3rd July, 2008
Ways must be found to turn the global labour movement into a win-win situation
By Peter Ngatia
The European Union’s plans to develop a ‘Blue Card’ to attract highly qualified migrants to meet its labour needs raises several urgent concerns, particularly for African governments grappling with critical shortages of health workers.
The International Organisation for Migration says Africa has already lost one third of its human capital and continues to lose skilled personnel at an increasing rate, with an estimated 20,000 doctors, university lecturers, engineers and other professionals leaving the continent annually since 1990. The IOM estimates that there are currently 300,000 highly qualified Africans in the diaspora, yet at the same time Africa spends US$4 billion annually to employ some 100,000 western experts.
The effects of this brain drain are felt directly in key social sectors of African economies, particularly education and health. Ten years ago, there were 1,600 doctors in Zambia; only 400 are left now. In Kenya, 90 per cent of the medical personnel migrate to Europe and the USA every year. There are more Ethiopian-trained doctors practising in the city of Chicago alone than in the whole of Ethiopia, and more Malawian-trained doctors practising in Manchester than in Malawi.
Largely as a result of this massive haemorrhage of personnel, Africa has only 3 per cent of the global health workforce, despite bearing 25 per cent of the world’s diseases. The health workforce is undoubtedly the driver of health systems. Immigration of this precious resource from Africa has resulted in severely weakened health systems that can barely provide services, leave alone pursuing the aspirations of the Millennium Development Goals.
The proposed EU Blue Card, a special residence permit granted to immigrants, is only bound to aggravate the situation, legitimising labour movements to Europe at the expense of low-income countries in sub-Saharan Africa. An exodus of health professionals will create even greater global imbalance, with host countries creating reservoirs of health care professionals to replenish their aging and diminishing workforce, while African countries have to put increasingly greater pressure on health systems that are already stretched to breaking point. Ultimately, further depletion of Africa’s intellectual property will reverse gains made in eradicating extreme poverty and hunger, reduction of child mortality, improvement of maternal health, and the fight against HIV and AIDS, malaria and other diseases.
The EU must consider the moral and ethical implications of its proposal before introducing the Blue Card. My gut reaction would be to ask the EU to have an exclusion clause for health professionals. But free movement is a human right, and African health professionals will move to Europe anyway, with or without the Blue Card. Moreover, we cannot ignore globalisation, and the need for African health professionals to contribute to ameliorating the global burden of disease while enjoying the fruits of their hard work. We must therefore look for ways to turn the global labour movement into a win-win situation for Africa and Europe.
The challenges of stemming the brain drain are daunting, but certainly not insurmountable. But the efforts must be collaborative between African governments, and the western governments and institutions that recruit from Africa. To contain the health workers still on the continent and attract others from the diaspora, African governments must vigorously address the ‘push’ factors that lead to migration. They must provide qualified health professions with employment, competitive salaries and incentives such as good housing; opportunities for professional and career development; and health facilities with necessary basic requirements.
Europe too must be proactive in ensuring that African health systems are not robbed of valuable human resources without compensation and restitution. Support could be extended to programmes that train health workers specifically for the African context, such as the African Medical and Research Foundation’s Diploma in Community Health course, and the innovative eLearning Programme that trains nurses virtually, allowing them to learn and work at the same time.
If Europe must recruit from Africa, it should invest in building the capacity of training institutions to enable Africa to train enough health workers for itself and to meet Europe’s needs. With expanded physical and fiscal space, the EU could contract individual African countries to produce health workers for them.
Ultimately, both the EU and African governments must implement policies that address health workforce densities, the weakened African health systems and resultant inequities, and the global diseases burden.
Dr Ngatia is the Director for Capacity Building at the African Medical and Research Foundation (AMREF)