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A new study reveals that more African doctors and nurses are working abroad than at home, which it says is contributing to the worsening shortage of health care professionals in Africa. From London, Tendai Maphosa has more in this report for VOA. 
 

Patients fall asleep in the long line of Tintswalo Hospital in South Africa, waiting for the doctor to attend them, 26 Aug. 2007 (file photo)

The new study says some 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in developed countries by the year 2000. It says this represents about one in five African-born physicians and about one-tenth of African-born professional nurses.  According to the British government, more than 17,000 doctors and nurses from Africa were recruited in 2007 to work in Britain.  

Co-author of the report, Gunilla Pettersson of Sussex University in the UK, tells VOA that the brain drain is cause for concern.

“The health situation in Africa is dire, so we are very interested in the impact of these emigration flows,” she said.

Pettersson says working conditions for African medical professionals must be improved to encourage them to remain in their own countries.

Analysts have long stressed an obvious link between economic and political instability and a brain drain.

The new health care study cites several examples of countries beset by civil war in the 1990s such as Angola, Congo-Brazzaville, Guinea-Bissau, Liberia, Mozambique, Rwanda, and Sierra Leone.  It says those countries lost more than 40 percent of their physicians by 2000. The report says Kenya, Tanzania, and Zimbabwe, which went through decades of economic stagnation, lost more than half of their physicians.
 
The United States and the UK are among the top destinations for African health professionals.

Britain’s National Health Service has a policy against directly recruiting medical personnel from sub-Saharan Africa, but it does accept African health professionals through recruitment agencies.

Abi Smith, a spokesperson for the British Medical Association, says her organization is concerned about the medical brain drain in Africa.  She says the association is encouraging African governments to improve training, working conditions and salaries for medical professionals in order to get them to stay at home.  But, she says there is also a human rights issue, the right of individuals to move about as they wish.

“People do have human rights to move, and I wouldn’t like to see any policy infringe that,” she noted.

Mason Ford, a spokesman for the international humanitarian group Medecins Sans Frontieres (Doctors Without Borders), says donor governments are throwing hundreds of millions of dollars a year at HIV care in Africa.  But he says developed countries and international donors can also do more to make it more attractive for medical professionals to stay in Africa. 

“Next to nothing goes into improving the working conditions of healthcare staff,” he said.  ” Donors have been very, very reluctant to pay salaries of health workers or pay for training through medical college.  These measures really, really ought to be funded by the international community as well.”

Ford says such assistance would provide long-term benefits for Africa by helping to stem the brain drain.

Experts compiling the new health care study acknowledge that the brain drain is not the only problem facing health care in Africa. 

“For example, in South Africa two thirds of the physicians serve only about one-fifth of the population in the private sector,” said report co-author, Gunilla Pettersson.  “Another example in Mozambique, 70 percent of the physicians live in the capital Maputo so they are thousands of miles away from the most remote parts of the country where health conditions are worse.”

The study, titled “New Data on African Health Professionals Abroad,” was published by the online journal Human Resources for Health.

On a recent trip to Zambia, a vacation, I had many chances to see the health care system at work.   As a country with universal health care, deeply affected by HIV/AIDS, and limited resources to expand its health care workforce, there are both opportunities and challenges within its current system.   

Zambia offers health care to all of its residents. Given that so many people live in poverty (about 70%), it is the only way most residents can receive care.   Indeed, even though the country it is stuck by the massive HIV/AIDS epidemic, the government is committed to ensuring that all HIV+ individuals have access to ARVs and other medicines that help treat the symptoms of HIV, help the infected live productive lives, and prevent the spread of disease.  I met many people who lived on less than one dollar per day, but had access to the medicines need to maintain a healthy lifestyle with HIV.   There are still many people in need, but the country is making progress in getting medicines to its countrymen.

At the same time, there is an utter dearth of health care workers, making it hard for individuals to receive quality treatment or the preventive education that they need.  Because many individuals cannot afford the time and money that it takes to go through schooling to become a health professional, there is a major shortage of physicians and right now many of the nursing staff only have a limited range of schooling.   The ones that do receive training are many times wooed to other countries, where there are nursing shortages.  In one visit to the hospital, there was not a doctor to be found and the nursing staff could not speak the local language of the patients, making effective communication and treatment very difficult.  

This experience really reinforced why we should be investing in more training of health workers across sub-Saharan Africa and in other areas of the world where the workforce has been reduced.  Until we do so, U.S. funding and dollars will only have limited impact on how each nation’s is able to ensure that their countrymen can take advantage of universals health care systems and ensure that each resident has the opportunity to achieve their personal best health status.

(photo courtesy of the Treatment Action Campaign)

World AIDS Day was yesterday, Saturday December 1st, 2007. Much thanks to the hundreds of organizations and the thousands of people who work day in and day out to garner funds, break down stereotypes, treat medically, and help prevent the spread of HIV/AIDS around the world. And thoughts and empathy to the many many people living with HIV/AIDS.

