Impact of the Increased Migration of African Health Professionals

Migration of professionals especially from the health sector of developing countries in Africa has intensive effects on the health status of these nations. Even without the migration of health professionals to progressive countries like Canada and United Kingdom, developing countries like those in Sub-Saharan Africa already have inadequate numbers of medical professionals to attend to the health needs of the people.Hence, the continuous migration of health service providers to richer countries in Europe and America decreases the already low numbers of health professionals present in these third world countries.

The quality of health services provided by the governments in Africa is adversely affected by the decreased numbers of medical professionals that will give the services (Awases, 2004: 1-2). The problem of migration of health professionals occurs not only to countries outside the African Continent but rather also within the continent itself.Medical practitioners move from poorer countries to richer countries within the continent. The migration also takes place intra-country wherein the health professionals from the rural area move to urban areas (Labonte, 2006: 1-3). The public health systems that are mostly affected therefore are those of the rural areas and relatively poorer countries in Africa. Those citizens that are poor and can not afford the services of private healthcare providers thus relying on the public health system for their needs receive most of the negative impacts of health professional’s migration.

Statistics serve as the evidence of the adverse effects of the continuous migration of African trained healthcare professionals. The estimated number of health professionals that migrate to other countries outside Africa is 23000 individuals per year. In Zimbabwe, roughly 50 percent of the Registered Nurses (RNs) and 80 percent of the doctors already migrated (Zondagh: p. 5).

These migrations lead to the present ratio of medical doctors to the population in Sub-Saharan Africa of only lesser than 13 doctors per 100,000 members of the population.The present public health system status of these South African countries are contributing factors to the decreased life expectancy of their people, the increased percentage of children dying before their fifth birthday, and the non-resolution of the HIV/AIDS crisis (Labonte, 2006: 1). In Southern Africa specifically in Zambia, the ratio of the number of nurses to the population is 1 per 1000. Much worse is the situation in Uganda wherein the ratio is estimated to be 6 nurses per 100, 000 members of the population.These statistics is in contrast to that of the developing countries in which there is a ratio of 1 nurse to a 110 people. The unequal division of the number of nurses adds to the burden in the ratio of nurses to the members of the population.

The bulk of the nurses are located in urban areas thus the rural areas have a greater nurse to population ratio problem. In Tanzania for example, the urban areas have 160 nurses for every 100,000 people while in the rural areas 6 nurses are equivalent to 100, 000 people (Zondagh: p. 7-9).Among the African countries that are widely afflicted by the migration of health professional’s phenomenon is Ghana, a West African Republic. The healthcare system of this country as of 2002 has a shortage of doctors to 50 percent and nurses to 57 percent. The countries in which most of the doctors from Ghana migrated to are: USA; UK; South Africa; and Canada.

The Ghanaian nurses on the other hand mostly move to UK, USA, Canada, and South Africa (Labonte, 2006: 3-4). South Africa is also having an increasing problem of migrating healthcare professionals.In 2002, it is approximated that not lesser than 5,000 doctors transferred to other countries. Every month 300 nurses from the Republic of South Africa migrate abroad. In 2002 alone, more than 25 percent of the 90,000 South African registered nurses left their country in pursuit for greener pastures.

In 2005, the nurses that remained in South Africa wanted to migrate to countries like UK and Saudi Arabia which can give them bigger salaries (Labonte, 2006: 4). Another African country that is affected by this problem is Zambia in which there is staggering proportion of the health sector that transferred to developed countries.Almost half of the health professionals in the nursing, medical, and paramedical positions migrated to other countries in 2003. The positions they held in their native country were left unoccupied. In contrast to Ghana and South Africa wherein the migrating health professionals went to developed countries of other continent, some the Zambian health service providers that moved from their country went to more advanced nearby countries in the African continent like South Africa, Namibia, and Botswana.Increasing numbers of health workers of Zambia though are migrating to developed countries in Europe and North America (Labonte, 2006: 5).

