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September 01, 2006
was published in the Mail & Guardian (SA)
public health services are in a state of emergency. Bad pay and
working conditions, plus the impact of HIV/Aids, are bleeding the
system of its most valuable resource: people. With the cost of training
a general practice doctor estimated to be $60 000, and that of training
a medical auxiliary at $12 000, the African Union estimates that
low income countries subsidise high income countries to the tune
of $500-million a year through the loss of their health workers.
Since 2000 in
Malawi, more than 100 nurses have applied each year for registration
to work abroad. Others have gone abroad without paperwork, and more
still have left to work in private clinics or for NGOs in Malawi.
With 28,6 nurses per 100 000 people, the country has one of the
worst nurse-to-patient ratios in Africa. In Zimbabwe, Botswana,
South Africa, Namibia and Zambia nurses are moving out at a similar
become a training ground for other countries," said Martin
Mwalukanga, clinical officer in charge at the Ngwerere rural health
center. "If I was given the chance to work overseas where I
would be adequately remunerated, then I would definitely go."
Not all head North.
Namibia imports nurses from Kenya, and South Africa draws large
numbers of healthcare workers from the region.
are doing what they can to plug the exodus. In Malawi, for example,
the Ministry of Health has designed a $278-million "emergencey
human resources programme". It includes a salary "top-up"
of 50% for essential health staff, supported by funds from the British
government, and the provision of emergency "stop-gap"
volunteer doctors and nurse tutors from overseas.
In Zambia, medical
personnel working in rural areas get a hardship allowance – although
Alex Mulala, a clinical officer at the Chipapa rural health clinic,
says even with the allowance the salary is "a mockery".
He adds: "The government knows that the money we are getting
is peanuts. It can’t see you from month-end to month-end."
In May this year,
the Jesuit College for Theological Reflection in Lusaka calculated
that the monthly cost of basic needs for a family of six to survive
is 1,4-million kwacha ($410). An average nurse’s salary is 1,2-million
But salaries are
not everything, said Ibrahim Idana, director of the Queen Elizabeth
Central Hospital in Blantyre, Malawi. "The most obvious reason
for leaving is that their remuneration is not big enough. They’re
told, ‘Don’t worry, you will get retirement packages’. Malawian
life expectancy is 37, but the retirement age is 65 – who’s going
to live to be 65? People want to live a happy life now."
In the meantime,
northern countries continue to proactively recruit health workers
from poor countries to prop up their own public services. One in
four doctors in Canada and the United States is from overseas. And
while the British government spends millions to top up health worker’s
salaries in Malawi, it simultaneously recruits nearly one-third
of its doctors from overseas – many from Malawi and other English-speaking
the challenge. Africa is likely to lose 20% of its health workers
to the disease in the coming years, with those remaining facing
increasing workloads and stress. This undermines efforts to expand
the provision of anti-retroviral treatment to people living with
HIV and Aids. "As much as we want to scale up, there are no
bodies," said Biswick Mwale, head of Malawi’s National Aids
Commission. "People can’t translate money into action when
there are no people."
Hooper-Box is the media coordinator for Oxfam in Southern Africa.
Additional reporting by Helen Palmer and Nicky Wimble
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