Rich countries draining SA
2005-05-27 08:49
Paris - A "medical carousel" in which doctors and nurses migrate to richer countries has become a major cause of the decrepit health infrastructure in poor nations, the medical journal The Lancet says.
"Doctors and nurses are the linchpins of any health care system," it says. "In countries already severely deprived of health professionals, the loss of each one has serious implications for the health of citizens."
In Asia, the big losers in the migration are Nepal, Bhutan, Papua New Guinea, Afghanistan, Cambodia and Indonesia, it says.
But the problem is acute across most of sub-Saharan Africa, where 24 out of the 28 countries have only one medical school and 11 of them have no medical school at all.
"Each migrating African (health) professional represents a loss of $184 000 (about R1.2m) to Africa, and the financial cost to South Africa, 600 of whose graduates are in New Zealand, is estimated at $37m (about R244m)," The Lancet says.
"Yet Africa spends four billion dollars a year on the salaries of foreign experts.
The report, published in the British medical weekly on Saturday, says Britain is especially to blame for the brain drain.
Thirty-one percent of practising doctors in Britain, and 13% of nurses were born outside of Britain; in London, the figures are 23% and 47% respectively.
Around five percent
By comparison, the figure for France and Germany is only around five percent.
The Lancet says that "poaching" is a form of migration in which medical personnel head towards a progressively richer country, and that the United States is the only overall winner.
Thus doctors in Tanzania, Kenya or Nigeria move to South Africa; South African doctors move to Britain; British doctors move to Canada and the United States; and Canadian doctors move south to the United States.
Research has shown that few of the migrants ever return home, and any money they repatriate goes into the home country's general economy, not specifically into its health budget.
"The medical carousel does not turn full circle ... so the poorest nations experience all drain but no gain."
The Lancet calls for more medical training for the natives of rich countries; restrictions on the duration of visas granted to doctors and nurses who go to rich countries for training, in order to encourage them to return home at the end of their course; and for incentives for health professionals in poor countries to stay or at least work there for a number of years before heading abroad.