健康人员的“大规模出埃及记”将跟随Covid-19

全球卫生安全专家警告说，卫生工作者的死亡，移民和援助削减使卫生系统处于危险之中。

Across the developing world, health and care workers are facing a similar scenario: the COVID-19 illnesses and deaths of colleagues, along with migration and resignations, are compounding workloads and stress for those still on the frontline.

世界卫生组织（WHO）说，“至少”有115,000名卫生和护理人员死于Covid-19，尽管总干事Tedros Adhanom Ghebreyesus承认，由于数据报告“很少”，因此真实数字可能更高。

随着Covid-19在非洲呈指数次传播，拉丁美洲和亚太面临不懈的健康紧急情况，卫生工作者的死亡可能会继续增加。

“对妇女进行投资是我们可以为所有未来和卫生安全的未来所做的最好的投资。”

Roopa Dhatt, executive director Women in Global Health.

在世界上最富有的国家中，过去20年来，受训练或外国出生的医生和护士的数量一直在增加。倡导者和卫生工作者说，现在因死亡和移民而失去的员工正在留下知识差距，倡导者和卫生工作者说。

但是，全球卫生安全专家认为，在大流行谎言的创伤中，制定保护卫生人员并激励他们留下的政策的创伤。

保护和投资

“Health workers all over the world have put their lives on the line to try and keep people safe from COVID-19, yet far too many have been left unprotected and paid the ultimate price,” said Steve Cockburn, head of economic and social justice at Amnesty International. “For one health worker to die from COVID-19 every 30 minutes is both a tragedy and an injustice.”

对于占全球健康和护理人员70％的妇女来说，这种缺乏安全性意味着使用个人保护设备为男人设计— which often fails to protect women — as well as violence and harassment in the workplace.

全球卫生妇女是一个国际卫生网络，倡导全球卫生领导力的性别平等，共同启动了所谓的“卫生和护理劳动力中妇女的新社会契约”。这Gender Equal Health and Care Workforce Initiative这是世界卫生组织，全球卫生中的妇女与法国政府之间的合作伙伴关系，旨在加强将投资和保护健康和护理人员的政策。

“Health workers are exhausted, many want to leave. We cannot afford to lose one single worker at this time,” says Roopa Dhatt, an Indian physician and executive director of Women in Global Health. “Investing in women is the best investment we can make for all our futures and the future of health security.”

特德罗斯告诉《世界》一代平等论坛，在7月1日宣布对该计划的第一轮承诺。

他说，妇女约占护士和助产士的90％，近一半的医生。

特德罗斯说：“这种依赖要求我们在工作场所条件和公平方面问自己棘手的问题，包括我们如何重视和奖励妇女在健康和护理员工中。”“以及我们如何保证工作场所摆脱歧视，暴力，性剥削和虐待。”

作为政府（包括墨西哥，巴基斯坦，刚果民主共和国和利比里亚民主共和国）以及致力于性别政策倡议的非政府组织，达特说，数百万的卫生和护理人员是未付的或没有付费的，并且无法访问Covid-19疫苗。

“We must provide incentives for women to stay,” says Dhatt.

偷猎的员工

这global South has long supplied many of the human resources for health systems in the global North. And as health services in the United Kingdom, the US and Europe struggled under the weight of their respective COVID-19 crises, the demand for trained staff from the global South intensified.

在世界上最富有的国家中，所有医生中有近25％和16％的护士出生在国外。简报纸from the Organisation for Economic Co-operation and Development (OECD). The paper, published in May, examines how wealthy countries have sought to attract staff from developing countries in response to the COVID-19 pandemic.

这brief acknowledged that the countries from which staff were being enticed “were already facing severe shortages of skilled health workers before the COVID‑19 pandemic”.

As the UK launched a fast-track健康和护理签证在2020年，为了吸引更多的外国卫生工作者，政府还大大降低了其外国援助预算，这是经合组织的建议。

减轻促使卫生专业人员离开本国的因素要求“加强国际合作，尤其是海外发展援助和技术援助，以帮助较低的先进国家建立足够的卫生劳动力并加强其卫生系统的政策，以帮助他们”经合组织摘要说。

写入这BMJ, Kaci Kennedy McDade and Wenhui Mao from Duke University’s Center for Policy Impact in Global Health said the aid cuts would put全球卫生系统at risk。他们说，在削减援助的102个国家中，有一半以上是中低收入收入，近四分之一的收入脆弱或受冲突影响。

卫生工作者死亡

全球卫生倡导者说，在脆弱的卫生系统中，当社区卫生工作者或受过良好训练的医学专家死亡可能会产生长期影响时，丢失的知识。

菲律宾是护士对富裕国家的最大贡献者，经合组织数据显示。印度提供了最多的外国医生，也是第二高的移民护士。

菲律宾英国护士协会有引起了人们的关注关于该国国家卫生服务局（NHS）和社会护理中COVID-19的死亡率不成比例高。在美国，菲律宾人仅占该国注册护士的4％，但死于Covid-19的护士中有30％以上是菲律宾人。国家护士联合联盟。

At home in the Philippines, prominent frontline health specialists have been lost to the pandemic. Paediatric surgeon Leandro Resurreccion III and Salvacion Gatchalian, who was president of the Philippine Pediatric Society and a paediatric infectious diseases expert, died in March 2020.

