Africa will not achieve the health related millennium development Goals

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 Africa^{2, 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 26^th

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;

5^th year medical student at MUST