Brain Drain In Africa - Migration In The Health Sector

Introduction

"African governments have a great responsibility to ensure that brains remain in the continent; otherwise, in 25 years' time, Africa will be empty of brains."

This quotation by Dr. Lalla Ben Barka, the Deputy Executive-Secretary of the Economic Commission for Africa, expresses more than clearly the dramatic situation of Sub-Saharan African countries when it comes to their most valuable human resource needed for development - their brains.

Migration and the resulting brain drain are a global phenomenon and universal problem. Especially in the health sector, there have been significant shifts of human capital from Europe to the United States, leaving a gap which is quickly filled by high-skilled immigrants from the Southern part of the world. (PSI, 2003).

According to the WHO (2006), Africa remains the sole continent still struggling with insufficient development in all fields: education and the health sector continue to deteriorate and cannot keep up with the rising demand due to an annual population growth of about 3%; HIV/AIDS is spreading fast and inexorably, further weakening the countries' systems and economies and increasing the demand for a functioning health system even more.

In this context, brain drain is continuing steadily, which deprives developing countries in the Sub-Saharan region of their skilled human capital at costs comprising of their lost value and productivity in their home country but also of their training and education costs.

This paper deals with migration and it motivations as well as its impact on the African health sector. Moreover, it will be critically discussed which of the concept - brain drain or brain gain - is prominent in the African health sector and will show some possible strategies to overcome the serious under-supply of health workers in the region.

Particularities concerning the African health sector and migration

Migration of health has had a huge impact on African health systems. Generally spoken, a global shortage of health workers exists, which significantly raises demand. In this context, African countries are one the key suppliers of workers in the field. However, shifts of worker do not only happen externally, meaning emigration of workers to another country, but also internally. Health workers also migrate from rural to urban areas or from the public to the private sector, or they completely withdraw from the health sector. (WHO, 2006).

According to the (IOM, 2006), main reasons for an insufficient supply of health workers include underinvestment, high work intensity, working conditions, and insufficient remuneration. It is clear that concerning remuneration, developed countries can offer higher incentives for health worker to work in countries in the North. Developing countries are simply not competitive, that is why migration rates of skilled health workers are not likely to decrease in the near future, leaving developing countries in devastating situations. Schrecker & Labonte (2004) state that "a nurse in the United States can expect to earn $3,000-$4,000 per month, as compared with $300-800 per month for a doctor in the Philippines" (p. 411).

Mass migration has then serious effects on global distribution of health services. Global average in health services is accounted to be 4 health workers per 1000 inhabitants, however, North America's worker base is 10,9 workers in comparison to Sub-Saharan Africa's worker base of 1.0 workers per 1000 inhabitants. (WHO, 2007).

With his concept of the "global conveyor belt", to be seen in Annex 1, Schrecker and Labonte argue that migration of health workers in Africa not only works internationally but also intra-nationally, with workers moving "from public to private health systems, or from less to more desirable work situations or regions [with serious consequences]. Nairobi has one doctor per 500 people, while Kenya's remote Turkana province has one doctor per 160.000 people". (2004, p. 411). It becomes clear that people in rural areas are in most need of health services due to the HIV/AIDS pandemic and other serious diseases but suffer the most from internal migration and the resulting unequal distribution of health services throughout the country. This is what Martineau et al. (2004) call the 'downward spirale': "if a vacancy in an urban area is created due to the incumbent moving overseas, a re-shuffle (another form of carousel) takes place with the vacancy being filled by someone from a more rural area and so on. Since the poorest citizens tend to live in the remoter areas, it is they who are most affected by migration" (p. 4).

Factors influencing migration of health workers

When analysing migration in the health sector, push and pull factors have to be considered in order to counter trends and fight the dramatic consequences for the African continent.

Xaba & Philips state the following, most prominent push factors for South African health worker to migrate: "lack of competitive incentives in the public sector, work pressures like long hours, poor resources and high ratios of patients per nurse, few opportunities for career development, escalating crime rates in the country, and the rise of HIV/AIDS in South Africa" (2001, p. 5/6). Obviously, pull factors then represent the mirror image of those reasons, which attract health workers to emigrate.

Another important factor concerning migration was brought up by Lien & Wang (2003). They argue that brain drain or gain can be predicted taking some factors into account, such as interactions of imperfect human capital transferability, investment in improving immigration probability and the budget constraint. Shortly explained, their main argument is that language skills can influence human capital transferability. Language skills often increase the probability of migrating, so often, due to budget constraints, people invest in language skill rather than in education. Until they immigrate, professionals do not invest in their education anymore and can therefore not provide appropriate services anymore - this is when brain drain occurs. In the case of African workers, language barriers are mostly low, which is why migration occurs in large scales and results in brain drain for the home countries.

The African health sector: Some important facts and trends

Mass migration of health workers has a serious impact on the health sector of African countries and their possibility to develop. According to the WHO (2007), "four doctors