Affect of Brain Drain on Africa's Healthcare System

Affect of Brain Drain on Africa's Healthcare System

Introduction

A global shortage of health workers makes it relatively easy for doctors and nurses from poor countries to emigrate to rich countries. This has raised fears of a medical brain drain from poor to rich countries and has been the subject of much - impassioned - debate. South Africa is argued to play a central role of 'victim' as well as 'executer' in this process. Victim because the country 'exports' doctors and nurses to richer countries and executer because it, in return, 'imports' doctors and nurses from poorer countries. The South African government frequently points to health worker migration as an exacerbating factor in the country's health crisis. In 2002, the South African Minister of Health claimed that 'if there is a single major threat to our overall health effort, it is the continued outward migration of key health professionals, particularly nurses'. The South African has consequently implemented policies to curb emigration .

Likewise, South Africa has imposed a moratorium on the recruitment of health workers from other African countries (unless a bilateral agreement exists) in order not to 'to wipe out [other African countries'] health care systems by taking away their health professionals'.This paper questions the underlying rational behind these policies. In doing so, it also challenges the dominating view on the medical brain drain: that out-migration of health workers from developing countries has damaging consequences and curbing that migration is pivotal in safeguarding developing countries' health systems. A view which is rooted in a perhaps intuitively convincing assumption that out-migration and low levels of health workers are closely correlated that outward migration causes low levels of health workers in South Africa and elsewhere. This paper will argue that this is a specious assumption. Consequently, it will question the calls for restraints on the recruitment of health workers from poor countries . Although such calls may appear to occupy the moral 'high ground', they have been largely ineffective and are counterproductive in increasing the number of health workers in poor countries.

The paper calls for a paradigm shift in perspectives on migration of health workers as the current one is built on questionable theoretical assumptions and hypothesis. It overestimates the effectiveness of its policy recommendations and systematically ignores important negative side-effects of these. Further, it completely ignores positive impacts from out-migration and focuses solely on the negative; its conclusions are, thus, not surprising.

Instead a perspective is needed which factors in the positive effects from migration of health workers, such as remittances, diaspora linkages, and socalled brain gain effects - and which provides realistic policy recommendations without counterproductive side effects. The paper will show that such a perspective - or rather a handful of several mutually reinforcing perspectives - is indeed emerging. These perspectives highlight the need for new policy directions toward international migration of health workers. The paper provides examples of different approaches and argues that South Africa has a potential role as a regional ...