Opinion

The migration of our Health Care Workers

By  | 18 December 2009 at 23:38 | 1064 views

As our president was witnessing the graduation of our future leaders a few days ago, so were some of the young graduates (especially nurses and doctors), simultaneously preparing to abandon the people they were trained to serve for lucrative opportunities abroad.

Sierra Leone is facing a shortage of health care workers and those trained annually are determined to quit the country upon graduation, to work abroad. This “brain-drain” of our health work force is contributing to the poor health care services in the country, with indicators such as infant and maternal mortality being unacceptably the highest in the world.

Human resources are critically important for well-functioning health systems. The availability of skilled health workers is dangerously low in developing countries. Africa represents 24% of the global burden of disease, but has access to only 3% of the world’s health work force to address this burden. In contrast, the countries with the least need have the highest percentage of health workers-the Americas comprise only 10% of the world’s disease burden but command a far larger share of health and medical professionals (37%). This explains one of the factors influencing the health inequalities at the international level.

Africa and other poor nations in the world often do not have the public health, medical and nursing schools necessary to train sufficient numbers of health care workers. But, even when these countries use their funds to train them, many leave for more lucrative positions in richer countries. This, in addition to the potential negative health impact, can represent a significant monetary loss for these poor countries, which subsidize medical education only to have their trained workers leave the country.

The migration of health workers is caused by a “push” from depressed working conditions and opportunities in poor countries and a “pull” from more attractive conditions elsewhere. The western richer nations are aggressively recruiting health care workers from poorer countries, even as they acknowledge the resulting dire situation in these countries. The West represents an overpowering lure for poor countries’ health care workers, offering salaries and career opportunities that far surpass what could be offered in poorer countries.

In Ghana and Liberia, for example, it is estimated that, 30% and 60%, respectively of these countries’ physicians are working in the UK or the USA. Physicians in other low-income countries such as India and Pakistan are similarly moving to the West in droves.

It has been recognised that, as many as 57 countries (Sierra Leone inclusive)-by WHO calculations, will be unable to meet the MDGs because of a shortage of health care workers. Also, empirical evidence demonstrates a correlation between health worker availability and leading health indicators. The World Health Organisation data, for example, show that maternal, infant, and child survival increases with the density of health workers in a country.

According to the World Health Statistics report for the year 2008, the total number of personnel in the different categories of health staff in Sierra Leone is: Physicians-168; Nurses-1841; Dentists-5; Pharmacists-340; and Community Health Workers-1227(CHOs, MCH Aides, and CHAs etc). The report also pointed out that, each of these cadres of staff represents less than 1 personnel per 10, 000 people in the country. This, for sure, is a critical factor for the country’s poor health indicators. This shortage of health workers and coupled with the exorbitant fees normally charged for health services, paved the way for the proliferation of traditional healers and quacks, with dire implications on the health of the country’s population.

Solving the problem of the large-scale exodus of health workers from poorer to richer countries is difficult, particularly because, freedom of movement is a basic human right. Further, our government can hardly stop these professionals from choosing where they work; as most of them had to fund their training without any support from the government.

Here are some suggestions to the current APC administration and to our donor partners:

The government should improve the welfare of the health workforce (especially the front-line health workers: CHOs and MCH Aides, most of whom have to abandon the luxury of living in bigger towns to serve the poorest people in very remote settings). Apart from the health workforce migrating for better opportunities elsewhere, these workers are likely to deprive the needy communities of the resources meant to improve the health of the people ranging from selling items such as drugs, bednets etc. to charging people for services meant to be offered free-of- charge and at a cost many cannot afford.

The Government should develop policies aim at ensuring that our graduate nurses and doctors serve the country for a period of time before allowing them to move and work abroad. If individuals ever wish to work abroad after their training, it is patriotic/nationalistic on their side to save the tax payers’ monies that should be spent to train them (through government subsidies and grants); by moving straight to, and be trained by, their host countries.

Similarly, the government should establish a National Service akin to that of Ghana and Nigeria, where graduates of any discipline (Health, Education for example) serve at least a year on voluntary service to the nation. This would definitely address the shortage of teachers and health workers in the country; as well as preparing the young graduates for the labour market.

Our donor partners should help the governments with funds to locally enable individuals to become useful health workers; by providing bursaries, and the free training of deserving students from poorer background on scholarships or loans, which they can repay when they commence their practice. This will help in increasing our health work force, as well as giving the government the muscles to control the movement of its health professionals.

The palpable determination of the offices of the president and the First Lady to improve on our health indicators and meeting the MDGs will only come to fruition with an effective and relatively sufficient cocktail of health workers.

*Alhassan Fouard Kanu (MPH, MSc, DCM&H, CTCM&H), currently in London, was a frontline health worker as a Community Health Officer (CHO) in Sierra Leone.

Comments