Should countries ban the migration of health workers?
Zimbabwe is taking a radical step by making the recruitment of health workers illegal. The country wants to combat what it calls a "violation of human rights" and a "crime against humanity". Constantino Chiwenga, the country's vice president and Health minister, believes that Zimbabwe is not able to maintain sufficient medical personnel. This is due to a severe brain drain, with an increasing number of health workers moving to Western countries.According to local media, more than 4,000 nurses and doctors have left the country since February 2021. It is believed that many have also moved to the United Kingdom, where there is a shortage of healthcare workers. The UK offers much higher salaries than Zimbabwe. But in March, the World Health Organization (WHO) placed the country on its red list, reserved for countries with severe shortages of health workers. The United Kingdom was forced to halt recruitment. According to the Zimbabwe Medical Association, the country has only 3,500 doctors for a population of 15 million.
Nurses: Between brain drain and international recruitment
Zimbabwe is not a unique case. Many other countries need more health workers and are recruiting. The health crisis has exposed the fragility of health systems and accelerated the brain drain. But there are huge disparities between rich and developing countries. The WHO sounded the alarm in March 2023. According to the agency, 55 countries are experiencing a significant shortage of health workers, most of them being African countries (37). These health workers prefer to relocate to other countries in demand, such as the UK, Canada, or France, for higher salaries and better working conditions.At its meeting on January 23, the International Council of Nurses expressed concern. At a press conference, it cited "7 or 8 wealthy countries, especially Britain, the United States and Canada" as responsible for "about 80% of the international migration of nurses," most of whom are recruited in Africa and Southeast Asia, regions of the world already in a precarious health situation. In addition to France and Germany, the United Kingdom, the United States, and Canada had been recruiting directly from developing countries. To address its shortage of health workers, the Quebec Ministry of Health had launched a campaign to recruit 4,000 health workers abroad, particularly in the Maghreb (in 2021-2022). Meanwhile, Germany set up consultation centers in developing countries, and one has been operating in Ghana since 2017. Others are expected to open in Indonesia, Egypt, Tunisia and Morocco, with the aim to recruit qualified caregivers and other foreign talent. However, this is perceived differently by the countries from which health professionals are moving. They see it more as an organized brain drain.
How can developing countries retain their health professionals?
This is not a new problem, and the challenge is growing for emerging economies. The current crisis is driving many health professionals to other, better-paying countries. Many feel guilty about "leaving" their home countries, knowing their departure will not be replaced. Nevertheless, they are willing to remind governments to honor their commitments.To retain their health workers, developing countries are focusing on two main areas: training and innovation. In terms of training, universities have increased their enrolment capacity since 2010. More medical students mean better quality training. Innovation also comes into play with investments in health facilities and hospitals (medical equipment, infrastructure, etc.). But the beautiful announcements and images hide a more complex reality.CubaCuba has been known for its "medical internationalism" since 1963. Used as a genuine diplomatic tool, medical internationalism has made Cuba a medical powerhouse despite a sluggish economy. In 2018, the country had 8.4 doctors per 1,000 people. That's nearly double the OECD average. Numerous well-trained caregivers, accessible care for the population, and medical teams sent to help in other countries are some of its advantages. However, the Covid pandemic has exposed significant flaws in the aging infrastructure of the health system, which reportedly has far fewer nurses than advertised.IndonesiaIndonesia's health system is healing from the health crisis. Already fragile and overburdened, the system became unmanageable during the Covid pandemic. Young graduates and medical trainees were quickly called upon to strengthen the system as many Indonesian doctors got infected. By July 2021, at least 434 doctors had died from Covid, according to the Indonesian Medical Association. Passion for the profession seems insufficient to convince young doctors to stay. Stress, anxiety, exhaustion, lack of equipment, staff shortages, unpaid salaries, ever-increasing tuition fees, etc., made things harder for healthcare workers. Although the government has raised wages to $1150 monthly to attract young doctors, the situation is still alarming.NigeriaNigeria is developing its infrastructure to retain its healthcare professionals. In 2014, the Ukana West 2 Community-Based Health Insurance (CBHI) program was launched by the Universal Health Coverage (UHC) organization, which brings together government, academic, and international bodies to strengthen health systems worldwide. The creation of CBHI (in Akwa Ibom State) has enabled the return of health workers, better salaries, a restored drug supply chain, more efficient services and improved equipment. Although this was a positive achievement, it did not alleviate the severe shortage of health workers in the rest of the country. The situation got worse, leading to an "exodus" of Nigerian doctors to the West. To retain these professionals, a member of parliament proposed a law in early April that would require medical students to practice in Nigeria for five years before graduating. However, the Nigerian Association of Resident Doctors (NARD) believes such a step would be too drastic. Instead, Nigerian doctors are recommending improved working conditions, higher salaries, modernized health facilities, and greater awareness of the risks involved in their profession.
Should health professionals move abroad?
Health workers in developing countries agree on the urgent need to save their health systems, blaming their governments that claim not to have the required financial resources. Still, those who choose to move abroad do recognize that they are leaving a greater burden on the shoulders of their colleagues. Others believe they should not waste their efforts and degrees in their own country. There are also those who are waiting for the right time to move to Saudi Arabia, the US, or the UK.Many also choose to stay out of solidarity; they are sometimes the only caregivers in their region and know their presence is essential for the locals. These caregivers speak of the bonds they have formed with the locals, their desire to work for their country, their initiatives to improve their situation, and their struggle to renovate a clinic or set up a care center. However, they do not consider themselves better than others and understand the choices made by their colleagues.
