The figures tell it all. In South Africa, 37 percent of the country's doctors and seven percent of its nurses have migrated to Australia, Canada, Finland, France, Germany, Portugal, Britain and the United States. These statistics, compiled by the Organisation for Economic Co-operation and Development (OECD) and the World Health Organisation (WHO), reflect the magnitude of the health worker "brain drain" in Southern Africa.
Human Resources
Medical brain drain puts Southern Africa in a quandary
Inter Press Service News Agency: Nduru M
Medical Schemes: Research Conducted by TAC and CARE
The Treatment Action Campaign (TAC) welcomes the results of the research done on HIV Benefits in Medical Schemes in 2002 by the Centre for Actuarial Research at the University of Cape Town in association with our organisation. One of the most important pieces of legislation promulgated by South Africa's first democratic government is the Medical Schemes Act (Act 131 of 1998). Unfair discrimination against people on a range of grounds including "any medical condition" is prohibited by private medical schemes. The AIDS Law Project, AIDS Consortium and current TAC members supported the passage of the legislation against powerful forces including the insurance industry, the Chamber of Mines and others. This survey shows conclusively that the Medical Schemes Act has been successful in ensuring coverage by medical schemes of people with HIV/AIDS.
Further details: /newsletter/id/29235
Medicines without doctors: In Mozambique, salaries are not the biggest problem
de Oñate WA: PLoS Medicine 4(7): 1280-1281
In the case of health workers in Mozambique, the brain drain is not the biggest problem, neither are the salaries. There is a pure lack of doctors, with only up to 60 doctors a year being trained at the University for a population of 18 million. The funds from international donors for the National AIDS Plan are not accessible to the Faculty of Medicine to support the basic education of doctors because of restructions placed by donors.
Medicines without doctors: Why the Global Fund must fund salaries of Health Workers to expand AIDS treatment
Ooms G, Van damme W, Temmerman M: Plos Medicine, 17 April 2007
Recent comments from the inside of the Global Fund suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and the support to the health workforce to others. This might create "Medicines Without Doctors" situations: situations in which the medicines to fight AIDS, Tuberculosis and Malaria are available, but not the doctors or the nurses to prescribe those medicines adequately.
Medicines without Doctors: why the Global Fund must fund salaries of health workers to expand AIDS treatment
Ooms G, Van Damme W, Temmerman M: Public Library of Science Medicine , 2007
The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to fight three of the world’s most devastating diseases. Recent internal comments from the Global Fund suggest an intention to focus more on these diseases, and to leave the strengthening of health systems and support for the health workforce to others. This article, in PLoS Med, examines the implications of this strategy, and suggests that it could create a ‘Medicines without Doctors’ situation in which the medicines to fight AIDS, tuberculosis, and malaria are available, but not the doctors or the nurses to prescribe those medicines adequately.
Meeting human resources for health staffing goals by 2018: A quantitative analysis of policy options in Zambia
Tjoa A, Kapihya M, Libetwa M, Schroder K, Scott C, Lee J and McCarthy E: Human Resources for Health 8(15), 30 June 2010
The authors of this study developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels.
Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system
Bradley S and McAuliffe E: Human Resources for Health 7(14), 19 February 2009
In Malawi, mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. These cadres undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While several studies address retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce. This exploratory qualitative study undertook focus group discussions and semi-structured interviews at in four rural mission hospitals in Malawi among mid-level providers of emergency obstetric and neonatal care. Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education (particularly for clinical officers) and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly demotivating. For optimal performance and quality of care mid-level cadres need to be supported and properly motivated. A structured system of continuing professional development and functioning human resources management would show commitment to these cadres and support them as professionals. Action needs to be taken to prevent staff members from leaving the health sector for less stressful, more financially rewarding alternatives.
Midwife shortage in South Africa impacts maternal health
IRIN News: 27 June 2011
Rather than making progress towards the Millennium Development Goal of reducing maternal mortality by 75% by 2015, the number of deaths resulting from pregnancy or childbirth in South Africa has doubled in the past 20 years, according to government figures. For every 100,000 babies born, up to 625 mothers die due to childbirth complications. Loveday Penn-Kekana, from the University of the Witwatersrand in Johannesburg, believes South Africa's poor maternal health outcomes are linked to the lack of midwifery services. She called for the government to invest in more and better trained midwives, especially as they bore most of the responsibility for day-to-day operations in maternity wards. Midwives are classified as nurses in South Africa so there are no figures on their numbers, but she argues that there are too few. Low enrolment at nursing colleges is part of the problem, but many midwives have also left the public sector to work for higher salaries overseas or in managerial positions, because of the limited opportunities for career development and advancement in the clinical area. The Society of Midwives of South Africa has noted that lack of midwives means that the quality of the services they provide is declining, as existing midwives are overworked. Also, because they argue that people are first trained as a nurse and then given midwifery skills, midwifery is not prioritised. A plan by South Africa's Health Minister to reopen unused nursing colleges across the country and increase the number of nurses may result in more midwives being trained.
Migrant remittances
Eldis
This key issues page looks at some of these perceived impacts, and provides recommendations for further reading on the subject of migration and remittances.
Migrant remittances
Eldis
The movement of people across and within borders has characterised the development of most global regions, resulting in a rich intermingling of cultures. Such movement is often motivated by the desire for a better life, whether this entails finding new land to cultivate or money making opportunities. In recent years, the process of movement has itself been simplified, opportunities for work in services and industry have boomed and globally, numbers of migrants have increased dramatically . In response, an increasing number of studies are emphasising the impacts of migration, particularly for developing countries, in the form of remittances - money sent by migrant workers back to communities and households. This key issues page looks at some of these perceived impacts, and provides recommendations for further reading on the subject of migration and remittances.