Health personnel in Southern Africa: confronting maldistribution and brain drain

Considering the effects of maldistribution and the brain drain are having on the foundation of skilled human resources, how can healthcare systems function adequately and effectively in Southern Africa ? This discussion paper, comissioned by EQUINET, examines the pattern of health personnel movement and migration, the factors that impact on inequity in distribution and on decisions to migrate, the current policy and stakeholder responses and the issues arising for future work on health personnel in southern Africa.

The paper explores the distribution, movement and migration of health personnel within southern African countries, between southern African countries and outside the southern African region, and the determinants of these distribution patterns. The production and attrition of health personnel in southern Africa are considered. The level and impact of migration at recipient country, source country and at an individual level is then discussed. A review of existing policy options and current stakeholder responses is then presented.

The report finds:

• an exodus of healthcare workers is occurring from areas of poverty and low socio-economic development, to more highly developed areas
• flows follow a hierarchy of ‘wealth’ and result in a global conveyor belt of health personnel moving from the bottom to the top, increasing inequity
• flows and migration are occuring from rural to urban areas, from public to private sectors, from lower to higher income countries within southern Africa, from African countries to industrialised countries.

The report concludes by a highlighting a range of areas for follow up work in southern Africa to support policy debate and development and ensure that the measures reached are effective, sustainable and equitable. These include that:

• public sector planning for health personnel needs to get a wider and more holistic sense of health personnel distribution and determinants
• more country-specific analysis is needed, given the range and variability across countries of health sector and exogenous conditions that influence human resource outcomes, in some settings sectoral analysis may also be needed
• steps need to be taken on a global basis to assess the scale, causes and impact of the skills drain before appropriate interventions can be devised and evaluated, there is a need to systematically analyse trends, develop perspectives, define response strategies and generally develop a coherent plan to meet the challenge in Africa
• it is important to identify the relative impact of push-pull-stick-stay factors in different dimensions of health personnel flows and distribution, both as measured from data and as perceived by key policy stakeholders
• a more rigorous framework for policy analysis is needed, both to stimulate relevant innovation and to avoid measures and incentives counteracting each other
• as new global trade policies are criticised for strengthening the voice of northern capital interests over southern and social interests, at the international level there is a need to strengthen processes that link public and equity-oriented interests south and north, to reinforce these interests in international policy.