|
Back to Index
How
the brain drain to the west worsens africa-s public health
crisis
Rotimi Sankore
Extracted from Pambazuka News 269
September 14, 2006
http://www.pambazuka.org/en/category/comment/37062
In its 2006
annual report, the WHO reports that out of 57 countries, 36 countries
in sub-Saharan Africa suffer from a severe shortage of health workers,
such as doctors, nurses, pharmacists, lab technologists, radiographers
and other frontline or support staff. Rotimi Sankore argues that
the ‘brain drain’ is slowly and indirectly killing the continent.
In times of
crisis and epidemics, diplomacy is a luxury the dying cannot afford,
especially when millions of Africans know that an over emphasis
on niceties will almost surely lead to millions more deaths.
Conventional
wisdom has it that Africa is suffering from an AIDS crisis. In reality,
Africa is suffering from a public health crisis, and the AIDS pandemic
is the most significant symptom of that crisis, which has been worsened
by the drain on Africa’s healthcare workforce to the ‘West’. The
amazingly wrong political diagnosis of the challenging healthcare
problems facing Africa and indeed the planet, has blunted the obvious
fact that tuberculosis, malaria, a host of other preventable diseases
and malnutrition still claim more African lives than the 2 million
deaths attributed to HIV/AIDS annually. Combined with HIV and AIDS,
these diseases are rapidly turning Africa into a continental graveyard.
Yet the emphasis remains mainly on AIDS, which has been crowned
the most sexy villain.
The countries
with little or no health worker shortages and better health infrastructure
have managed to cope better with HIV/AIDS because they are better
able with preventable diseases like TB, sexually transmitted infections,
sexual and reproductive rights education and malnutrition. AIDS
is a problem on its own, but it is also being fed by other unresolved
health problems and the lack of political will and courage. Resolving
Africa’s public healthcare crisis will resolve most of the other
issues and be a step towards isolating AIDS which can then be tackled
more easily. The first step must be resolving the health worker
shortages, which includes dealing with the "brain drain".
2006 has been
a landmark year for HIV/AIDS in terms of the number of huge international
meetings and conferences organised. These include the Abuja African
Union Special Summit on HIV/AIDS, Tuberculosis and Malaria in June;
the UN General Assembly Special Session on HIV/AIDS (UNGASS); and
the 16th International AIDS Conference in Toronto in August.
These events
reflect the huge progress that has been made in tackling HIV/AIDS.
With the exception of the most backward governments and institutions,
it is clearly understood by the majority that inequality in gender
relations is one of the most significant factors behind heterosexual
transmission.
On the other
hand, these events underscore the huge failures and missed opportunities
in the struggle against HIV/AIDS, the biggest yet being the comprehensive
failure to resolve the human resource and health infrastructure
crisis in Africa.
The problem
seems to be that acknowledging, prioritising and acting on the "brain
drain" problem means that governments of countries that have
benefited from the "brain drain" have to take responsibility,
and cease their recruitment of healthcare workers from Africa. Likewise,
many African governments will also have to address their governance
problems and the working conditions for healthcare workers as means
to counter the "brain drain".
United Nations
population researchers conclude that unless the spread of HIV is
halted or reversed, Africa will top the global AIDS death league
with about 100 million deaths by 2025. This is more than double
the projections for India and China of 31 million and 18 million
respectively, both of which have larger populations than Africa.
People aged between 16 and 45 years of age will be most affected.
It is remarkable
that institutions and social movements alike focus not on the continent’s
health care crises, but on anti-retroviral drugs only. Anti-retroviral
drugs are useful but when there are no healthcare workers to administer
them to patients, they become useless
To drive the
point home, let me put it like this, no war can be fought successfully
without soldiers.
In April 2006,
the World Health Organisation (WHO) officially acknowledged what
African intellectuals have been saying for the last three decades,
that the "brain drain" from all sectors of African society,
but especially from the health sector, is slowly and indirectly
killing the continent.
In its 2006
annual report, the WHO reports that out of 57 countries, 36 countries
in sub-Saharan Africa suffer from a severe shortage of health workers,
such as doctors, nurses, pharmacists, lab technologists, radiographers
and other frontline or support staff. The report noted that the
richest countries are filling their shortages by draining away doctors,
nurses and others from less developed countries. As a result, one
in four doctors and one in twenty nurses trained in Africa, is now
working in the 30 most industrialised countries. Consequently, Africa
is the only continent where the absolute number of shortage of health
workers (817,992) far outstrips the current stock of 590,198.
Other studies
have shown that "the majority of the countries in sub-Saharan
Africa also do not meet the WHO’s recommended ratio of 1 to 1,000
[doctors]. Indeed, there are fewer than 10 doctors for every 100,000
people in 24 of the 44 Sub-Saharan African countries for which the
statistics are available." (Orji, Utsimi & Uwaje in paper
presented to the International eHealth Association in 2005).
In contrast,
Cuba has a doctor-population ratio of 1 to 165, South Korea 1 to
337, the UK 1 to 610, the USA 1 to 358, and Italy 1 to 165 (UNDP/Human
Development Report, 2004). Figures from the International Development
Research Centre (IDRC) state that on average, "The doctor-patient
ratio is currently one per 500 in wealthy countries, and only one
per 25 000 in the 25 poorest countries."
