Dr. Kate Tulenko, Founder and CEO of Corvus Health
Medical education is expensive and time-consuming, healthcare workers are often overloaded and underappreciated, and some end up securing better, higher-paying jobs overseas, resulting in a significant shortage of qualified medical personnel, says Dr. Kate Tulenko, CEO of Corvus Health. In an interview with IFC, Dr. Tulenko explains how aging populations and the rise in non-communicable diseases like cancer, diabetes, and heart disease exacerbate the worker shortage. She also offers private and public health leaders practical advice on addressing the deficit.
What primary factors contribute to the shortage of healthcare workers in Africa and other emerging markets?
Although we will focus today on the shortage in Africa, it is important to understand that the factors contributing to the health worker shortage on the continent are similar to those in high-income countries. The primary constraint is how resource-intensive the education of health workers like nurses, doctors, pharmacists, and allied health professionals is. Unlike other professions, health workers need physical labs like chemistry, physics, biology, and pathology labs as well as clinical practice in hospitals. Training is expensive and time-consuming: four years for nurses, six to seven years for physicians, and ten or more years to train a surgeon. It's not just the amount of time but the lost wages and accumulated debt.
Another problem is related to conflicts of interest. An example might be medical professionals blocking hiring more nurses or doctors because they fear wages falling. For instance, a nursing union in Tunisia recently lobbied the government to cap pre-service nursing education even though they have a shortage. This is a conflict of interest.
Healthcare workers also pursue better opportunities overseas, leaving gaps in care at home. The issue is that most countries don’t train enough healthcare professionals to be self-sufficient. They recruit workers from low-income countries, offering them more money, status, and better career ladders.
And then there is a vicious cycle of understaffing: health workers become overloaded and stressed and quit the profession, leaving behind fewer health workers who are now even more overloaded and stressed. We saw a lot of this during the Covid-19 pandemic.
Aging populations are growing around the world, while young ones are declining. How is this trend influencing the health worker shortage?
Aging populations are worsening the health worker shortage in two ways. First, older people need six times more the amount of health care compared to younger people. They have more non-communicable diseases—they are more likely to be frail, and their immune systems aren’t as strong. They also need more professional support with things like bathing and feeding. Second, in many countries, we are looking at inverted population pyramids—more older adults than young—which means there won’t be enough people to train, and the shortage of workers will only grow.
Noncommunicable diseases like diabetes are on the rise. Is the healthcare worker shortage contributing to this? If so, how?
Lifestyle changes and longevity are the main contributors to the rise in illnesses like diabetes, heart disease, and cancer. People have shifted from more traditional diets to highly processed ones and moved from physical labor to more sedentary work. And, as the world becomes wealthier, populations have more disposable income to spend on alcohol and tobacco, which cause cancers and other NCDs.
We have also succeeded in preventing infectious diseases like tuberculosis and malaria through vaccines, and we are treating other infectious diseases like pneumonia and diarrhea so people are living longer. Patients with non-communicable diseases need more healthcare because they are chronic and require attention several times a year for the rest of their lives, while infectious diseases are episodic.
How can stakeholders create lasting, sustainable solutions to the workforce shortage?
Healthcare reform, specifically health workforce reform, is so complex and fraught that it has to begin at the presidential level. Heads of state are in the best position to bring together finance, health, education, labor, and civil service ministers and encourage them to set aside their interests and be willing to work with doctors and nurses. Collaboration and cooperation efforts are essential to lasting and meaningful healthcare reform. In addressing its health workers shortage and maldistribution, Thailand did a good job engaging all the relevant ministries and health professional associations and creating effective, evidence-based solutions.
What steps can be taken to improve workforce planning over the long term?
One of the more essential steps in health workforce reform is analyzing data and making decisions based on it. We see a lot of information being collected, but it’s just not being used. By tracking who the workers are, their career paths, salaries, and data on schools and school failure rates, healthcare systems can improve their existing systems and plan better for the future.
We also must acknowledge that health workforce planning is a critical practice area. Whether it’s the government or the private sector, we must start opening health workforce training programs for health workforce experts and establishing career paths for them.
What three pieces of advice would you give to leaders who are struggling with the health worker shortage?
My first advice would be to view health workers as investments, not expenses. They are people with feelings, families, and fantasies, not chess pieces that can be moved around without consideration. Health workers need to feel respected and valued. If they work in rural posts, their children need to be adequately educated, and they need housing. I always remind governments in low- and middle-income countries that they will never be able to compete with salaries being offered in Europe and North America. Employers need to highlight the advantages of staying home like health workers becoming leaders in their local communities.
Second, leaders must invest in all stages of the health worker lifecycle, which includes data and analysis, regulation, recruitment, pre-service education, retention programs, and performance support. The Philippines, for instance, has been very smart about regulation. To enable private nursing schools to flourish while maintaining quality standards, they post the license pass rates of nursing schools so students can make informed decisions, and poorly performing schools either improve or go out of business.
Lastly, private and public health leaders must manage the migration of their workforce. If a health worker trained in one country wants to pursue an opportunity elsewhere, either the receiving country or the worker should repay the cost of their education. Signing bilateral agreements is another great way to manage migration. Ireland and Sudan, and Germany and Mexico are prime examples. Through these bilateral deals, recruiting practices are transparent. People are being recruited by reputable agencies and advocated for should anything go wrong.
This interview has been edited for length and clarity.
Published in September 2023
Dr. Kate Tulenko MD, MPH, MPhil, FAAP is a physician entrepreneur and health systems and health workforce expert. She is the founder and CEO of Corvus Health, a global health workforce firm that helps health systems and governments develop, manage, and retain an optimized health workforce. In 2022, she was appointed by President Biden to the President’s Advisory Council on Doing Business in Africa, which advises the President and Secretary of Commerce on how to support African and U.S. businesses to increase mutual trade.
Dr. Tulenko is also founder and CEO of Appleseed Education, an EdTech platform that addresses the global health worker shortage by helping African nursing schools undergo their digital transformation and expand and improve. Previously, she served as director of the U.S. government’s global health workforce project and the coordinator of the World Bank’s Africa Health Workforce program.
Dr. Tulenko is adjunct faculty at the Johns Hopkins School of Public Health and serves on the board of advisors for the Global Business School Network (GBSN). She received her bachelor’s in biochemistry from Harvard, her master’s in history and philosophy of science from Emmanuel College, Cambridge, her MD from the Johns Hopkins School of Medicine, and her Master of Public Health from the Johns Hopkins School of Public Health.
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