Medical migration

Worldwide, an estimated 4.3 million doctors are needed, according to the WHO.

Dr Kassahun Desalegn serves as department head and assistant professor of dermatovenereology at the University of Gondar, College of Medicine and Health Sciences, in northern Ethiopia. He explains “I practice in a university hospital where I am the only dermatologist for 6 million people. Ethiopia as a whole has a population of 80 million, but only one doctor for every 40,000 people. The United States, where many African health workers end up practicing, has one doctor for every 500 people...Where are all the doctors? When I started practicing medicine in 2004, there were 200 newly graduated doctors all over the country. Only a third of them are now in practice. A third work in international organisations in the country and a third have moved to practice abroad...This shortage of doctors and other health professionals has led many people to turn to alternative medicine as a treatment option. As a result, 80 percent of Ethiopians prefer traditional healing, which can often be harmful when used as the only treatment. Most of my patients have used spiritual healing such as drinking holy water, for diseases they believe to be caused by evil spirits, or applied traditional herbs before coming to me.”

Nearly 30 percent of African doctors leave to work abroad after graduation. Dr Lee Jong-Wook, the past director general of the World Health Organization (WHO), has said that brain drain from Africa is severely hobbling the continent’s fight against HIV/AIDS. Africa loses billions of dollars and countless lives because of doctor migration. Poor countries have attempted to tackle this problem through task-shifting - training middle- and lower-level healthcare providers to do higher-level tasks - developed nations insist on high-skilled and specialised care, which continues and accelerates the medical brain drain from developing to developed countries. Destination countries should  avoid recruiting doctors from countries with critical health manpower shortage. In May 2010, the WHO developed the Global Code of Practice on the International Recruitment of Health Personnel to mitigate damage to low-income countries struggling to meet the basic health needs of their populations. Unfortunately, its implementation, both by developed and developing countries, has faced enormous challenges. Only Norway has formally adopted this code.

“African governments should provide much better compensation for doctors. Improved wages, pension, housing, tax benefits, childcare, and medical insurance will bring immediate and dramatic results. My colleagues earn monthly wages ranging from $150 in Ethiopia to $2,000 in Botswana, though many employers can pay more. The same doctor can earn up to 50 times more in a Western country...

African health worker gap catastrophic

Socialist Banner has previously reported upon the African brain drain and especially in the health service sector ( here and here ) . Freedom Press have produced an article which is worthy of a re-post .

Rob Ray looks at claims that a brain drain to West is crippling healthcare across the African continent, for Freedom Press

It has been revealed that the global shortfall in healthcare professionals has reached four million people – with one million needed in Africa alone. The figures were voiced at the Global Forum on Human Resources for Health, which opened in the Ugandan capital of Kampala on March 3rd.
Poor working conditions in Africa, along with heavy incentives from the West, are drawing a heavy proportion of newly-trained health professionals out of the continent. Some 57 countries, especially in Africa and Asia, are particularly affected and unable to effectively provide health services for the population, which also hampers prevention and information campaigns, drug distribution and other life-saving interventions.

Africa has been particularly badly hit as measures from wealthy countries to encourage skilled workers to emigrate have stripped African countries, particularly in sub-saharan regions, of up to 75% of their physicians (Mozambique) and up to 82% of nurses.

"They seek better employment and quality of life. Income is an important motivation for migration [as well as] better working conditions, career opportunities and more job satisfaction," Sigrun Mogedal, one of the conference organisers, said.

Across the continent, Africa has 11% of the world population and 24% of the global burden of disease, but only 3% of the world’s health workers. Nine countries, including Britain, the US, France, South Africa, Belgium, Spain, Canada, Australia and Portugal, received the vast majority of all migration from Africa – 92.4%, amounting to over 65,000 people in the year 2000 (the most recent figures available).

Britain has been particularly active in Kenya, recruiting the vast majority of the 51% of healthcare workers which have left the country, leaving many of those injured in recent fighting around the elections unable to find medical help.

At the conference, Ugandan health minister Stephen Malinga said that wealthier African countries, particularly South Africa, had been poaching healthcare workers as their own emigrate – around 5% of South African health professionals leave the country. The effect created is of a feeder chain, with the wealthiest countries buying in doctors and nurses from African countries, wealthier African countries copying the tactic to draw people away from weaker neighbours, and the poorest and most vulnerable populations left with the least protection.

Uganda is facing an acute shortage as there is only one doctor for every 15,000 patients, far below the recommended 1.5 per 10 patients. Last October, the Ugandan Ministry of Health reported a staggering shortfall of 2,290 nurses out of the required 5,568 in government funded hospitals alone.

While money is often sent back to the country by healthcare workers abroad, the absence of proper healthcare is contributing to a catastrophic fatality rate. The Global Health Workforce Alliance said one in four doctors trained in Africa was working in western industrialised countries.

The Draining of Health- workers

Socialist Banner has directed attention to the export of people and their skills and talents from African countries before ( here and here ) and yet another report on the problem has come to our attention that highlights the problem of the brain drain .

