Africa, Development & Aid, Headlines, Health, Human Rights, North America

HIV/AIDS: Medical ‘Brain Drain’ Worsens African Crisis

Eli Clifton

WASHINGTON, Jul 15 2004 (IPS) - To cope with the AIDS epidemic that continues to ravage Africa, the international community and the region’s governments must do more to stop the "brain drain" of skilled medical professionals to wealthier countries, argues a new report by Physicians for Human Rights (PHR).

The document, ‘An Action Plan to Prevent Brain Drain: Building Equitable Health Systems in Africa’, released by PHR on Thursday, asserts that movement of African-trained physicians away from their home countries is a huge barrier in the battle against HIV/AIDS.

To address the problem, PHR proposes that African countries, wealthy nations and international institutions should link their response to the AIDS epidemic to a broader initiative to build not only stronger health-care systems in Africa, but also to ensure that doctors and nurses stay in the region.

Thirty-eight of sub-Saharan Africa’s 48 countries fall short of the World Health Organisation’s (WHO) minimum standard of 20 physicians per 100,000 population. Thirteen of these countries have five or fewer doctors for every 100,000 people.

While health-care resources are already dangerously low and under-funded, health workers continue to leave their countries for a number of reasons. Some choose to migrate to wealthier countries for more lucrative salaries while others leave to avoid the sub-standard and unsafe clinical conditions in their home countries.

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.

Nursing shortages are also severe in the 17 sub-Saharan countries that do not even have one-half of the WHO’s minimum standard for nurses – 100 for every 100,000 people.

Such problems could be overcome if governments and international institutions cooperate in addressing the obstacles that exist in delivering affordable health care to the AIDS-stricken region, suggests Eric A Friedman, a PHR policy associate and author of the report.

"If governments commit the resources and if everyone involved in health-sector financing and planning recognises the urgent need to implement strategies that will bolster human resources, the nations of the world can achieve their AIDS treatment and other health goals," he said in a statement.

"Meeting these goals requires a renewed commitment to equity," he continued. "Just as intolerable gaps exist between health care in rich and poor countries, the gaps between rich and poor – between urban and rural areas – within countries must be closed.."

The report proposes that African countries sharply increase investment in rural health infrastructure, provide incentives to health professionals to work in under-served regions, and re-orient health professional training and recruitment practices to increase the number of new health professionals who decide to work in rural areas. All of these initiatives should be supported by foreign donors, according to the report.

While the brain-drain crisis in Africa would exist without HIV/AIDS, the epidemic is central in the shortage of health professionals, it adds.

The United Nations estimates 24.5 million Africans are HIV positive, that HIV rates exceed 30 percent is some urban areas and that more than six thousand Africans die each day from AIDS.

The disease is responsible for the death of many health professionals as well as an increased workload in health care facilities.

Despite the increase of funds destined to HIV/AIDS treatment and education programmes in countries such as Botswana and South Africa, what progress is made is often set back by the shortage of health professionals, the report states.

But those shortages can, in fact, be exacerbated by external funding for HIV/AIDS programmes, says Bill Fletcher, president of Washington-based TransAfrica Forum.

"Greater external donor support of public health in Africa should be particularly sensitive to the fact that specialised AIDS centres in Africa, funded by external sources, are creating an internal drain on public health workers," he said in an interview.

The PHR report makes several recommendations on how to address the effects of brain drain on African countries, whose resources are already drawn perilously thin due to the financial and health sector demands of the AIDS epidemic.

First, African governments must do more to protect their healthcare professionals from infection; such as providing gloves, syringes and other necessary to prevent transmission of HIV. Foreign countries should assist in funding these efforts.

Foreign donors, with the assistance of the Global Fund to Fight AIDS, Tuberculosis and Malaria, should also help African countries increase salaries and benefits for healthcare workers.

African health-training institutions should re-orient their curricula to be more responsive to local public-health concerns, and focus recruitment on students from rural areas, who will be more likely to practise in under-served areas after graduating, adds the report.

In addition, wealthy nations must address their own shortages of health professionals, especially in rural areas, to reduce the pull that is draining Africa of its healthcare professionals to wealthier countries.

The report further emphasises that African governments, as well as the health profession as a whole, should give greater recognition to the critical roles played by nurses and mid-level health professionals and compensate them accordingly.

In addition, medical and nursing schools in wealthy countries should develop programmes to enable health professionals in developed countries to work in African nations that cannot meet their needs through native health professionals.

PHR specified that foreign health professionals could be used to help build capacity and deliver services in African countries.

The report also argues that low-income countries whose educated and trained health professionals move to wealthy nations should be compensated for their loss.

Finally, the International Monetary Fund (IMF) and donor governments must encourage recipient countries to spend more on public health rather than impose strict budgetary caps to reduce the public deficit.

Overall, public health spending is less than 10 dollars per capita in most African countries, according to U.S. State Department estimates.

"The health consequences of brain drain are enormous and result from practices of both developed and developing countries," said Leonard S Rubenstein, PHR executive director, in a news release. "Rich and poor nations each have responsibilities to secure people’s right to the highest attainable standard of health in Africa and other regions of the developing world."