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WORLD HEALTH DAY: Medical Brain Drain Puts Southern Africa in a Quandary

Moyiga Nduru

JOHANNESBURG, Apr 7 2006 (IPS) - The figures tell it all. In South Africa, 37 percent of the country’s doctors and seven percent of its nurses have migrated to Australia, Canada, Finland, France, Germany, Portugal, Britain and the United States.

The figures tell it all. In South Africa, 37 percent of the country’s doctors and seven percent of its nurses have migrated to Australia, Canada, Finland, France, Germany, Portugal, Britain and the United States.

In Zimbabwe, 11 percent of doctors and 34 percent of nurses have left in search of greener pastures.

These statistics, compiled by the Organisation for Economic Co-operation and Development (OECD) and the World Health Organisation (WHO), reflect the magnitude of the health worker “brain drain” in Southern Africa.

Across the region –- the worst-affected by AIDS – South Africa, Namibia, Botswana, Swaziland and Mauritius are the only countries that do not face a critical shortage of health workers. (The OECD is a Paris-based multilateral institution that, amongst other things, researches economic and social issues.)

World Health Day, Friday, is intended to draw attention to the lack of medics in Southern Africa, and elsewhere. Held under the theme ‘Working together for health’, it is also aimed at stimulating debate about how best to ensure adequate staffing levels of doctors, nurses and other health professionals.

”The situation is not going to get better in the short term. Perhaps it will get worse,” Tim Evans, WHO assistant director-general, said earlier this week in South Africa’s commercial hub of Johannesburg. He was speaking at the unveiling of the ‘World Health Report 2006 – Working Together for Health’; this document was made available in a number of cities ahead of World Health Day, when WHO Director-General Lee Tong-Wook is officially launching it the Zambian capital, Lusaka.

In part, the migration of health workers is attributed to poor remuneration.

According o the ‘World Health Report’, the Americas – with 10 percent of the global disease burden – have 37 percent of the world’s health workers, and account for more than 50 percent of health spending. Africa has 24 percent of the burden, but only three percent of health workers commanding less than one percent of world health expenditure.

Evans said the ageing populations of OECD states, which are in need of care, have also contributed to the demand in these nations for foreign health workers, mostly from developing countries.

According to the WHO, there are currently 57 countries with critical shortages of medical staff; this amounts to a global deficit of 2.4 million doctors, nurses and midwives.

”The proportional shortfalls are greatest in sub-Saharan Africa, although numerical deficits are very large in South-East Asia because of its population size,” notes the ‘World Health Report’.

“Africa…has 2.3 workers per 1,000 people. The Americas have 24.8 per 1,000 people. If you are a doctor in Africa, you have 10 fold (more) diseases to deal with compared to your colleagues in other regions,” observed Evans.

However, migration of medical professionals is not only taking place from Africa, but also within the continent.

In a draft report titled ‘A National Human Resources Plan for Health to provide skilled human resources for healthcare adequate to take care of all South Africans’, South Africa’s Department of Health notes that 20 percent of doctors on the South African Medical Register in 1999 were mostly from around Africa and Cuba.

“The existence of a policy not to recruit health professionals from fellow developing countries in the African continent has assisted the department in stemming the internal African brain drain to South Africa,” said the report.

A number of health professionals have expressed concerns about initiatives to re-allocate tasks normally performed by pharmacists to other health workers in South Africa, in a bid to provide care more effectively.

”This is inefficient, and in direct conflict with cabinet-approved policy as stated in the (1996) National Drug Policy…and affirmed in the (1997) White Paper on the Transformation of the Health System,” said Barbara Raftesath, president of the Pretoria-based South African Association of Hospital and Institutional Pharmacists, in documentation submitted to the Department of Health.

“The opportunity to make the best possible use of appropriately trained, deployed, and supervised mid-level workers exists and should not be ignored, either in planning or in current practice.”

IPS could not get comment from the department about these claims at the time of publishing this article.

The theme of World Health Day 2006 was initiated by African countries, notably South Africa and Ghana.

In addition, ”The report (‘World Health Report’) wouldn’t have emerged if African members didn’t introduce a resolution on the migration of health workers during the WHO meeting in 2004,” said Evans.