Poor working conditions and inadequate pay have driven away health professionals from developing countries, thereby undermining medical services, a conference to address the global shortage has noted. The deficit, the conference heard, had reached four million doctors, nurses, midwives and other healthcare professionals. Of these, one million are needed in Africa alone .

Some 57 countries, especially in Africa and Asia, are particularly affected and unable to effectively provide access to essential health services, prevention and information campaigns, drug distribution and other life-saving interventions such as immunisation, maternity care and treatment of several diseases. While Sub-Saharan Africa has 11 percent of the world population and 24 percent of the global burden of disease, it has only 3 percent of the world’s health workers. In Africa, 36 countries have fewer than 2.3 doctors, nurses and midwives per 1,000 people, mainly because of “brain drain” of trained personnel to developed countries. Only two countries have fulfilled a 2001 pledge by African countries to commit 15% of their national budgets to funding the health sector to meet the Millennium Development Goals. None of the East African countries have met that pledge. Uganda contributes 9.6%, while Kenya and Tanzania contribute only slightly more.

Uganda’s health minister, Stephen Malinga, said his country had lost more than 500 doctors and thousands of nurses, of whom 200 were working in South Africa. "Our neighbours have also taken them ... they are paid in dollars in Sudan and others with indispensable expertise have gone to Rwanda," he said. Those who opt to stay in Uganda, Malinga explained, were earning so little they could often not afford to pay the rent. Uganda thus had one doctor for 100,000 patients. [ An EU official said "The corruption index in Uganda, especially in the health sector, is still very high. I think health comes second after the Police in corruption.”]

Global Health Workforce Alliance said one in four doctors trained in Africa was working in western industrialised countries.

"They seek better employment and quality of life. Income is an important motivation for migration as well as better working conditions, career opportunities and more job satisfaction," Sigrun Mogedal, one of the conference organisers said.

The conference held out its begging bowl to solve the problem with the usual plea for funds - a 10-year global action plan to deal with the problem, which would require US$3.3 billion per year to train 1.8 million health workers in Africa for the next eight years. Another $27 billion would be required to pay them to stay. Needless to say , no solution , at all .

Not so healthy Africa

Poverty and war are harming advances in infant mortality, particularly in sub-Saharan Africa, a new Unicef report on global child health has said. Sub-Saharan Africa is home to 28 of the 30 countries with the highest mortality rates.

Sierra Leone was the worst performer, with 270 deaths before the age of five per 1,000 live births, in 2006 figures. In Sierra Leone one in four children will die before their fifth birthday. In Sweden it is one in 350. In Sierra Leone one in eight mothers will die in childbirth. In Sweden 0ne in 17,400 mothers die in childbirth and one in 8,200 in the UK. Sweden has one of the best staffed health services in the world. It has 320 doctors per 100,000 people compared to two doctors per 100,000 people in Sierra Leone.

In Sub-Saharan Africa the annual average rate of reduction in the child mortality rate between 1990 and 2006 was only 1% per year - meaning the rate will have to increase to 10.5% per year between 2007 and 2015 if the region is to meet the fourth MDG.

26,000 infants under five die every day around the world. They mostly die from preventable causes such as diarrhoea, malaria, malnutrition, mother-to-child transmission of HIV, unsafe water, poor hygiene and neonatal problems.
The solutions to child deaths are well-known, says the report - "simple, reliable and affordable interventions with the potential to save two-thirds of the children currently at risk are readily available". Such interventions that have already been shown to be effective include promoting breast-feeding, immunisation, vitamin A supplementation and the use of mosquito nets.

BOTTOM FIVE COUNTRIES/ DEATHS PER 1,000 LIVE BIRTHS
Sierra Leone: 270
Angola: 260
Afghanistan: 257
Niger: 253
Liberia: 235

A Remarkable Doctor

Samuel Kargbo stayed in Sierra Leone throughout the horrendous civil war. He brought basic health services and vaccines to children who lived in the rebel areas. He had to negotiate his way across checkpoints and his life was frequently at risk. Now he is one of just two doctors in a region of nearly 300,000 people. Having trained in Russia, Germany and the UK, Dr Kargbo could easily get a job overseas. But he refuses to leave.
"A lot of doctors who qualify in Freetown, go abroad", he said. "Some forget that the greatest need is here".
He earns around $200 - £100 - a month.

UNICEF Goodwill Ambassador , the England international football player , David Beckham said: “We can’t turn a blind eye to the tens of thousands of young children who die every day in the developing world mostly from causes that are preventable...Saving these children’s lives is a top priority for UNICEF and as an Ambassador I hope I can help to draw attention to this issue across the world.”

Socialist Banner , however , knows it takes more than well-meaning words from a millionaire sports star to change things . It is socialist revolution , not press releases , that will change how people will live or die .

