Migration

The migration of doctors and nurses from Africa to rich countries has raised fears of an African medical brain drain. But empirical research on the issue has been hampered by lack of data. How many doctors and nurses have left Africa? Which countries did they leave? Where have they settled? A new database of health professional emigration from Africa is now available. This database includes information on the flows of African-born physicians and nurses to nine destination countries. It looks specifically at skilled professionals and is part of the US Center for Global Development’s ongoing research between on the links between international labour mobility and global development.

The Africa Regional Office of the World Health Organization (WHO AFRO), in Migration of health professionals in six countries: a synthesis report, outlines how the migration of skilled health professionals out of Africa has adversely affected the quality of care offered in health institutions.

However, both the WHO AFRO study and James Buchan and Delanyo Dovlo, in International recruitment of health workers to the UK: a report for DFID, find that the migration of African health care workers is not confined to migration out of the region. It takes place within countries from rural areas to urban areas and from poorer countries such as Malawi to richer countries such as South Africa.

With respect to doctors, migration from Africa to the United States (US) is particularly important. In the paper The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain, the authors found that the majority of migrating African doctors to the US came from three countries – Nigeria, South Africa and Ghana. Furthermore, 79 per cent of these doctors were trained at only 10 medical schools. The findings suggest that policy interventions in only a few locations could be effective in stemming the brain drain.

The reasons for migration are often complex. Some developed countries have developed codes of practice intended to reduce active recruitment of health workers from countries where migration is a problem. However, there are a number of factors that motivate health workers to migrate.

Is there any solution to the “Brain Drain” of health professionals and knowledge from Africa? Describes both the “push” and “pull” factors involved in migration of health workers. The pull factors (factors drawing workers towards developed countries) include better pay and working conditions, job satisfaction, and prospects for further education. Push factors (factors pushing workers away from developing countries) are characterised by poor working conditions, which includes a lack of promotion and other career advancement opportunities.

While the loss of health worker adversely impacts on the local health system, Buchan and Dovlo highlight the beneficial effects of migrant workers sending money back to their families. For more on the impact of remittances, see the id21 insights on Sending money home.

Stopping health workers from migrating is neither an ethical or viable option, nor does it address the reasons for migration. Many have suggested ways of encouraging health workers to continue working in African health systems.

Adamson Muula suggests that adapting health training curricula to the African context in African medical schools and encouraging the development of specialist training programmes in African medical schools could also help to retain health care workers.

Actively managing migration could also be a way to maximise the benefits and minimise the problems it can cause. Buchan and Dovlo suggest that encouraging structured, temporary moves of staff to other organisations could help to build career and personal development opportunities as well as contribute to organisational development.

Ultimately, the work environment and benefits for health workers will need to improve for African health systems to retain staff. The WHO AFRO study suggests that African governments need to ensure regular and fair provision of a living wage for health professionals.