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Africa: International Crime
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The East African (Nairobi)
12 May 2008
Posted to the web 12 May 2008
Dagi Kimani
Nairobi
SHOULD THE WORLD DEVELOP a global treaty to regulate the emigration of African medical personnel to the rich West?
The jury is still out, but this is an issue that is likely to gain prominence in coming years as thousands of African health workers - trained at a great cost by their impoverished countries - flock en masse to developed countries lured by higher salaries, better working conditions and more training opportunities.
The human costs of the migration, some activists now contend, are so horrendous that they are comparable to crimes against humanity.
"Active recruitment of health workers from African countries is a systematic and widespread problem throughout Africa and a cause of social alarm," Edward J. Mills of the British Columbia Centre for Excellence in HIV/Aids and nine co-authors wrote recently in the Lancet. "The practice should, therefore, be viewed as an international crime."
According to this team, those facilitating the transfer should be tried at the International Criminal Court, since their trade deprives poor countries of much-needed medical personnel, resulting in millions of deaths each year.
The outward flow of nurses and doctors from sub-Saharan Africa, medical analysts say, is particularly devastating, because the region carries 25 per cent of the global disease burden, yet has only three per cent of the world's health workers.
According to the World Health Organisation, Africa's cash-strapped health systems actually need 1.5 million new health workers to resolve the existing shortages. These would require at least $3.3 billion annually to train in the next eight years.
The continued migration of the few workers there are has made the situation worse across the continent. Currently, statistics indicate, more than 13,000 health workers trained in sub-Saharan African countries practise in Australia, Britain, Canada and the US. Incredibly, one in four doctors trained in the region works in a developing country.
"There are more Ethiopian doctors on the east coast of America than there are in Ethiopia," noted Prof Miriam Were, a leading Kenyan scientist.
According to the proponents of some sort of global regulation, the fact that migrating African medical personnel are allowed to relocate to serve in relatively better-staffed situations casts into doubt the developed countries' oft-stated goal of improving health indicators in developing countries.
"Let's call a spade a spade; rich countries are perpetrating sort of genocide against the people of Africa by robbing us of medical workers in broad daylight, even as they claim they are helping us fight disease," said a highly-placed Kenyan ministry of health official who sought anonymity.
According to figures published in the Lancet, the US for example has 9.37 nurses per 1,000 people, while Uganda has just 0.55. Kenya has 14 physicians for every 100,000 people, but the US has 256 doctors serving the same number.
Shortages in destination countries have fuelled migration. For example, the US need an extra 800,000 nurses and 200,000 doctors more. Globally, the WHO estimates that more than 4 million more health workers are needed worldwide to improve health systems and achieve international health and development goals.
Recruiting agencies generally offer to pay higher salaries, cover moving expenses and provide assistance in navigating the visa and citizenship process.
At its inaugural conference in Kampala in March, the Global Health Workforce Alliance acknowledged that recruiting trained health personnel from sub-Saharan Africa to work in developed nations is weakening health infrastructures and undermining efforts to fight HIV/Aids in a region already devastated by the pandemic.
Together with attrition from Aids, continued health-worker migration could lead to the collapse of some national health systems, the Alliance noted.
IN ADDITION TO ESTABLISHING stricter guidelines on the migration of medical personnel, such as mandatory service periods in the public health sector after graduation, activists say that African governments themselves have to do more to retain their health workers.
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By allocating 15 per cent of their budgets to health care, said Dr Sam Zaramba, Uganda's director-general of health services at the Kampala conference, developing countries would be able to "provide enough remuneration, increase the number of health workers, provide enough medical supplies, improve health infrastructure to provide a conducive environment for the health workers leading to retention."
According to the alliance, a physician in some sub-Saharan Africa or Asian countries earns as low as $100 per month, but could earn $14,000 monthly in some developed countries. In Kenya, fresh medical graduates earn about $1,000 a month.
"Better working conditions at home would be a massive factor in mitigating migration but these countries don't have money," said Dr Francis Omaswa, executive director of the alliance at the Kampala conference. "Rich countries should also invest in training in the South so that we have a big enough pool of health workers to share around between all of us."
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