Health Brain Drain

Many African countries now have more doctors and nurses working in richer countries abroad than they have at home . The study, carried out by the Center for Global Development in Washington, looked at census records collected between 1999 and 2001. It examined nine receiving countries: The UK, the US, France, Canada, Australia, Portugal, Spain, Belgium and South Africa.

Several countries, including Mozambique and Angola, have more doctors in one single foreign country than at home. And for every doctor in Liberia, there are two working abroad.

The loss of doctors often went hand-in-hand with civil strife, political instability and economic stagnation. Angola, Republic of Congo, Guinea-Bissau, Liberia, Mozambique, Rwanda and Sierra Leone all experienced civil war in the 1990s and all had lost 40% of their doctors by 2000.
Countries such as Kenya which experienced economic stagnation in the late 20th Century and Zimbabwe, which saw political repression as well as economic problems, saw more than half of their doctors leave.

At the same time countries with greater stability and prosperity, such as Botswana managed to keep many of their doctors .

But so did very poor countries such as Niger .The researchers speculated this could be to do with destitute countries not producing large numbers of would-be doctors with the financial capital or connections to leave.

UK Home Office figures show that 17,620 African doctors and nurses joined the NHS last year.

The charity ActionAid said the brain drain was "a huge threat" to Africa.

"One of the best way to keep healthcare professionals in the countries that need them is to pay them properly - but currently health systems in many African countries are woefully underfunded," said Nick Corby, policy officer at the charity.

NUMBER OF DOCTORS ABROAD
Mozambique - 75%
Angola - 70%
Ghana - 56%
Kenya - 51%
Rwanda - 43%
Sudan - 13%
Niger - 9%

The African Brain Drain , Slavery and Racism

Senegalese President Abdoulaye Wade said he was not interested in students from his country receiving scholarships "only to have them fly off to France."

The violence, corruption and generalised poverty marring more than three decades of independence in Portugal's five former colonies in Africa have been the main obstacles for development in these countries, but not the only ones.

Brain drain is another phantom that is slowly but inexorably destroying hopes for progress and wellbeing for the people of Guinea-Bissau, which became independent in 1974, Angola, Cape Verde, Mozambique and Sao Tomé and Príncipe, which became independent in 1975 .

Skilled and academically qualified people from African countries where Portuguese is an official language often give up their status in their unstable home countries to build a new life in peaceful Portugal, even if it means sacrificing their former careers and having to take up a hastily learned, lower skilled job.

Brain drain does not only affect the former Portuguese colonies, but is a problem throughout the developing South. The editor of the monthly magazine Africa 21, Joao Matos, describes it as "planetary apartheid."

"Nicolas Sarkozy...asked on a recent visit to Senegal if it could be considered normal that there are more doctors from Benin in France than in Benin itself."Africa needs its élites, because if they all end up in France one day, who will concern themselves with the development of Senegal?"" said the Angolan writer who lives in Lisbon. But according to Matos, the French president's statements were "of doubtful sincerity." He said he does not believe that "Sarkozy would make do without the doctors from Benin who are working in France: what he really doesn't want are poor and indigent migrants, mostly from Africa."

The shaky economies of most African countries "are largely a consequence of the plundering of the continent's resources by the West, which continues to this day. It began with its most valuable resource, people, millions of whom were taken by force to far-off lands, which they helped to develop with their slave labour," Matos said.

In a article published by Angolan professor Jonuel Gonçalves, who lives in Rio de Janeiro, in the latest issue of Africa 21, entitled "Negroes and Mestizos in Latin America Today Gonçalves points out that Latin America "is the region of the world with the highest degree of 'mestizaje' (mixed ancestry), from both the biological and cultural points of view, because it was the destination of the greatest flow of slaves in history, and the way in which slavery was abolished left deep marks that still endure."

"There was no consistent programme in Latin America to help former slaves integrate into society, which condemned them to poverty and illiteracy that have lasted, to a greater or lesser degree, through the successive generations," Gonçalves says.

One of the characteristics of Latin American social structures that demonstrate this "is the extremely low representation of descendants of slaves, blacks or mestizos in decision-making," the article says. "Brazil is one of the most striking examples, in spite of having the second largest population in the world of blacks and Afro-descendants, who make up at least 45 percent of its population of 188 million. It is surpassed only by Nigeria," with 131 million people, Gonçalves says. "Cuba, for three centuries another major destination for the slave trade, has similar characteristics," because, in spite of the 1959 revolution and the country's socialist system of government, "the number of black people in the governing bodies remains very small,"

Matos acknowledges that Africans themselves are not entirely free from blame because since independence they have not managed to turn their countries into "good places to live, beginning with our own citizens, especially the young.".

Former secretary-general of the United Nations Kofi Annan , of Ghana, spoke of the problems of destructive self-racism and of "our tolerance" of African tyrants.

Angolan intellectual Arlindo Barbeitos frequently deplored the tendency for Africa to reproduce "the same ideas and models imposed by the colonial powers, such as racism, but in reverse."