In an editorial in the latest British Medical Journal (BMJ), British Medical Association (BMA) Chairperson James Johnson said the Commonwealths developing countries were particularly hard hit because their health professionals speak English and are therefore a valuable commodity to plug manpower gaps in the United States, Canada, the United Kingdom, New Zealand and Australia. Figures from 2001 show that as many as 3 500 South African health professionals were working in Australia, 2 360 in Canada, 1 600 in New Zealand, 9 000 in the United Kingdom and 7 000 in the United States. The latest South African Health Review reveals that 6% of UK and 10% of Canadian hospital based doctors are South African. Vacancy figures for 2003 in the South African public health sector compiled by the Health Systems Trust reveal a bleak picture in most of the provinces. A staggering 67% of posts in Mpumalanga were vacant, 41% in the Free State, 33% in the NorthWest, 32% in Gauteng, 28% in the Eastern Cape, 27% in the Northern Cape, 25% in KwaZulu-Natal, 13% in Limpopo and 14% in the Western Cape. Indications are that the situation has worsened since these figures were published.
Johnson pointed at that large parts of sub-Saharan Africa affectively had no health care at all, with only 600 000 healthcare workers for a population of 682 million. He revealed that Ghana was faced with a ratio of nine doctors to every 100 000 patients. Only 60 of 500 doctors trained in Zambia since independence are still there while in 2001 alone, it lost 2 972 nurses pushing the vacancy rate to 57%. Mozambique has only 500 doctors for a population of 18 million. Professor Chris Lavy of the Department of Surgery at Malawis College of Medicine laments that Malawi, a country of 12 million people, has only one Malawian orthopaedic surgeon and one Malawian general surgeon in the entire government health service. Johnson said it was a romantic delusion that international exchange and diversity enriched us all. We gain in the North, but developing countries lose out by losing their doctors permanently, Johnson added. He said the most important element of the solution was self-sufficiency. The BMA and the Royal College of Nursing urged the British Government to commit the country to training enough people to become self sufficient in workforces of doctors and nurses.
However, he pointed out that the United States already employed half of all English speaking doctors in the world. And it wants more, he claimed. By deadly coincidence the US wants to employ one million more healthcare workers in the next 15 years, exactly the extra number needed for sub-Saharan Africa to fulfil the millennium development goals. The US regards healthcare professionals as a commodity to be purchased in the market and is making little provision currently to increase the number of doctors and nurses it trains at home, said Johnson.
In a parallel BMJ editorial Dr Eric Buch, health advisor for the New Partnership for Africas Development (NEPAD) and Lola Dare, executive secretary of the African Council for Sustainable Health Development write that as the G8 meets, Africa is at a crossroads: It faces a double edged crisis: its health workforce is rapidly depleting, and its health systems are weak, fragile and hanging on a precipice.
They noted that several groups had called on the G8 to invest in Africas efforts to stem the brain drain, but added that Africa did not simply need more health workers, but that investments also needed to help to increase the motivation, retention and accessibility of the workforce to make a real difference. A draft human resources plan to address the critical shortage of health workers in South Africa is yet to be released despite promises that it would be published by the end of March. The National Health Council (formerly MinMEC) was expected to consider the draft plan when it met at the end of June.
Explaining the delay at the time, the Health Departments Human Resources director Dr Percy Mahlati said that health minister Dr Manto Tshabalala-Msimang first had to discuss the plan with provincial MECs but had not yet been able to as she had been out of the country.
(Source: Health-e, July 6, 2005)