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Africa's Health-Care Brain Drain

August 13, 2004

As Africa tries to fight AIDS, the single most serious obstacle is a desperate shortage of health workers. Yet at the same time, doctors, nurses and pharmacists in English-speaking African countries are emigrating in droves to Britain, the United States, Canada and Australia. In Ghana and Zimbabwe, three-quarters of all doctors emigrate within a few years of completing medical school. Randall Tobias, President Bush's global AIDS coordinator, said in a recent speech that there were more Ethiopian-trained doctors practicing in Chicago than in Ethiopia.

The problem isn't new, particularly when it comes to African doctors, but as Celia Dugger wrote recently in The Times, the flight of nurses is a growing phenomenon, fueled principally by the nursing shortages in wealthy nations. Instead of paying salaries that would attract homegrown nurses, American hospitals recruit in the Caribbean, the Philippines, India and Africa. The same is true in Britain. From 1994 to 2001, the number of nurses registering to work in Britain who came from outside Europe grew to 15,000 from 2,000.

The group Physicians for Human Rights recently published a detailed report about this problem and its consequences. One is that the world's poorest countries are providing enormous quantities of medical aid to the richest. The United Nations estimates that every time Malawi educates a doctor who practices in Britain, it saves Britain $184,000.

It's understandable why overseas work is attractive. AIDS and tuberculosis have stretched African health services to the breaking point, placing impossible demands on nurses in particular. They do their jobs without adequate equipment or drugs. Their paychecks sometimes arrive months late. They risk infection - in some places, even gloves are scarce. While rich countries average 222 doctors per 100,000 people, Uganda has fewer than 6. Malawi has 17 nurses for every 100,000 citizens; many rich countries have more than 1,000.

This is a problem with no easy solutions. One of the worst ideas would be any sort of restrictions on emigration, which would not only be discriminatory, but also counterproductive. Africans would be even less likely to choose careers in medicine. Nevertheless, it's unseemly for wealthy countries, which could afford to pay nurses enough to create an ample homegrown supply, to run ads instead to recruit skilled staff in places like South Africa. In 2001, the British National Health Service swore off recruiting nurses from countries without their governments' agreement, but private hospitals and nursing homes still do it.

African doctors and nurses understand how much they are needed at home, and many would resist relocation if the conditions under which they work were more bearable. The obvious long-term solution to the medical brain drain is for wealthier countries to reimburse Africa's health and educational systems for the cost of poaching their professionals, and to greatly increase the financing and technical help for Africa's health systems - in their entirety, not just the clinics that deal with AIDS.

The concern over AIDS, paradoxically, has created an opportunity by focusing world attention on Africa's miserable health care. Improving it would cost very little money, relatively speaking, and end the exodus of doctors and nurses that is exacerbating the epidemic's devastation.