HANDS-OFF? The growing exodus of health professionals from Africa. The shortage of health professionals in Africa is a huge problem and it is likely to worsen in the coming years. Wealthier countries are actively -- some would say aggressively – recruiting African health workers through special visa and licensing programs. The UK, for example, offers a “health and care” visa for foreign health professionals; and Canada has a special process for certain skilled professions, like nurses. But in an attempt to fill their own shortages, wealthier countries are making things worse for poorer countries in Africa, creating a "brain drain" as nurses, doctors, and other health professionals emigrate for new opportunities. This exodus is exacerbating in Africa existing healthcare shortages that are having a negative impact on public and private health service provision. A WHO survey released last year found that the ratio of health workers to people in Africa is about a quarter of what is needed to provide essential healthcare and achieve universal health coverage. The loss of health professionals makes already weak health systems – like in Africa – even worse. In the UK, the lack of sufficient nurses may create a backlog for some treatments, but patients still have a place to go. In some parts of Africa, when a nurse leaves, the whole clinic can be at risk. There is no easy solution. Everyone has the right to try to improve their lives and emigration certainly can help the person who is being recruited and their family. But shouldn’t wealthier countries hiring these workers also take steps to strengthen the health system that helped train and develop the person that’s being hired? For example, what about contributing to more training schools, creating online programs, and supporting partnerships with other medical schools to expand capacity? My view is -- and I am happy to be proved wrong -- that the UK's scarce skills visa to encourage health worker migration, along with the efforts by other countries to target the continent, will have a significant long-term negative impact on Africa by exacerbating existing shortages of skilled professionals and impeding economic development. We all need to be more vocal on these issues and I call on stakeholders to move this discussion forward given how the developed world continues to undermine health service provision in Africa through these types of initiatives. Africa has suffered too much from the imbalance of dealing with Western nations that have often taken and not equally given back. Africa can become the global training ground for health professionals, but the developing world has to help these countries put in place the building blocks that can benefit the local health system first and support health worker training.
Kola Oni
2mo
On point, we can’t or shouldn’t try to stop the emigration but I do agree that the developed world should pay a price for poaching these talents especially those who received free education. We can agree that training institutions can be built and you can only receive a certain percentage of those you’ve trained. Developing nations like Nigeria may also start requesting for some type of compensation - no easy answers but we need to find them. On the flip-side, diaspora remittances from the emigrants are a boost to the developing countries but they can also promote inequalities and increase Gini co-efficient because a Doctor trained from the public purse ends up only supporting his immediate family through his remittances, not the entire economy and even though there is a case for ‘trickle-down’ economics, it doesn’t quite cover it.
Maureen Lewis
2mo
Let me be a devil’s advocate as well. It isn’t only the Philippines that “trains for export”. It is a major industry in the Caribbean for both doctors and nurses. It provides high end jobs and expands the number of trained medical staff. Moreover, the return migrants offer an insight into new ways of management and clinical care. Finally, a study a number of years ago ( when migration was also common) in Kenya found that a significant proportion of trained nurses worked outside of medicine. So trained nurses were living in Kenya, but chose to work in other fields. This is not to diminish the problem but to suggest that multiple solutions exist to the HR problem from quality of national working conditions to investment options for countries with high rates of migration. I agree that it is a serious problem. But some creative options exist that may be worth considering. The aging of OECD populations is only going to raise demand for nurses, and those countries are unlikely to stop recruiting in Africa and elsewhere where nurses are well trained and willing to migrate.
What is most frustrating is that major efforts have been made for years on this matter under GHWA resulting in an international code of practice on international recruitment adopted in 2010 by WHO members ... but the same do not comply with what they agreed on!
Hiddo Huitzing
2mo
Playing the devil's advocate, one can also look at countries such as The Philippines which have made nurses an export model, and create a surplus of nurses and care-takers. As Kola Oni points out, the diaspora remittances can make up for lost revenues. There is also a back side to this story, which are the broken families living apart...
If I were king for a day: for every Healthcare worker enticed into a developed market, also admit a student for the same role on a student visa only (or find another way to promote return.)
Charles, we need to catch up! Well said.
Mostafa Hunter
2mo
Well said Charles You have to come on board with us on our newly launched Health Workforce Governance Africa initiative with Amref.
Global Sector Specialist - Health. IFC
2moReport
Report
Thanks for all the comments. A very complex topic and no easy answers. What is very clear is we are facing a major global crisis and most countries are opting for quick fix solutions (to keep the politicians happy?) without addressing the underlying problems.