Gatchalian帮助建立了针对结核病的菲律宾联盟，并领导了儿童的结核病倡议，而Resurreccion已从澳大利亚返回为菲律宾的卫生服务部门工作。

南非医学研究委员会（SAMRC）主席格伦达·格雷（Glenda Gray）表示，高技能的研究人员在低收入和中等收入国家中很少。她说SciDev.Net：“任何因死亡或移民而失去科学家都是一个问题。”

研究表明，医师的移民几乎使贫穷国家造成每年160亿美元and contributes to excess deaths resulting from lost medical knowledge.

根据经合组织的说法，由于某些非洲和拉丁美洲国家的医生和护士的移民率高达50％，这可能意味着，在经合组织中出生的地区出生的医生比其原籍国更多。

Africa’s research community lost a respected and loved colleague when renowned HIV scientist Gita Ramjee died of COVID-19-related complications in March 2020. Among a long list of roles that Ramjee played, she managed large-scale research networks with the SAMRC for more than 25 years.

“Gita was fundamental and inextricably linked to the endeavours to find solutions to prevent HIV in women. She was tireless in this pursuit, her tenacity will never be forgotten,” Gray said last year. Winnie Byanyima, executive director of UNAIDS, said Ramjee’s death was a huge loss “at a time when the world needs her most”.

阻止潮汐

健康workers in fragile systems face a vicious circle: poor pay and working conditions drive migration and pressure, and stress and workloads increase for the staff who remain. With COVID-19 has come the deaths of colleagues, and long-term physical and mental health effects.

“只要情况仍然存在并且苦难仍在继续，科维德后19阶段将见证医生的大规模飞行。”

阿拉伯·本·哈拉（Al Arabi bin Hara），阿尔及利亚医生

埃及医师Abdel Hamid Mahmoud告诉Sets：“死亡，感染和[增加工作量]的心理影响促使许多医生请假，如果管理层拒绝，一些人诉诸于政府医院辞职。”SciDev.Net。

开普敦大学的耳朵，鼻子和喉咙疾病专家约翰·法根（Johan Fagan）表示，诸如英国快速健康和护理签证之类的政策将刺激进一步移民。

“These countries aren’t training enough of their own healthcare professionals and are exploiting the workforce in developing countries,” Fagan says. “In a pandemic, this has a significant impact on our health systems and how we’re able to deliver care.”

Algerian doctor Al Arabi Bin Hara predicts an exodus of skilled workers once borders reopen. “Last year and the beginning of this year, there were the smallest number recorded in doctors’ immigration because of the closed borders as of the measures imposed by the pandemic,” Bin Hara says.

“只要情况仍然存在并且苦难仍在继续，科维德后19阶段将见证医生的大规模飞行。”What hurts, says Bin Hara, is that hospitals and clinics in Europe — particularly in France — are attracting Algerian doctors with critical specialisations that are often lacking even in Algeria’s largest hospitals.

“We must invest now in nursing education, leadership, jobs and practice, and we need member states to own their new strategy and implement it now.”

国际护士理事会主管霍华德·卡顿（Howard Catton）

在津巴布韦，这是家庭培训医生的移民率最高的一员，专家也听起来很警告。南非的津巴布韦医生培训查尔斯·莫约（Charles Moyo）表示，如果没有阻止卫生工作者损失的潮流，非洲将面临医疗危机。

“医疗体系已经年代trained by limited resources and by COVID-19. If more manpower is lost, the entire healthcare system could collapse,” he says.

这International Council of Nurses, which has signed on to support the Gender Equal Health and Care Workforce Initiative, celebrated the unanimous adoption at the World Health Assembly of the WHO’s updated global护理和助产士策略。该战略提出了支持助产士和护士的政策优先事项，以实现普遍的健康覆盖范围。

ICN负责人霍华德·卡顿（Howard Catton）说，该策略的信息很明确。卡顿说：“我们现在必须投资于护理教育，领导，工作和实践，我们需要成员国拥有他们的新战略并立即实施。”

“当然，悲惨的讽刺是，如果我们以前这样做，我们将拥有一个更好的保护医疗保健劳动力，而我们的同事中会有更少的死亡。”

*文章和图表于2021年7月19日更新。