Spending more is important, but spending better is even more so. Funds should be used to increase the quantity, quality and relevance of health workers and thereby have the highest impact on the type and volume of services that the country needs. This is an issue of efficiency in the allocation of available funds: in what proportion should the funds be allocated to training physicians (and among them specialists or family practitioners), nurses and other technical personnel, or community workers? Evidence on allocation of resources among schools is scarce. Most studies compare the efficiency of different health workers in providing the same type of services, such as midwives/nurses/gynaecologists (Matendo R. et al, 2011, Rana TG et al, 2003). When studies on cost are performed, it is generally found that investing in midwives and nurses is cost-effective (Anderson RE , Anderson DA, 1999, Fagerlund K, 2009) although the evidence is mixed in highly developed health-care systems (Hendrix MJC et al, 2009).
What is the right balance between investing in infrastructure, compensation and working conditions, including continuing education, for health professionals? In the case of small countries without a faculty of medicine or specialty training, should they opt for training abroad or for developing their own training capacity?