Susan McCallister at the Hesperian Foundation talks about leadership and responsibility in the movement:

Closer to the ground, we can see what real leadership on HIV and AIDS looks like:

• The people living with HIV who publicly disclose their status, especially those who were earliest to disclose in their communities, where they risked their lives to do so.
• The thousands of health workers and community organizers who have dedicated themselves to providing care for communities overwhelmed with HIV, and have strategized brilliantly to mobilize and manage scarce resources to have the greatest impact.
• The children who, having lost parents, step capably and uncomplaining into the role of raising younger children in their care.
• The determination and rage of groups like Act Up, which have forced the development and greater accessibility of ARV medicines.
• The solidarity represented by organizations like Partners In Health and Medecins Sans Frontieres, committed to providing first world health care and pharmaceuticals to poor communities around the world.

This is leadership in action.

Those agencies and individuals in control of the world’s vast streams of wealth, whose small spigots are so inadequately turned on over the giant basins of HIV need, may wear the mantle of world “leadership,” but many don’t deserve it. If the elite and powerful had anywhere near the courage, dedication, intelligence, and passion of the people directly confronting HIV in the world today, things would be different. We could restore health care systems, relieve poverty, extend public water and sanitation projects, improve nutrition, and widely distribute affordable second-line medicines. We could also generate hope, little nurtured by the timid and bureaucratic half-measures deemed realistic by the “leaders.”

If the AIDS Day slogan “Take the Lead” is to have any real meaning, we have to find ways to empower and recognize leaders who treat health as if people matter — especially people with HIV.

The National Physicians Alliance has teamed up with other organizations to work specifically on the crisis of the Health Care Workforce globally (see our work on this issue here)

A few of the other hundreds of organizations doing amazing work around the globe:

* ’08 Stop AIDS
* Medicines Sans Frontiers (Doctors without Borders)
* HealthGAP
* American Medical Student Association
* Partners in Health
* Treatment Action Campaign (South Africa)
* CHAMP: Community HIV/AIDS Mobilization Project
* Physicians for Human Rights
* CoCoSi (El Salvador) click on english version of the site

(add other inspiring organizations in the comments section, or contribute your thoughts on the NPA’s work on the healthcare worker shortage around the globe)

From Drug companies attacked over gifts for Third World doctors:

Multinational drug companies are showering doctors in the developing world with gifts and inducements to persuade them to prescribe drugs of dubious value, an investigation has revealed.

Intense marketing of medicines has resulted in up to half of drugs being wrongly prescribed, the campaign group Consumers International says in its report “Drugs, Doctors and Dinners”. It calls for a ban on gifts to doctors. [...]

In Pakistan, doctors who wrote 200 prescriptions for one high-price drug were offered the down payment on a new car.

Multinational companies are turning to the developing world as profits stagnate in the West. But regulation in these countries is weak and drug sales representatives can influence prescribing by the inducements they offer [...]

Richard Lloyd, of Consumers International, said: “The pharma industry sees the developing world as a trillion-dollar opportunity… but consumer health expenditure in these countries can ill afford to be squandered.” He added: “The best way to ensure patients in the developing world get rational impartial treatment is… to ban gifts for doctors.”

Check out the full report “Drugs, Doctors and Dinners” (PDF, 1.49mb, 44pages) published by Consumers International.

Past AMSA President, recent medical school graduate and new NPA member Leana Wen is traveling in Africa this week with Nicholas Kristof of the New York Times. She was selected to provide a perspective on the healthcare system in Rwanda and Uganda. During the trip, she is posting her thoughts and ideas on a blog, Two for the Road.
Today’s blog is about Rwandan refugees and the challenges they face obtaining health care, but the hope of the Millennium Villages Project. Tomorrow, she’ll be talking with Dr. Paul Farmer, who gave the keynote address at NPA’s annual meeting last March.

I’d love for this blog to serve as a repository for our anecdotes about the health workforce crisis. In our travels abroad (either working, volunteering or just vacationing) many of us come across the barriers created by weak health systems and inadequate numbers of health workers in developing countries. By collecting these stories, we can convert them into action by bringing them to decision makers in Congress and elsewhere. And this is on top of the obviously interesting discussion our stories can generate!

Most recently, I was in Botswana at Princess Marina Hospital in Gaborone. Although Botswana is one of the wealthiest nation in sub Saharan Africa (by some indicators, it’s the wealthiest), it until recently did not have a medical school or residency program. In fact, Botswana has actually been a country that has created some intra-Africa brain drain as it drew physicians and nurses from neighboring Zimbabwe. At the Princess Marina Hospital as of a few months ago, there was only one attending in internal medicine who was actually from Botswana! And when I spoke with the interns (although they didn’t have a residency program, they did have one year of internship), they all stated that because of the fact that they had to go abroad for the rest of their residency, most predicted that they might stay in the country where they would complete their residency (ie U.S., U.K., Australia).

Fortunately, in January a formal internal medicine residency program was started at Princess Marina Hospital. Residencies in Peds, Surgery and OB/GYN are also being planned. The current internal medicine program is a joint program between U Penn and the Botswana ministry of health. It will be interesting to watch how this joint program develops and to see if it increases the supply and quality of physicians not only to Botswana, but to the rest of the region. This is particularly crucial as Zimbabwe which formerly provided quality training for physicians and nurses in the region is now not able to because of their horrible political/economic situation.