The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country. For example, for every Liberian physician working in Liberia, about two live abroad in developed countries. Countries that experienced recent civil war (e.g. Mozambique, Sierra Leone) or economic stagnation (e.g. Cameroon) see about half their home-born doctors working in a developed country.
The numbers were calculated using the most recent census data from the nine most important destination countries for African health professional emigrants. They are the first standardized, systematic and occupation-specific measure of skilled professionals working in developed countries who were born in a developing country. The numbers have almost certainly increased since the censuses were conducted between 1999-2001.
“The lack of systematic data on the extent of African health workers’ international movements has hampered any study into the causes and effects of African health professional migration,” explained author Michael Clemens, from the Center for Global Development, Washington DC.
The fear that health services in developed countries are poaching medical expertise from developing countries is a highly emotive and political issue. South Africa's health minister, Dr Manto Tshabalala-Msimang, claimed in 2002 that “if there is a single major threat to our overall health effort, it is the continued outward migration of key health professionals, particularly nurses.”
Similarly, after the UK National Health Service ended its active recruitment of staff from Sub-Saharan Africa in 2001, the British Medical Association (BMA) and the Royal College of Nursing praised its “strong moral lead.” BMA Chairman of Council James Johnson flatly declared that “the rape of the poorest countries must stop.”
But Clemens says that there is insufficient research to make such categorical judgements. “A Kenyan nurse working in London isn’t taking care of sick people in Kenya,” he says, “but that nurse is pursuing professional possibilities that aren’t available to her at home – something of inherent value. The amount of good she can do at home is often constrained by dazzlingly complex problems in the health system, problems utterly ignored by the blunt coercion of recruitment bans.”
The new data overcome some of the limitations of previous estimates and facilitate efforts to analyse the global impacts of health worker movements.Media Contact
Human Resources for Health aims to disseminate research on health workforce policy, the health labour market, health workforce practice, development of knowledge tools and implementation mechanisms nationally and internationally; as well as specific features of the health workforce, such as the impact of management of health workers' performance and its link with health outcomes. The journal encourages debate on health sector reforms and their link with human resources issues, a hitherto-neglected area.
3 BioMed Central (www.biomedcentral) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
Matt McKay | BioMed Central
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