, Geneva: World Health Organization.Google Scholar
  33. WHO (2007), Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA, and The World Bank, Geneva: World Health Organization.Google Scholar
  34. World Bank (1993), Investing in Health: World Development Report, Oxford: Oxford University Press.Google Scholar
  35. Xu, K., Evans, D. B., Carrin, G. and Aguilar-Rivera, A. M. (2005), Reducing Catastrophic Health Expenditure in the Design of Health Financing Systems, Technical Brief for Policy-Makers, Number 2, Geneva: World Health Organization.Google Scholar
  36. Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J. and Murray, C. J. (2003), ‘Household Catastrophic Health Expenditure: A Multicountry Analysis’, Lancet, 362, 111–17.CrossRefGoogle Scholar
  37. Zurn, P., Dal Poz, M. R., Stillwell, B. and Adams, O. (2004), ‘Imbalance in the Health Work Force’, Human Resources for Health, 2, 13–15.CrossRefGoogle Scholar

Copyright information

© Staffan Bergström 2010

Authors and Affiliations

  • Staffan Bergström

There are no affiliations available

Personalised recommendations