Inter Press Service (Johannesburg)
March 23, 2006
Posted to the web March 24, 2006

By Gustavo Capdevila
Geneva

Kenya is just one of many developing countries worried about the growing 
loss of healthcare workers, who mainly migrate to industrialised nations, 
said Dr. Francis Kimani of Kenya. Most of Africa faces the same problem, 
which has led to an estimated shortage of around 820,000 doctors, nurses and 
other health workers throughout the continent. Although the total shortage 
of health professionals worldwide is estimated at around four million, most 
of the demand is concentrated in industrialised countries, due to largely 
demographic reasons.

The majority of the migrating health workers come from the world's least 
developed countries, especially in Africa and Asia, where health 
professionals typically earn low wages and have little prospect for 
advancement in their careers, Kimani told IPS.
Other reasons for emigrating are a poor working environment and lack of 
motivation, said Kimani, director of Medical Services in Kenya's Ministry of 
Health.

Isaac Ziba, a nurse who left Malawi with his family in 2004 to work in the 
Western General Hospital's surgery department in Scotland's National Health 
Service, said his decision was motivated by several of these concerns, 
notably "career advancement, further training, new experiences, and better 
remuneration."  "I made a good decision for myself and possibly my family," 
he told IPS. When asked whether he planned to return to his country 
eventually, he said he was not sure.

In the case of Africa, the phenomenon takes on unique dimensions because the 
"brain drain" has coincided with the HIV/AIDS epidemic. Africa has accounted 
for the majority of the 25 million people killed so far by the disease 
worldwide.
But despite its disproportionate burden of HIV/AIDS and other contagious 
diseases, Africa only has 0.6 percent of the world's registered healthcare 
professionals.

The other side of the coin is seen in industrialised countries, which have 
ageing populations and declining birth rates, making it difficult to replace 
retiring health workers, and creating a large proportion of people with 
special healthcare needs.
This is illustrated by two of the countries with the "oldest" populations, 
Japan and Italy. By 2050, Japan will have 77 pensioners for every 100 
workers, compared to 30 for every 100 in 2005. And in Italy, the ratio will 
have risen from 30 per 100 to 75 per 100.

By contrast, the developing countries have reduced infant mortality in 
recent years, and while fertility rates are slowly declining, the future is 
expected to bring an explosive increase in the number of young people 
entering the labour market.
These are just a few of the considerations being addressed by the experts 
gathered together by the International Organisation for Migration (IOM) for 
a seminar on Migration and Human Resources for Health, taking place Mar. 
23-24 in Geneva.
Danielle Grondin, director of the IOM Migration Health Department, began by 
stressing that the migration of healthcare workers is not a new phenomenon. 
As far back as the early 1970s, there were already more Filipino nurses 
working in Canada and the United States than in the Philippines, she noted.

"Now it is an issue because of increased growth in the scale of the flow," 
she explained. There is a greater demand for health care personnel in many 
developed countries due to population ageing, which has started to create 
special health needs at the same time that the overall population is 
shrinking, she said. "But there are also considerable concerns about the 
economic, social and health situation in the poorest countries," she added. 
Grondin also emphasised that migration of health workers is a global 
phenomenon, and is no longer "just a South-North issue." Today migration can 
be North-North, as with Spanish nurses recruited in France; South-South, 
with doctors heading to South Africa from neighbouring countries like Kenya; 
or East-West, as large numbers of Polish nurses emigrate to the U.K., she 
explained.

Moreover, the loss of health professionals is not solely due to the 
international mobility of health professionals, but also to internal 
migration, because in many countries - both developed and developing - 
health workers move from rural to urban areas. "This internal migration 
compounds the drain brain effect of international migration and contributes 
to inequities in access to healthcare within countries," said Grondin. 
"Another type of loss associated with migration is what we call brain waste, 
which is associated with the cross-industry migration of qualified 
healthcare professionals who leave to work in non-health-related 
occupations," she added.
This "brain waste" is frequently the result of stringent licensing 
regulations in many of the developed countries, she noted, which means that 
migrant health professionals in countries like Canada and the U.K. are 
unable to put their skills to use by exercising their professions.

In the meantime, there has also been a growing movement of patients to 
foreign countries for diagnosis and treatment, driven by differences in 
cost, the availability of quality specialised treatment, and the absence of 
waiting lists. This movement is facilitated by the increased portability of 
health insurance and by linguistic, cultural and geographic proximity, as in 
the case of patients from Bangladesh going to Thailand for treatment, said 
Grondin. As a means of curbing the brain drain represented by the flow of 
health professionals from the developing to the developed countries, some 
experts recommend improving remuneration and working conditions in their 
countries of origin. As far as Kimani is concerned, however, this supposed 
solution is "paradoxical."

"When you take the most important resources from a poor country, you 
destabilise the poor country and make it very difficult to improve 
conditions, because to improve conditions you also require the brains which 
have left that country. That makes it difficult to improve the reasons or 
the causes of migration, and it becomes a vicious circle," he maintained. A 
potential solution would be for the developed countries that benefit from 
the migration of health professionals to compensate the developing countries 
with the funds and resources that were used to educate them, suggested 
Kimani. He also proposed that health professionals who have been recruited 
from developed countries could remit money back to their country of origin 
as a form of tax that could be used to finance development programmes.

"When one is educated by taxpayers' money and then disappears from his 
country, he no longer pays tax, and therefore he no longer contributes to 
the welfare of the rest of the society," he said. For his part, however, 
Ziba opposed this strategy, because it would entail double taxation. In the 
meantime, there seem to be few prospects for alleviating the growing problem 
of health workers from the South migrating towards the industrialised 
nations. The United States Department of Labour has acknowledged that the 
country is currently facing a shortage of 125,000 nurses, and this figure 
could rise to as high as a million in ten years. And Canada has predicted 
that its shortage of nurses will reach 195,000 in the year 2011 and 282,500 
in 2016.

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