The main factor
that contributes to the low doctor-patient ratio in Africa is the
"brain drain". Quoting WHO and OECD figures amongst others,
the IDRC illustrates the problem in Nigeria and South Africa. "One-third
to a half of all graduating doctors in South Africa migrate to the
US, UK and Canada, at a huge annual cost to South Africa (lost investment
in education/training). Including all health personnel, the losses
for South Africa reach US$37 million annually. This exceeds the
combined (multilateral and bilateral) estimated education assistance
for all purposes, not just health professional training, received
by South Africa in 2000." Alongside this, "over 21 000
Nigerian doctors are practising in the US, while there is an acute
shortage of physicians in Nigeria."
Not surprisingly,
the IDRC concludes that "another reason for the deterioration
of health-care systems in developing countries is the ‘brain drain’
of health professionals… which primarily benefits wealthier nations,
such as the UK, the US and Canada, [and] calls into question G8
commitments to support developing countries in reaching health targets
of the International and Millennium Development Goals".
IDRC findings
also reveal that "developing countries invest about US$500
million each year in training health-care professionals, who are
then recruited by or otherwise move to developed countries… Meanwhile
the United States, with its 130, 000 foreign physicians, saved an
estimated US$26 billion in training costs for nationals… while estimates
suggest that Africa spends approximately US$4 billion annually on
salaries of 100 000 foreign experts (all sectors, not only health)
to ‘build capacity’ and/or provide technical assistance, and incurs
a loss of US$184 000 per migrating African professional".
Dr Peter Ngatia
of AMREF puts it more sharply: "Africa literally subsidises
the West. It is a reverse subsidy from the poor to the rich… History
is replete with instances of outflows of human resources from Africa
to the rest of the world. The disgraceful and shameful slave trade
epitomises this outflow, which robbed parts of the African continent
of its young and strong-bodied men and women. This was followed
by the colonial exploitation of the same in-fighting imperial wars
that had nothing to do with Africa. The recent migration of workers,
in the opinion of many, is nothing new. It is a perpetuation and
perfection of what started centuries ago and has continued unabated."
He expands by
saying "According to the International Organisation for Migration
(IOM), Africa has already lost one third of its human capital and
is continuing to lose its skilled personnel at an increasing rate,
with an estimated 20,000 doctors, university lecturers, engineers
and other professionals leaving the continent annually since 1990.
This same source estimates that there are currently 300,000 highly
qualified Africans in the diaspora, 30,000 of whom have PhDs."
Taking these
factors into account, a coalition led by the US based Physicians
for Human Rights, HIV Medicine Association and Association of Nurses
in AIDS Care issued a 15 point plan at the July 2006 G8 summit aimed
at ending Africa’s healthcare worker shortage. The statement emphasised
that "G8 countries, particularly the US and UK, should reduce
their reliance on health workers from abroad and seek to become
self-sufficient in meeting their own health worker needs. For example,
they should increase the domestic training of nurses, doctors, and
other health workers. The United States should also develop a code
of practice on international recruitment of health professionals,
which includes not actively recruiting health workers from developing
countries except in the context of an agreement with those countries
that respects the right to health in those countries and is mutually
beneficial."
The British
Medical Association has also cautioned that severe shortage of healthcare
workers in sub-Saharan Africa because of migration to developed
countries is a significant component of Africa’s AIDS crisis, and
that countries like the UK must end their reliance on overseas doctors
and nurses.
It is crucial
to continue to stress the role of the "brain drain" in
undermining African development in order to fight the myth that
millions of Africans are dying of AIDS because Africa is a useless
continent incapable of saving itself from anything. But stressing
this is not enough. Africans must also lead from the front, or complain
all the way to their graves, where only the silence of the tombstones
will speak for them.
There is no
doubt that Africa can rebuild its healthcare workforce both by further
training and attracting some of those in the diaspora back home.
The fact that a small country like Cuba, despite political and economic
constraints, has a better doctor to patient ratio than most of the
world’s developed countries also shows that it can be done by any
country with the right healthcare priorities.
There is no
human right more significant than the right to quality public health
care. The infected and the deceased need first to live in order
that all other rights to be significant.
This is why,
as a contribution towards upholding the right to a healthy life
in Africa and resolving Africa’s health care crisis, the AIDS and
Public Health Program of CREDO-Africa, together with partners in
Africa and around the world, are launching a campaign towards:
- That African
governments make resolving the health worker shortage their number
one public health care priority.
- That governments
of countries that have benefited most from the "brain drain"
cease such policies and examine ways to compensate Africa’s health
care system for the damage their recruitment policies have done.
- That the theme of the next International Aids Conference is
focussed on scaling up human resources and health care infrastructure,
especially in Africa.
- That all
intergovernmental organisations such as UNAIDS and its key agencies
focus on and act rapidly towards resolving the human resource
and infrastructure shortages in Africa and the infrastructure
in the next eight to 10 years.
*Sankore
is Coordinator of Centre for Research Education & Development
of Rights in Africa [CREDO-Africa]. He can be contacted at: info@credonet.org
*Please
send comments to editor@pambazuka.org
or comment online at www.pambazuka.org
Please credit www.kubatana.net if you make use of material from this website.
This work is licensed under a Creative Commons License unless stated otherwise.
TOP
|
