The quality of health care is generally low. Life expectancy at birth is estimated to be 56 years in 2012, with 48 healthy life years expected. Fertility rate remains high in Cameroon with an average of 4.8 births per woman and an average mother's age of 19.7 years old at first birth. In Cameroon, there is only one doctor for every 5,000 people, according to the World Health Organization. In 2014, just 4.1% of total GDP expenditure was allocated to healthcare. Due to financial cuts in the health care system, there are few professionals. Doctors and nurses who were trained in Cameroon, emigrate because in Cameroon the payment is poor while the workload is high. Nurses are unemployed even though their help is needed. Some of them help out voluntarily so they will not lose their skills. Outside the major cities, facilities are often dirty and poorly equipped.