Brain drain adds to AIDS crisis in developing world.

Stanley Green, born in South Africa and raised mainly in Jamaica and the U.S., has been active in the fight for equitable access to care for people living with HIV/AIDS through his work with several organizations in the U.S., Spain, and South Africa. He plans to return to South Africa to pursue medical studies and help reverse the brain drain.

Many doctors and nurses are leaving poor countries that cannot afford to employ them, for jobs in the U.S., UK, and other industrialized countries. The crisis has become so severe that poor countries like Malawi in southern Africa now have about 100 doctors and 2000 nurses to serve their entire population of 12 million people. The hospital beds in many poor countries are full and overflowing. Staff are unable to keep up with the seemingly endless flow of patients near death.

The disparity in the numbers of healthcare workers in the "brain gain" countries, which receive foreign-trained medical professionals, and the "brain drain" countries which train them (often with educational investments of over $150,000 each) is staggering. The US, where more than 25% of doctors are foreign trained, has an estimated 25.6 doctors per 10,000 population. In comparison, the small country of Lesotho in southern Africa has 0.5 doctors per 10,000 population, and an adult HIV prevalence rate of 28.9%--in addition to tuberculosis, malaria, and the host of other lower respiratory and gastrointestinal illnesses that plague that part of the world.

A 2003 study conducted by the Organization for Economic Cooperation and Development revealed that 23,407 South African doctors were employed in the US, Canada, the UK, Australia [1], and New Zealand. These numbers are especially troubling in the light of statistics released in 2001 that found only 11,323 doctors were working in the South African public health sector, upon which more than 75% of the population depend. (See The Placement Project, South Africa--link below.)

Many rich countries fail to train enough medical professionals to meet their own needs. U.S. medical schools produce an average of 17,000 graduates annually--30% below the number needed to fill the empty residency positions. Several rich countries have announced commitments to increase medical training.

As Eric A. Friedman of Physicians for Human Rights explained to AIDS Treatment News, a comprehensive approach would fund employment of thousands of trained health professionals now unemployed in poor countries unable to pay them, as well as training both high-level professionals (doctors and nurses) and paraprofessionals and community health workers. It would retain these workers with a living wage, safe working conditions, medicines and supplies so that they can treat patients effectively, professional development opportunities, and good management so that health workers receive feedback and can have concerns addressed. It would provide incentives to practice in rural areas, such as hardship allowances, housing, and transportation. It would enable health workers to be treated, as many are now dying of HIV. It would reform local policies such as rules requiring that only physicians can draw blood, and give nurses more authority. And it would reform rich-country policies to follow ethical recruitment practices and increase their domestic supply of health workers, rather relying on health workers from abroad to address their shortfalls.

A new paradigm in international funding seems to be refocusing funds towards human resources. The WHO's World Health Report 2006 featured training and funding of health care workers as key to solving many health problems. A radical rethinking of interconnected global health systems may be on the horizon, and perhaps with it the way to more equitable access to health care for all.

For More Information

1. Physicians for Human Rights: An Action Plan to Prevent Brain Drain, http://www.phrusa.org/campaigns/aids/pdf/braindrain.pdf

2. Health GAP: Human Resources for Health Campaign, http://www.healthgap.org/camp/hcw.html

3. World Health Report 2006, http://www.who.int/whr/2006/en/index.html

4. The Placement Project, http://www.theplacementproject.co.za/

References

[1.] A Google Gmail address used in editing this article displayed a targeted ad "Nurses jobs"; it linked to http://www.liveinvictoria.vic.gov.au, an Australian government site to recruit people with certain skills to move to Victoria, Australia's second most populous state.