The medical brain
drain: An obstacle to the achievement of the millennium development goals in
Africa.
The health-related Millenium Development Goals
are arguably difficult targets for most African countries to attain 1.
The key obstacle is now recognised as the lack of a stable human resource base
in the health sector1. WHO recommends a minimum of 2 physicians per
10,000 population; 29 of the 46 sub-Saharan countries are below this level, and
an additional 7 are at the bare minimum; only 10 are above. Interestingly 4 of
the 5 North African countries are above the WHO minium2. It is
estimated that in order to meet the millennium development Goals in sub-Saharan
Africa by 2015 an additional one million health workers will be required3.
The already inadequate health system of Africa has been badly damaged by the
migration of health professionals4. They leave the severely crippled
health system in a region where the life expectancy is only 50 years, 16 per
cent of the children die before their fifth birth day and HIV/AIDS continues to
begeon5.
Africa faces a health
crisis occasioned by the number of important factors that have risen over the
past two decades most importantly being the HIV/AIDS epidemic , the emergency
of old communicable diseases like tuberculosis, malaria, cholera not to mention
the concurrent increase in the level of non communicable disorders (diabetes,
stroke, and hypertension)1. It is unfair that only 1.3 percent of
the world’s health workers care for people who experience 25 per cent of the
global burden of disease 2.
There is a considerable
amount of literature testifying to the fact that the migration of skilled
professionals from developing countries is large and increasing dramatically.
The world health organisation found that quarter to two third of the health
workers interviewed in a study expressed intention to migrate6. Developing
countries are hit hardest by the brain drain as they lose sometimes staggering
portions of their college educated workers to wealthy countries7. The
problem is that the rate of loss often out strips the production and production
itself is often inadequate to meet the countries’ needs2. In
recognition of the enormous challenge posed by the international migration of
health personnel to health systems in developed countries, the World Health
Organization has proclaimed 2005-2015 the decade on human resources for health
(HRH).8
The brain drain
has meant not only the exodus of human capital but financial resources as well,
as the African health care professionals left their countries with their
savings 5. The rate of loss of doctors, nurses and other health professions
by migration has exacerbated the severe shortage of health workers 2.
According to the World Health Organisation, this shortage has affected the basic
services such as immunisation, child birth and HIV care and treatment of
disease. The United Nations Conference on Trade and Development estimated that
each migrating African professional represents a loss of 184,000 dollars to Africa2.
Furthermore, the migration of health workers provides a substantial financial
benefit to the economy of developed countries the UK and Canada save about
200,000 pounds and 800,000 dollars respectively from every doctor that moved
from Africa2, 5.
Published literature on
the migration of health professionals document the push and pull factors which
include the lack of opportunity for post graduate training, under funding of health
services facilities, lack of established post career opportunities and poor remuneration
among other reasons. Although countries in Africa have attempted to mitigate
the problem created by the brain drain a lot of effort is needed to retain home
graduates and to train more health professions to solve the shortage of health
workers in Africa1. Addressing the challenges posed by the migration
of health profession requires the efforts of institutions, the governments of
both the country of origin and destination and efforts of international
organisations.
In conclusion, Africa’s
increasing exodus of human capital will leave it empty of brains in 25 years
warns Dr Lalla of the UN Economic
Commission for Africa EAC 4.The brain drain poses a threat to the
already collapsed health service delivery and is major risk to the lives of
Africa’s poor. African countries must take steps to recruit more health professional
otherwise Africa will not achieve the health-related MDGs by 2015.
References;
1) Adapted from the
report The State of the Health Workforce in
Sub-Saharan Africa:
Evidence
of Crisis and Analysis of Contributing Factors by Bernhard
Lieseabout
Available at http/www.state
of the health workforce in sub-Saharan Africa. 64
2) Ethnicity
& Disease, volume 19, spring 2009 available from www.ishib.org/journal/19-1s1/ethn-19-01s1-60.pdfle
last accessed on 22 April, 2013
3) L. Chen
et al., “Human Resources for Health: Overcoming the Crisis” The Lancet
364(9449).
4) Available at: http//www.idrc.ca › IDRC › Resources › Publications lasted accessed 26th
January
2013
5)
Reported in the presentation by Simi Arora of the IOM’s Office of the Director
of Health Human Resources at the 12th Canadian Conference on International
Health,
Ottawa,
Canada, 9 November 2005.
6) WHO, Report
by the Secretariat on the Recruitment of Health Workers from the Developing
World, WHO Document EB114/5, 19 April 2004, Para. 2. Also, see generally
D.A. Mc Donald and J. Crush (eds.), Destinations Unknown: Perspectives on
the Brain Drain in Southern Africa (Cape Town: Southern African Migration
Project, 2002).
7) See
Ozden and Schiff, International Migration, Remittances, and the Brain Drain.
Extracted
from the brain drain of health professional in sub-Saharan Africa. Available at:
http// www.queensu.ca/samp/sampresources/samppublications/.../MAD_2.p
8)
WHO, Human Resources for Development, 9 January 2006, Document EB117/36.
Available at: http://www.who.int/gb/ebwha/pdf_files/EB117/B117_36-en.pdf.
Written by Ivan Lumu;
5th
year medical student at MUST
