Paying for health care migration: the case for compensation

Thousands of health care professionals leave sub-Saharan Africa each year to work in the UK. This flow of skilled workers creates a subsidy to the UK health services that leaves African health services understaffed and unable to deliver effective health care. Should the UK be obliged to pay compensation for the healthcare professionals that it takes from Africa?

A report from the Open University in collaboration with a Ghanaian medical researcher looks at the migration of health professionals from sub-Saharan Africa to the UK. In the UK, 29 percent of doctors registered in 2004 trained overseas, with over four percent from sub-Saharan Africa. Over 50 percent of doctors trained in Ghana have migrated, and most current trainees plan to leave. The value to the UK health service of Ghanaian-trained staff in 2004 was estimated at £39 million, while total UK aid to Ghana in the same year was only £65 million. For all doctors and nurses trained in sub-Saharan Africa now in the UK, the subsidy estimate is £880 million.

This subsidy to the UK health services undermines struggling African health services, and increases the gap in mortality, illness and service provision between developed and developing countries. But the UK government opposes compensation, as it is unwilling to link aid increases to UK health service benefits from migration.

The most serious argument against compensation is that it can be a tax on migration, and could have negative effects on the right to freedom of movement of African health care staff. However, the authors point out that:

• Suggestions that there is not enough information on which to base compensation claims are incorrect, as claims can be derived from employment and training statistics.
• Health managers say there is no case for compensation if people move by free choice, but the extent to which movement between countries results from free choice is debatable.
• Compensation can be destabilising or replace other health service spending, but if properly managed it can generate employment, support incomes and economic growth.
• Fears that compensation will disappear through misuse can be dealt with through existing treaties and new monitoring mechanisms.
• While money sent back by health care professionals may be spent on health care, it does not rebuild health services or retain staff, and so cannot be seen as compensation.
• Improving salary levels, the ability to save and invest, and opportunities for professional success in African countries will retain and re-attract staff, reducing migration.

Migration policies that support compensation from the UK to African health services that are losing staff should:

• repay the value of what has been taken so far, and ensure future payments provide a positive net income for African health services
• support current expenses, such as part of local salaries and the costs of drugs and supplies
• be limited to health services only, so that compensation is used to rebuild services
• be an institutionalised commitment that is not dependent on each new government
• be monitored for misuse of funds
• pay compensation as part of the existing exchanges between health professionals and health institutions in the UK and Africa.