Africa is losing its brightest to the First World. Less than 10% of doctors trained in Zambia since its independence in 1964 are still in the country: the other 90% have migrated, mainly to Europe and the United States. No less staggeringly, there are more Sierra Leonean-trained doctors in Chicago alone than in the country itself. These medical examples are merely one facet of the massive loss of skills Africa as a whole continues to suffer. In effect, one-third of the continent’s university resources are serving the manpower needs of Western nations and not those of Africa itself. United Nations estimates suggest that Africa is spending a staggering $4-billion a year training professionals for developed countries. Why this is happening, and what African universities need to do to counter the problem, came under the spotlight in the Libyan capital of Tripoli, which hosted the Association of African Universities’ (AAU) two-yearly conference of rectors, vice-chancellors and university presidents.
Human Resources
This paper analyses the relationship between physician migration from developing source countries to more developed host countries (brain drain) and the developmental and global health profiles of source countries. Source countries with better human resources for health, more economic and developmental progress, and better health status appear to lose proportionately more physicians than the more disadvantaged countries. Higher physician migration density is associated with higher current physician and public health workforce densities and more medical schools. Policymakers should realize that physician migration is positively related to better health systems and development in source countries. In view of the "train, retain, and sustain" perspective of public health workforce policies, physician retention should become even more important to countries growing richer, whereas poorer countries must invest more in training policies.
This paper discusses gender issues manifested within health occupations and across them. It examines gender dynamics in medicine, nursing, community health workers and home carers and explores from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. Gender plays a critical role in determining the structural location of women and men in the health labour force and their subjective experience of that location. The paper shows that woman are overrepresented in caring, informal, part-time, unskilled and unpaid work and within occupations there are significant gender differences in terms of employment security, promotion, remuneration.
The Health Service Extension Programme (HSEP) is an innovative approach to addressing the shortfall in health human resources in Ethiopia. It has developed a new cadre of Health Extension Workers (HEWs), who are charged with providing the health and hygiene promotion and some treatment services, which together constitute the bedrock of Ethiopia's community health system. This study seeks to explore the experience of the HSEP from the perspective of the community who received the service. A random sample of 60 female heads-of-household in a remote area of Tigray participated in a structured interview survey. While the introduction of HEWs has been a positive experience for women living at the study site, the frequency of visits, extent of effectively imparted health knowledge and affects of HEWs on other health providers needs to be further explored.
This key issues page looks at some of these perceived impacts, and provides recommendations for further reading on the subject of migration and remittances.
Nurses in the public health sector would receive increases of between 20 percent and 88 percent on their starting salaries, Health Minister Manto Tshabalala-Msimang said. The increases, which would be retrospectively introduced from July this year, comes as part of the occupational specific dispensation which would see substantial improvements in the salaries of professionals in the health department and the rest of the civil service over the next few years.
This briefing paper explores different ways of addressing the health worker crisis in Africa. It addresses problems of poor training, motivation and retention of health workers, the lack of skilled health workers in remote and hard to reach areas, and poor community engagement with health systems. The authors argue that to tackle the immediate health worker crisis it is important to find models which can quickly deploy and retain workers and ensure they get appropriate training and support. Responses need to expand the cadres of workers with basic clinical and community health competencies, such as enrolled nurses, clinical officers and community health workers.
This paper discusses gender issues manifested within health occupations and across them. It examines gender dynamics in medicine, nursing, community health workers and home carers and explores from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. Gender plays a critical role in determining the structural location of women and men in the health labour force and their subjective experience of that location. The paper shows that woman are overrepresented in caring, informal, part-time, unskilled and unpaid work and within occupations there are significant gender differences in terms of employment security, promotion, remuneration.
Providing maternal care requires a viable and effective health workforce. In many countries, and certainly in all countries where maternal mortality is high, the size, skills and infrastructure of the workforce is inadequate. The most visible features of the maternal health workforce crisis are the staggering shortages and imbalances in the distribution of health workers. With insufficient production, downsizing and caps on recruitment under structural adjustment and with frozen salaries and losses to the private sector, migration and HIV and AIDS, filling the supply gap will remain a major challenge for years to come.
The East, central and Southern African Health Community College of Nursing (ECSACON) has released a report documenting how health professionals can take the initiative to come together to address regional issues of concern. Documenting the process of developing the ECSACON model also demonstrates how acting together in synergy and partnership can expand the impact of similar networks.