The exodus to the global north that leaves Africa without health workers

by Amref Health Africa

Nairobi, Oct 6 (EFE) – Long lines at hospitals or endless working hours are some of the consequences of the shortage in Africa of health workers, who are increasingly seeking new opportunities in the global north in an aggravated trend due to COVID-19.

Workers “are the backbone of every health system and, yet, 55 countries with some of the most fragile systems (…) in the world do not have enough”, and many are losing them “due to international migration,” he warned, last March, the director general of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus.

Of those 55 countries identified by the WHO, because they have a density of doctors, nurses and midwives lower than the global average of 49 per 10,000 inhabitants, 37 are in Africa.

In fact, according to the African Union (AU), despite suffering 25% of the global disease burden, the continent has only 3% of health workers.

A paradox

There are many reasons behind this historic shortage, from the lack of infrastructure to rapid population growth, all framed by per capita health spending in sub-Saharan countries that is still very low, an average of $128 compared to more than $4,000 in the members of the Organization for Economic Cooperation and Development (OECD), in 2019.

The problem, furthermore, is not only educating health professionals but also being able to hire them.

“We see a paradox in which, on the one hand, we have a shortage of health workers but, on the other, we have trained workers who cannot find suitable jobs because there is no budget space to hire them,” warns James Avoka Asamani, economist leading the team on WHO Africa Health Workforce.

According to Asamani, one in three educated health professionals in Africa cannot find a job within the first year after graduation.

And those who do, face poor conditions, with low salaries and lack of tools, something that contrasts with the opportunities and infrastructure in countries such as the United States, the United Kingdom, Canada or Australia.

The impact can be seen in the data: between 2005 and 2015, for example, the number of international medical graduates in the US trained in Africa increased by 27%, as if an African student migrated to that country every day for a decade.

The perfect Storm

As if this were not enough, in recent years a factor that was as unexpected as it was decisive emerged: the COVID-19 pandemic, which left rich countries with a growing gap between the supply and demand of health personnel, the perfect storm.

“International hiring offers two benefits to employers: it is faster, instead of training a nurse or doctor for three or ten years, you hire someone who is already qualified, and it is also cheaper, because you do not pay for their training,” James Buchan, an analyst at the Health Foundation, a British organization that investigates and advises institutions, explains to EFE.

Thus, Africa not only loses the talent of its workers, but also the money it invested in their training. According to a 2011 study, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe lost about $2 billion a year due to this phenomenon.

To mitigate this constant leakage, the WHO published a voluntary code of conduct in 2010 that advises against “active” recruitment in vulnerable countries. But, although it was adopted by its 193 Member States, which have taken some steps in that direction, the numbers continue to grow.

According to Buchan, rich countries “argue that this is not active recruitment”, a “swampy” concept, but rather “individual nurses and doctors applying or, in some cases, it is done through bilateral agreements”.

The truth is that, since the beginning of the pandemic, these governments have implemented a long list of mechanisms, such as accelerating the recognition of qualifications or simplifying the bureaucracy for migrating.

Ban or regulate?

Faced with this crossroads, African countries are opting for different solutions: from a controversial bill in Nigeria to prohibit doctors from leaving the country during the first five years after graduating, to a bilateral agreement between Kenya and the United Kingdom for the hiring of nurses.

Although no solution works for everyone, experts advocate respecting the free movement of workers but promoting orderly migration, which allows for increasing the continent’s income through remittances or agreements between governments.

“We want Africa to produce for the world, so we must improve training capacity with investments,” George Kimathi, a specialist at the NGO Amref, tells EFE, although he admits that this does not solve the underlying problems of African health systems, suffocated by insufficient budgets.

“We have to do much more to retain our workers and serve our populations,” he concludes.

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