AFRICA – SciDev.Net has reported that the outbound healthworker movement from Sub-Saharan Africa to developing nations in Europe and the Americas has unfortunately only gone up despite the World Health Organisation (WHO) red list.
The report notes that the WHO’s introduction of a safeguard list to prevent rich countries from poaching healthcare workers from countries where health workers are in short supply is not active.
The red list, the WHO health workforce support and safeguards list, was launched in 2020 to replace the list of countries with critical health workforce shortages contained in the WHO’s World Health Report, and the WHO updates it every three years.
The list is advised by the “Expert Advisory Group on the Global Code of Practice on the International Recruitment of Health Personnel” or “ the Code”.
The list has recommended that countries with the most pressing health workforce needs related to universal health coverage should be identified, and support and safeguards targeted at them.
WHO’s Expert Advisory Group further has called on leading destination countries and development partners, as well as others interested in providing health workforce-related support and safeguards, to commit multi-year flexible funds towards implementation of “the Code” as a global public good.
WHO during the release of the updated list in March noted that the impact of COVID-19 and widespread disruptions to health services had resulted in a rapid acceleration in the international recruitment of health workers.
Moreover, for countries losing health personnel to international migration, this could negatively impact health systems and hinder their progress towards achieving UHC and health security.
Specifically, of the 55 countries, 37 are in the WHO African region, eight are in the Western Pacific region, six are in the Eastern Mediterranean region, three are in the South-East Asia region and one is in the Americas.
Eight countries have been newly added to the WHO health workforce support and safeguards list in 2023 since its original publication in 2020.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General said, “Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems do not have enough, and many are losing their health workers to international migration.”
Dr. Ghebreyesus added that the WHO was working with these countries to support them to strengthen their health workforce, and called on all countries to respect the provisions in the WHO health workforce support and safeguards list.
“The list should be used to inform advocacy, policy dialogue at all levels and financing efforts in support of health workforce education and employment in these countries,” reiterated the Director-General.
Despite the Code’s novel intentions emmigration is higher than ever
According to the UK’s Nursing and Midwifery Council, more than 7,000 Nigerian-trained nurses relocated to the United Kingdom between 2021 and 2022.
Additionally, data from the Ghana Registered Nurses’ and Midwives’ Association shows that nearly 4,000 nurses left the country in 2022.
Meanwhile, in Zambia’s case more than 4,000 health workers, including about 2,600 nurses, left the country in 2021 and 2022, the Zambia government revealed.
WHO has recommended, “that government-to-government health worker migration agreements be informed by health labour market analysis and the adoption of measures to ensure adequate supply of health workers in the source countries”.
Health sector organizations, however, say it appears to be ineffective in stemming the tide.
For instance, the British government currently flouts the safeguard list by recruiting from these countries.
The latest data from the UK’s nursing regulator, the Nursing and Midwifery Council, show significant increases in recruitment of nurses from outside Europe, including countries on the WHO red list.
The RCN said those entering the UK nursing workforce included recruits from 14 countries on a red list of 47 that the UK Government had stipulated should not be actively recruited from.
“The UK list mirrors the World Health Organization, which says these 47 countries face the most pressing health workforce shortages and have been identified as having serious workforce challenges and must not be targeted for systematic recruitment by NHS or independent employers,” the RCN said in a statement when the data was released.
Nurses working in the UK, who spoke with SciDev.Net, say the British government only stops third parties such as agencies from recruiting but allows individuals to apply directly to the NHS or care homes of their choice.
In a revised code of practice issued earlier this year, the UK government confirmed that the embargo was not applicable to direct application.
“For the purpose of this code of practice, a ‘direct application’ is when an individual makes an application directly and on their own behalf to an employing organization,” a clarification posted on the government website read.
Nigeria sits top of the list and has the highest exodus figures
Nigeria sits in the top three countries outside Europe, with over 3,000 joining the UK’s official register in 2022.
The WHO notes that in Nigeria, each doctor has an average of 5,000 patients, whereas the Organisation for Economic Co-operation and Development (OECD) average is around 270 patients per doctor.
While the Nigerian Association of Nurses and Midwives has reported that Nigeria now has a nurse-to-patient ratio of one nurse to about 1,160 patients, whereas the OECD average is one nurse to around 114 patients.
Michael Nnachi, the president of the National Association of Nigeria Nurses and Midwives, told SciDev.Net that over 75,000 nurses had left Nigeria since 2017.
Nnachi said the improved conditions of service as well as the provision of social security could solve the emigration crisis.
He said that inflation in Nigeria compounds health workers’ situations and makes it difficult for people to afford a decent life on their salary.
According to the WHO’s estimates, the world will face a shortage of 10 million health and care workers by 2030.
And the numbers are mostly in low-income countries, where health workers are leaving to find opportunities abroad.
Will policies plug the drain?
Governments across Sub-Saharan Africa have been pushing for various legislations to curb the brain drain.
In April, Nigeria’s House of Representatives, or lower chamber, passed the Medical and Dental Practitioners Act (Amendment) Bill, 2022, for the second reading.
The bill, which is yet to be passed by the senate – the upper chamber – seeks to make it compulsory for graduates in medical and dental fields to render services within Nigeria for five years before being granted a full license.
The lawmaker who sponsored the bill, Ganiyu Johnson, said the move was to curb the mass exodus of medical professionals from the country.
Zimbabwe’s vice president and health minister, Constantino Chiwenga, had also hinted that the government plans criminalize foreign recruitment of its healthcare workers.
“If one deliberately recruits and makes the country suffer because it lacks the required professionals, that’s a crime against humanity,” Chiwenga said.
Although no legislation has been passed to back this, stakeholders and rights activists have kicked back against the measures, which many claim may be counter-productive.
Julian Ojebo, a medical doctor and consultant anaesthesiologist at Irrua Specialist Teaching Hospital, in Nigeria’s Edo state, said pushing for policies such as withholding licenses would only worsen the problem.
He noted that the brain drain is not limited to the health sector, saying, “Even people in the military and commerce are leaving the system. Check what is happening in Canada today. We have people from the banking sector, engineering moving there.”
Ojebo believes the government needs to be taking action to reduce brain drain, “One of the options is to actively employ. There should be active employment of nurses and doctors.”
Former Nigerian lawmaker Shehu Sani says health workers will only be retained if their prospects in the country improve.
“Doctors and nurses are leaving for greener pastures in the West and the Middle East. Do we need a law to stop them or do we need to improve their working conditions in order to keep them?” questioned the lawmaker.
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