Public Agenda (Accra)
Dr. Kwame Osei
21 November 2008
opinion
Britain likes to pride itself that it is helping Afrika out of poverty by supporting developmental programmes via DFID - such programmes include help in the healthcare sector.
As far back as 2005 UK doctors warned the labour government that the UK was crippling Afrika's healthcare system by stealing its staff.
In 2005, 5,880 UK work permits were approved for health and medical personnel from South Afrika, 2,825 from Zimbabwe, 1,510 from Nigeria and 850 from Ghana.
About 33% of the doctors that are practicing in the UK were trained outside the UK. In comparison, only 7% of doctors in Germany and France are not home grown.
The well meaning UK doctors suggested that the UK should encourage more home grown doctors and limit the time period that overseas recruits can train and work in the country, they told the Lancet. Financially compensating nations for lost staff will not work, they warned.
Brain drain
Nor will strategies that split the training of healthcare staff between developed and developing countries, according to Dr. John Eastwood and his colleagues from St. George's Medical School in London.
He said "One basic measure would be an agreement in consultation, with the World Health Organisation, to establish a basis in developed countries for minimum annual numbers of health professionals in training.
"This would help reduce developed countries reliance on the investment in training made by developing countries".
Ethics
The UK does have an ethical code which means it will not actively recruit from certain developing countries including those in Afrika.
However and this is where the contradiction is, healthcare professionals from Afrikan countries are free to apply for jobs in the UK.
Dr Edwin Borman the former chairman of the British Medical Association's International Committee said: "Shortages of doctors and nurses are having a devastating effect on the developing world.
"Afrika alone needs around a million more healthcare workers, and unless the situation improves drastically rates of HIV will spiral, disability from childhood diseases will rise, and thousands more lives will be lost.
"Industrial countries like the United States and Britain must recognize that they have some responsibility for this crisis.
"At least the UK now has an ethical recruitment mode, and we hope other countries will follow suit - but we also need to address the financial barriers that we have imposed on developing countries through our aid policy that are preventing them from investing in basic healthcare and training".
Many people inside Afrika and outside Afrika wrongly accuse Afrikan governments and their leaders of not investing in healthcare.
However, what the above indicates is that it is the intention of Afrikan governments and their leaders to invest in their countries' healthcare but they are stopped from doing this by the very same western countries that criticize them for not spending money on healthcare by imposing draconian conditions on the loans or aid money that they give to Afrikan countries.
Case study
At Korle Bu hospital in Accra nurse Ms. Osei walks past the drab concrete walls of the children's emergency unit, she hears some unwelcome news.
Two six year old boys have just died - one had malaria, the other stopped breathing, it is not clear why.
"Those deaths were probably preventable," she says. "We could have saved them if only we had more staff."
Upstairs in the maternity department, mothers often have to queue for emergency caesareans.
One of the operating theatres here has been closed for two years because of a shortage of anesthetists and nurses.
Korle Bu's neonatal intensive care unit has plenty of drugs and equipment - it was once the pride of West Afrika - but it too is desperately short staffed.
Four exhausted looking nurses have to care for 86 seriously ill babies.
And many of the babies are only in incubators now because of the shortage of midwives around the country.
Thousands of mothers go into labour without any supervision and some of their babies then suffer from asphyxia. Lack of oxygen during birth can lead to irreversible brain damage.
'Colonization'
Ghana has lost a frightening 60% of its nurses. Two thirds of young doctors have left the country within three years of graduation. Many have left for better paid jobs in the UK.
"It's very unfair of Britain to poach our nurses", says Ms. Osei. "I think it is new form of colonization.
"Tony Blair once said Afrika is a scar on the conscience of the world and that the UK government wants to help Afrika but then why does the UK rob us of our medical staff?"
Ms. Osei is used to seeing her colleagues leave without even saying goodbye.
"When people leave suddenly, we say they've ruptured", she explains.
"And the next time you hear from them they're calling you from another country thousands of miles away."
Code 'makes no difference'
It is a vicious circle. The more of her colleagues leave Ghana, the worse it is for those left behind.
"Their workload falls on us and we suffer from the burn-out syndrome. It is so stressful that a lot of us just have to pray to God for survival."
When the British government was planning to expand its health system in the late 90s it urged hospitals not to plunder the developing world.
In 2001 it drew up a code of practice which discouraged active recruitment from the world's poorest countries.
But for many, Britain remains an attractive destination. Salaries are low in Ghana - about £45 a month for a junior nurse, £75 pounds for a senior.
The code of practice "hasn't made any difference" according to Ken Sagoe, a former head of human resources at the Ghana Health Service.
Since it was introduced, he points out; the number of Ghanaian-trained doctors working in Britain has actually doubled.
Although staff are no longer recruited openly, they are snapped up by recruitment agencies who send them to work in private sector clinics and nursing homes before they enter the UK's NHS, through the back door.
Home training
The UK's Department for International Development (DFID) has given £560m in aid to help support Afrika's health care systems and train new medical staff in the last five years.
Former British Prime Minister Tony Blair set up an Africa Commission to try and lift the continent out of poverty.
But Afrika is still paying for the British NHS. Think about it - If the doctors and nurses from Africa registered to work in the UK over the last five years had actually been trained in the UK it would have cost the UK £1.95 billion - almost four times as much as Britain has given in aid to Afrika - see the hypocrisy and double standards!!!
Some believe the code of practice is irrelevant because, whatever the rules, higher salaries and better conditions in the UK will always draw staff away from developing countries like Ghana.
"The only answer is to train more of our own doctors and nurses", says James Johnson of the British Medical Association.
"We are training more now but it is late in the day and we started from a very low base.
"As long as we cynically under-produce in this country, countries like Ghana will pay the price."
Ms. Osei agrees with this analysis.
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