The continuous migration encourages the remaining health professionals in Africa to do the same because they are burdened with greater workload as a result of the decreased numbers of the healthcare providers that can serve the African population. These professionals are also meagerly paid; with poor equipments that they can use; and with restricted career opportunities (Labonte, 2006: 1).The health system status in these countries can not sustain the needs of its health professionals so the migration is continuous. Their health systems are not only faced with human resources problems but with disease crisis as well which is a result of the later problem (Development Research Centre on Migration, 2005: 1). It is an established fact that the migration of the professionals in the health system is dramatically growing and causes the deterioration of the services offered by these systems.

The migration of Africa’s health professionals to other countries has a complex cause (Labonte, 2006: 1). Economic, cultural, political, social, and legal factors interact resulting to the migration of healthcare professionals (Stwart, 2007: 2). Various reasons are all rooted to the poverty that stricken these countries. The challenged monetary capacities of the third world countries can not afford to give the health professionals better salaries, state of the art medical equipments, and excellent career opportunities (Stwart, 2007: 3).

The identified specific causal factors of health professional migration to other countries are the following: income; job satisfaction; organizational environment or career opportunities; government; protection or risk factors; and, social security and benefits. The income factor is due to the big difference in the salaries offered in other countries for these healthcare providers than their own country. Job satisfaction factor is associated with the good professional working environment that the other countries have.Developed countries also have career opportunities and organizational environment that attracts professionals. Opportunities for the advancement of the health service profession is sustained in well developed countries hence this is also a factor that lead to the migration of health workers from third world countries in Africa. The government factor is associated to the level of administrative bureaucracy and the efficiency of government services that can be observed in developed countries like UK, USA, and Canada.

The protection or risk factor is another cause of the movement of healthcare professionals.Most of the countries in Africa expose their health professionals to diseases due to the lack of protective paraphernalia. The occupational risk for diseases like HIV/AIDS is also great in African countries thus health professionals tend to seek places wherein this occupational risks are non-existent. Lastly the social security and benefits factor entice the individuals working in the health industry to try the working life comforts as well as retirement benefits offered in developed countries (Dovlo, 2003: 5).

Professionals in a developing countries desire to uplift their way of life as well as their families.These upgrading of their economic and social status are mostly not sustained in developing countries thus migration occurs to developed countries that can provide better opportunities as well as much bigger salaries. The World Health Organization (WHO) discovered in their recent study that two-thirds of the health service providers they interviewed have the intention to migrate (Labonte, 2006: 1-2). This implies that the growing number of migrating professionals will continue if adequate intervention can not be instituted.The increasing number of studies done on the health professional’s migration phenomenon as well as the adverse effects felt by the third world countries of Africa in their health systems created an awareness about the problem.

The growing awareness created by various institutions which is pioneered by the World Health Organization resulted into the research and formulation of government plans and policies to resolve the increasing migration that is observed in African health professionals (Awases, 2004: 1-2).The adverse effects in public health system which is caused by the migration of health professionals can be counteracted through government policies that promote the retention of these professionals in their native countries despite the bigger opportunities abroad. A single policy alone though could not solve the problem. The solution of this problem is alteration in the economic status of these developing countries so as to promote their health industry and in turn encourage the medical professionals to stay and serve their fellow countrymen.Various strategies are utilized by African countries in order to cope up with the health system problems that are caused by the migration of health professionals to other countries.

Recruitment of medical professionals from other countries thru international arrangements is one of the coping up strategies employed. African countries like Botswana and South Africa recruits healthcare providers from countries within and outside their continent. Twenty-seven percent of the doctors in South Africa were hired from other countries in 1998.Inter-country arrangements of hiring doctors from nearby countries are instituted in poorer countries of Africa. Most of the doctors serving in the health system of sub-Saharan Africa are from Cuba (Dovlo, 2003: 6). Another coping up policy is the extension of the retirement ages of medical professionals beyond 60 years old so as to utilize the workforce for the health system of African countries even though they are already of retirement age in other countries.

Through this the working life of African health professionals are maximized to the benefit of their respective country’s health systems. Medical professionals in Ghana for example are allowed to work beyond 60 years old instead of requiring them to retire (Dovlo, 2003: 6). Incentives and motivation systems are promising coping up strategy for the retention of medical professionals in the African countries. The outmost reason why medical professionals venture to other countries is the increased rate of pay they will receive for their jobs.Thus, by increasing the salaries of these professionals the migration cases will be lessen.

