The brain drain of medical personnel to countries that offer better pay, working conditions and better facilities has been going on for some time.

It is in the rural areas that the effects are felt most. Medecins sans Frontieres says drugs are available in some clinics, but there is no staff to administer them. A spokesman criticised donors who fund health clinics but not nurses’ wages.

In Zambia, the Aids death rate is 3.5 per cent for nurses and 2.8 per cent for medical assistants. In the capital Lusaka and Kasema districts , it is double the number who applied to work as medical staff in the United Kingdom.

In southern Africa, doctors and nurses are underpaid, over-worked and disillusioned, and are leaving in large numbers. In Malawi, for example, 44 nurses graduated in 2005, but 86 left the country.

According to the World Health Organisation (WHO), the minimum standard is 20 doctors for every 100,000 patients. This is the minimum. In developed countries, it is higher. Yet, in Lesotho it is five doctors for 100,000 patients, 2.6 in Mozambique and two in Malawi. What is happening down south is just as much the case here.

Many Kenyan and Ugandan doctors are working in South Africa. Tanzania has nearly 200 doctors working outside the country and 100 skilled medical workers leave the public service every year. Nurses, too, have been leaving to man wards in countries such as the UK where nursing has ceased to be the attractive profession it was for local women.

A WHO move is welcome. The UN agency is planning to enforce a new initiative that aims at making it difficult for health workers to migrate from poor to rich countries by imposing restrictive work conditions.

New employment policy guidelines are being developed to stem the brain drain. They are expected to be completed next year. This is not to say that medical students and personnel should not travel abroad for further studies or practical experience. But one thing is clear: They are needed more at home. Charity, it is often said, begins at home.

However, this is easier said than done. They cannot be expected to survive on meagre wages and carry out a service that is often unpleasant, tiring and sometimes thankless. As the MSF spokesman pointed out: Donor money needs to be better invested. Clinics and dispensaries are needed, but without contented and efficient staff, and a sufficient number of them, medicines and basic equipment, they are little more than white elephants.

The brain drain is not the same as emigration. The United States and Australia are examples of countries that have developed due to large-scale immigration. The average emigrant left his homeland because he could not make a living or for fear of persecution. He started on the lowest rung of the social and economic ladder.

The brain drain is a drain of the intellectual and skilled elites. Brains go wherever they are paid best, and not just to survive. Many European and Asian ‘brains’ have settled in the US, not because they cannot live well at home, but because they were made offers they could not refuse.

Some people leave to earn money and come back. Others are offered a university course which no local university can match. They take it, but later discover that they are too qualified to come back. They never forever. Others go to study and would like to come back, but find themselves trapped. Things do not work out as they had hoped and cannot afford to come home.

We have little choice but to entice our skilled and intellectual elite to remain and those outside to return as soon as they can – and make it worth their while to do so.

Source: Martyn Drakard on the EA standard


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