Southern Africa’s public health services are in a state of emergency. Bad pay and working conditions, plus the impact of HIV/Aids, are bleeding the system of its most valuable resource: people. With the cost of training a general practice doctor estimated to be $60 000, and that of training a medical auxiliary at $12 000, the African Union estimates that low income countries subsidise high income countries to the tune of $500-million a year through the loss of their health workers. The article touches on the experience in several eastern and southern African countries.
Members of the African Union struck a deal with wealthy members of the World Health Organisation to be compensated for the loss of their health care workers to richer countries, the Nairobi Daily Nation reports. The negotiations were held during the 57th World Health Assembly in Geneva May 17-22. "The African Union pushed the agenda of compensation as one voice and we will jointly negotiate the terms like the European Union does," said Gideon Konchella, Kenya's assistant minister for health.
According to a report in the UN's IRIN (Integrated Regional Information Network) humanitarian information unit, Capital Alliance, an insurance company, has produced South Africa's first insurance product that allows employers to take out insurance against the risk of their employees contracting HIV/AIDS.
How is the AIDS pandemic affecting growth and distribution in South Africa, and what are the economic impacts for workers likely to be? While the overall picture is murky, certain worrying trends and findings present themselves: If firms react by continuing to decrease their reliance on unskilled labour and by moving out of economic sectors whose customer-base comprises lower income consumers, then poor households will find themselves doubly disadvantaged, as their access to the labour market becomes ever more tenuous and the products that they purchase may become scarcer and more costly.
South Africa is suffering from a ‘brain drain’, or loss of its professionals – but how serious is the problem and what effect is it having on the homeland? This study attempts to assess the number of emigrants and the skills being lost, and asks whether the loss is permanent. Skills loss due to emigration has recently become a high-profile public policy issue in South Africa. A major, unresolved question is the actual scale of the problem and its impact. There has been growing suspicion that South Africa’s official emigration data, SSA, significantly underestimate the number of South Africans leaving the country to settle abroad. This report by the University of Cape Town attempts to assess the true extent of emigration by examining data from the recipient countries.
The United States (US), with its high salaries and technological innovation, is the world’s most powerful magnet for doctors, according to this article, attracting more every year than Britain, Canada and Australia combined. Some of the responsibility for the migration of health care workers lies with the immigration laws in the host countries. For example, in the US, some states may grant waivers to foreign doctors if they agree to practice in communities where doctors are in short supply. The author compares Zambia and the US, acknowledging that salaries and working conditions in a country like Zambia are never going to match those in the US, and considers some of the factors that influence a person’s decision to emigrate, such as family ties, the cost of living and home language. There are signs of change, as doctors from Ghana, who used to mass emigrate to the US, now prefer to stay home as salaries rose enough to weigh the scales in favour of staying. Although there are foreign-funded initiatives to train and recruit doctors, such as a project funded by the Global Fund to help Zambia recruit and retain doctors, these solutions can create further problems. For example, many of the doctors hired by aid agencies are doing research and don’t see patients so they don’t contribute to improving health services. Frustrated public health officials in Zambia and other developing countries call this the “internal brain drain”.
To mark International Day of the Midwife (5 May), AMREF is calling on African governments to accelerate implementation of Human Resources for Health (HRH) strategies to increase the number of midwives trained and upgraded in the country, to fast track the attainment of MDG 5 (maternal mortality) in all countries where targets have not been achieved and to adopt innovative mechanisms to support the training, recruitment, deployment and retention of midwives across rural and remote areas. Governments should ensure that midwives access to the UN Commission’s 13 lifesaving commodities for women and children, including long-term family planning methods and other commodities for reproductive health, for them to be able to provide appropriate quality health services. At the same time, AMREF recommends that development partners should adopt and support innovative mechanisms for training, recruitment, deployment and retention of midwives in Africa within the post MDG priority setting processes.
"The nations of the world are setting ambitious health and development goals, including the World Health Organization (WHO) target of providing AIDS treatment to 3 million people by 2005 and health-related UN Millennium Development Goals. Unless greater attention by donors and governments is given to developing human resources, these goals almost certainly will not be met. Many of the countries in sub-Saharan Africa, the region that will be the focus of this report, are experiencing severe shortages of skilled health care workers. There are multiple causes, the significance of which varies by country, but one of the most important factors is brain drain."
This Agenda for Global Action will guide the initial steps in a coordinated global, regional and national response to the worldwide shortage and maldistribution of health workers, moving towards universal access to quality health care and improved health outcomes. It is meant to unite and intensify the political will and commitments necessary for significant and effective actions to resolve this crisis, and to align efforts of all stakeholders at all levels around solutions. It builds on commitments already made by high level policy makers in efforts designed to marshal the world’s collective knowledge and resources to reverse this crisis. Everyone committed to this agenda shares the vision that ‘all people, everywhere, shall have access to a skilled, motivated and facilitated health worker within a robust health system’.
In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy- and decision-makers need to make within given resources limitations.