Governments in African countries though can hardly institute this strategy because of the economic constraints that they countries are facing. The governments of these countries needs to first find budget allocations for the increase in the salary of there medical professionals. Outsourcing is the main factor for the efficiency of this strategy in order to retain the professionals without draining the funds of their governments.The institution of this salary increase and incentives is of some success in Uganda. The strategy needs to further develop so as to aide in the retention of medical professionals (Dovlo, 2003: 6).

Awarding training grants of medical professionals to other countries will help in decreasing the migration of healthcare providers. A study grant will require medical professionals to return and serve their native countries. By doing so the skills of these professionals are enhanced and at the same time the rate of migration is decreased.It must be ensured though that these professionals will really return to their countries. Incorporating bonds to the grants offered will ensure that these professionals that are given the chance to study abroad will return and serve their fellow country utilizing their newly developed skills and abilities (Ahmad, 2005: 44).

Improving the health system working condition is also a good policy to establish. Governments can re-channel their resources and make efforts to provide a good working environment to the medical practitioners (Ahmad, 2005: 44).The working environment can be made better through establishment of programs that will increase the number of infrastructures for health system, increase the benefits of the healthcare providers, increase the supply of medicines provided by the government, secure the safety of the medical practitioners during working hours as well as decreasing the risks of disease acquisition by providing proper protective paraphernalia, and provision for the education of their citizens to be part of the health system.If monetary constraints are the primary problem that deters the granting of incentives to health professionals then the African countries can try the less expensive incentives like: subsidized transport to their work, food expenses subsidy, better housing programs, and inexpensive education programs for family members or children of the health professional (Stwart, 2007: 5). Developing countries such as the African can countries can engage into bilateral agreements with the countries that are receiving healthcare professionals from their country.

In doing so these African countries can regulate the migration of the people and at the same time derive funds from the agreement which can be utilize to support the uplifting of their country’s health status. The countries that hire professionals from the African countries can pay significant fees for every individual that they hire (Ahmad, 2005: 44). The monetary resources of the developing country are increased through the process as well as the workforce need of the well developed countries can be satisfied.The migrating professionals can also be required to pay fees to their countries in the form of taxes for them share their income to the development of their countries health system. This policy if proper instituted will benefit all the parties without the adverse effects on the health system status of African countries.

The developing countries can also do some rechanneling of the funds derive from the bilateral agreement to educate and train individuals to be medical professionals that will replenish the decreased number of health workforce in their country due to migration.Policies that cater the involvement non-governmental organizations will also be of significant aide in solving the adverse effects of migration on the health systems of African countries. The Physicians for Human Rights (PHR) for example is a group of medical doctors that have an advocacy of helping Africa in finding solutions to the shortage of health workers. An example of the solutions supported by PHR is the sophisticated training program for health professionals in Uganda.

In PHR’s 15 Point Plan for G8 Countries to Stop Africa's Health Worker Shortage they enumerated various plans such as: offering intensive support to the health practitioners in the advocacy against HIV/AIDS; investing funds for the development and expansion of the health workforce in Africa; and support to community caregivers like providing appropriate training, compensation, and materials. The involvement of private organizations and NGO’s in instituting policies will be significant in reducing the migration and increasing the number of health practitioners in African countries (Krauss, 2006).Regulated recruitment in developing countries that are in front of health workforce shortage is also a proposed by organizations like Physicians for Human Rights (PHR) and International Council of Nurses. In 1995, the republic of South Africa released a mandate to prohibit the recruitment of doctors from the South African Development Community.

The said mandate is a good example of a successful policy that aides in the solution of shortage in health professionals in African countries (Hamilton, 2004). Finding solutions and instituting this to solve the crisis in the shortage of health workers in Africa is not an easy task.The governments of the countries in Africa need to employ drastic measures and long term- strategies. The recruitment of medical practitioners of the well developed countries must be done in cooperation with the developing countries wherein these professionals are natives of, so that the continuous decrease in medical workforce can be stopped (Mahlathi). But with the awareness that is created with various studies and researches an intensified an integrated action from various concerned institutions and organizations is established.

The shortage of health workers in Africa is not a hopeless case.