THERE is a universal shortage of 4.3 million healthcare workers, but the crisis is most severe in Africa, according to the World Health Organisation’s (WHO) World Health Report 2006, launched on Friday.
The shortfall occurs worldwide, but is ‘most severe in sub-Saharan Africa, which has 11 per cent of the world’s population and 24 per cent of the global burden of disease, but only three per cent of the world’s health workers’, the report noted.
‘Not enough health workers are being trained or recruited where they are most needed, and increasing numbers are joining a brain drain – migrating to better-paid jobs in richer countries,’ WHO Assistant Director-General Dr Timothy Evans said at the launch of the report.
Attracted by better pay and working conditions, ‘one in four doctors and one in 20 nurses in seven surveyed developed countries were trained in Africa’, Barbara Stilwell, coordinator of the Human Resources for Health Department at WHO, reported.
‘English-speaking countries, such as the USA, UK, Canada and Australia, have the lion’s share of healthcare workers from Africa.’
Danielle Grondin, director of the Migration Health Department of the International Organisation for Migration, said stemming the exodus of healthcare workers raised complex ethical and financial questions.
‘This is a very difficult issue. Stopping migration is impossible: we live in a globalised world and freedom of movement is a basic human right, also for healthcare workers.’
It was difficult to reconcile the extremes of ‘poaching practices by rich countries’, where professionals were aggressively recruited from poorer countries, and ‘respecting the fundamental human right’ and choice of the individual to pursue a better way of life, she pointed out.
‘There are recruiting agencies that are very unethical – we have seen cases where recruiters go into an African country and recruit 100 percent of a graduating class,’ Grondin said. ‘But the majority want to leave on their own accord.’
According to Stilwell, a number of factors were driving healthcare workers abroad: ‘pay is very important – in many African countries payments are bad and often late’.
But it wasn’t simply about fatter pay cheques. ‘It is time to move away from that stereotype; sometimes, what makes people want to leave is the freedom to do their work,’ Grondin remarked.
Stilwell added: ‘Working conditions, such as safety and level of violence, are also important – one South African nurse said she was afraid because patients would come in with guns and demand treatment.’
Migration was usually a response to uneven development at a global level. ‘’Push factors’, such as poor working conditions and low wages, reflected the migrants’ desire to leave, whereas enticing alternatives in destination countries acted as ‘pull factors’.
Governance issues were key in the source country as well as the destination country, Grondin said. Also important were ‘the ability to properly take care of patients requires proper facilities, proper hospitals, opportunities to further education and upgrade skills, and even education opportunities for their children’.
A recent WHO survey in six sub-Saharan African countries (Cameroon, Ghana, Senegal, South Africa, Uganda and Zimbabwe) revealed that the main reason for healthcare migration, ahead of ‘conflict and social unrest’, was ‘further professional training’.
Retention was an issue that both destination and source countries should deal with. Source countries ‘should look at their own governance situation and try to improve it’, Grondin remarked.
According to Stilwell there was a ‘lack of investment in public health sectors and despite the need for them there are not enough jobs to absorb the amount of healthcare workers’.
‘African countries, especially South Africa, have become particularly concerned over the ‘perverse subsidy’, Stilwell commented, referring to the return on investment lost when the government paid for medical education but students left for better paying jobs abroad as soon as they graduated.
‘They end up unwillingly providing the wealthy countries to which their health personnel have migrated with a kind of perverse subsidy,’ the report noted.
According to Grondin, ‘South African medical schools report that a third to a half of their graduates emigrate to the developed world every year.’
Stilwell said international codes of practice for responsible recruitment have become essential. Grondin agreed: ‘The key is ethical recruitment. Recruitment should not be done through the migrants themselves but through institutions, so that there is more control (and) better planning.’
‘South Africa is a good example,’ she said. ‘The country has drawn up a bilateral trade agreement with the UK . . . provisions that, among others, make return to South Africa easier, and this seems to be working.’
The figures tell it all. In South Africa, 37 per cent of the country’s doctors and seven per cent of its nurses have migrated to Australia, Canada, Finland, France, Germany, Portugal, Britain and the United States.
In Zimbabwe, 11 per cent of doctors and 34 per cent 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 in the Zambian capital, Lusaka.
The crisis of African health care, and the robbery of its health resources by the advanced capitalist states makes it crystal clear that there is no solution to this crisis under capitalism and imperialism.
On the one hand crocodile tears are wept copiously for the suffering people of Africa, while on the other hand the robbery of its health resources is accelerating.
The only answer to this capitalist crisis is the socialist revolution, not just in the developing states but also in the advanced capitalist countries, that can ‘no longer afford’ to train home produced doctors, nurses and medical scientists, but act like a plague of locusts on the health ‘services’ of Africa.
Revolution is the only answer.
Cuba, in a former life a paradise for the mafia, with millions of impoverished people, saw an anti-imperialist revolution in the late 50s and 60s of the last century, which transformed health care, and turned the country into a leader in many fields of medicine.
Cuba now produces ‘too many’ doctors, many of whom volunteer to work in less fortunate states, where imperialism still dominates.
It is revolution and the world socialist revolution in particular that will resolve Africa’s health crisis.
