Sub-Saharan Medical Braindrain

In comments I made to a recent post on Obsidian Wings, I noted that although I have a number of problems with our health care system, my most significant problem is that it is immoral. This observation was met with a certain amount of puzzlement and even derision so I thought I’d flesh out my observations with a special focus on medical braindrain in Zambia.

The flight of doctors and nurses from countries in sub-Saharan Africa is a serious problem. According to Inter Press Service News Agency:

The situation is perhaps most dramatically illustrated in Zambia. Only 50 of the 600 physicians trained in the country’s medical school between 1978 and 1999 are still working in the nation.

CapitalEthiopia reports:

Because it is only a nation’s human capital that can be converted into real wealth, that human capital is much more valuable than its financial capital. A few years ago, Zambia had 1,600 medical doctors. Today, Zambia has only 400 medical doctors. Kenya retains only 10% of the nurses and doctors trained there. One can find the best Ethiopian University lecturers not in Addis but in Botswana. A similar story is told from South Africa to Ghana.

Where are the medical professionals going? Some are going to nearby Botswana. But the preponderance are going to the United States, the United Kingdom, and Australia. News.Scotsman.com reports:

The UK is believed to have taken on at least 3,000 African nurses a year since Gordon Brown launched his massive NHS investment programme after Labour’s second election victory in 2001. A recent report revealed that, in 2002-3, almost half of the new nurses registering to work in Britain were from abroad, making the UK the world’s biggest recruiter of nursing staff. The number of work permits issued to nurses rose from 14,000 in 2000 to more than 27,000 last year.

Britain is also second only to the United States in the number of overseas doctors it recruits every year. The PHR report said 5,334 doctors trained in African medical schools were practising in the US in 2002. The flow of nurses and pharmacists to Europe has also risen.

Why are the medical professionals leaving? Honestly, you can hardly blame them. There are both “push” and “pull” factors. “Push” factors include low pay, poor working conditions, civil unrest, and oppressive political climate. “Pull” factors are equally or more important. Accord to the U. S. Department of State:

Major “pull” factors (deliberate or unintended actions of the destination countries that attract health care professionals to recipient countries) include the high demand for health professionals in developed countries with aging populations who require increasing amounts of care. For example, the United States had 126,000 unfilled nursing posts in 2002; by 2015, this shortage will increase to 500,000. Canada currently needs 16,000 nurses and will need up to 113,000 nurses by 2011. In the United Kingdom, it was estimated that 15,000 foreign nurses were recruited for positions in 2001, with 35,000 more needed by 2008. In 2006, Australia expects 31,000 nursing vacancies. To meet these needs, active recruitment of health care personnel is ongoing in sub-Saharan African countries such as Kenya, Ghana, South Africa, Uganda, and Zambia. According to the U.S. Immigration and Naturalization Service, immigrants during fiscal year 2002 with medicine- and health-related occupations included 64 from Kenya, 181 from Nigeria, 212 from South Africa, 15 from Uganda, 11 from Zambia, and 31 from Zimbabwe.

What are the effects of this braindrain? According to the Canadian Red Cross:

In Zambia, measles is one of the five major causes of childhood illness, contributing about 70% of under-five morbidity and mortality. Outbreaks of measles continue to occur seasonally and sporadically in both rural and urban districts of the country.

From 1991 to 2000, the annual number of reported measles cases ranged from 2,822 to 30,930. More than 50% of reported measles cases were in children five years of age and older-and only 2% were older than 14.

According to the Proposal on Accelerated Measles Control in Zambia, there were 33,318 reported measles cases in 2001. Fifty percent of these cases and 64% of the measles-related deaths occurred in children under the age of five.

Two-thirds of Zambian children under the age of six are Vitamin A deficient. Vitamin A supplementation will help to prevent up to 23% of child deaths from measles, diarrhoea and pneumonia.

Another problem is the soil-transmitted helminth or worm infections, which occur widely in tropical and sub-tropical areas and especially among poor populations.

Measles, diarrhoea, pneumonia, dysentery. These are all avoidable forms of death. And money alone won’t help. Health care professionals are needed to provide care.

There is only one medical school in Zambia and it is heavily subsidized by the state. When the United States “imports” a Zambian-trained doctor, it is, in effect, offshoring the training of medical doctors to Zambia. Zambia just can’t afford to make this kind of donation to the U. S. health care system.

What reforms will enable Zambia to outbid the United States for health care professionals? I just don’t see any feasible set of reforms that will stem this tide without substantial changes in the health care system in the United States.

According to the WHO there are more than 200 physicians for each 100,000 population in the United States. In Zambia there are 6.

UPDATE:

Kenya Pundit asks Where are all the African doctors?. Hat tip: Winds of Change Africa regional briefing.