Government wakes up to flight of health workers

South Africa's leading nurses' union on Tuesday welcomed comments by the government addressing the debilitating flight of health professionals from the country. Speaking at a Commonwealth meeting of health ministers in Geneva, Health Minister Manto Tshabalala-Msimang said: "The recruitment of health workers from developing countries has created unforeseen shortages in those countries." She said that the exodus of medical professionals could be stemmed by bilateral agreements between developing and developed countries. "While we are pleased that the minister acknowledges the magnitude of the problem, we insist that the health department consult us throughout the setting up of these bilateral agreements," nurses' union leader, Thembi Mngomezulu, told IRIN. "It would be in the government's best interest to make sure we agree to all of the terms of any agreement," said Mngomezulu, deputy secretary of the Democratic Nursing Organisation of South Africa (DENOSA). More than 300 specialist nurses leave South Africa every month according to DENOSA. Many never return. Many of those who leave have complained of their conditions of work and how they are treated. "We are tired of lip service. The time has come for some real action," Mngomezulu said, adding that nurses run hospitals and carry a huge responsibility but "are suffering or leaving". She said that if experienced nurses carry on earning the same as other nurses after six years service, all the experienced staff would be lost. Fully trained public sector nurses can earn US $716 a month, unless they move away from the bedside into management. Their starting salary after four years' study is US $296. "A vicious cycle has developed in that the few loyal nurses that remain in the public service are required to deal with a heavier if not totally unrealistic workload. The state as an employer, last year agreed on introducing incentives to retain specialised skills in the health services. To date, such incentives have not materialised," Mngomezulu said. She added that the flight of specialised skills would have a devasting effect on the quality of care for the terminally ill, especially for HIV/AIDS patients. "We are smack in the middle of a national epidemic. The last thing we need now is people jumping ship. Already many of the hospitals which come face to face with dying patients are understaffed and ill equipped." Dr Kgosi Letlape, chairperson of the SA Medical Association (SAMA) said: "Countries must address the underlying reasons why health care workers find it necessary to leave their countries to continue their medical careers abroad." He emphasised that developing countries should appreciate their health care workers and remunerate them for what they are worth if they were serious about stopping the poaching of their skilled health work force. "Doctors leave for many reasons and do not necessarily have to be actively recruited to pursue their careers elsewhere. South African doctors are very well trained and have always been sought after by other countries." Letlape stressed that there were various reasons why doctors in both the public and private sector choose to emigrate. These include inadequate facilities and resources that sap morale, and a lack of treatment policies for diseases such as HIV/AIDS in the public sector. There are no accurate statistics available on the brain drain, but SAMA estimates that at least 5,000 South African doctors have moved to countries such as Canada, America, Britain and Australia South Africa is particularly angry at UK-based recruiters, accusing them of poaching the country's best medical professionals in what the government calls "a crucial time in the nation's development". The migration of health professionals is not particular to South Africa. Over the last five years there has been an increase in medical personnel leaving the Southern African region as a whole to seek greener pastures in the more affluent west. A recent study by the World Bank reported that some 70,000 highly qualified African scholars and experts leave their home countries every year in order to work abroad. "Many of these highly skilled emigrants never return home due to the lack of motivation and opportunities for doing so. In order to replace those that have left the continent for greener pastures, Africa spends an estimated US $4bn annually on recruiting some 100,000 skilled expatriates," the report read. According to official statistics, 10,000 people emigrated from South Africa in 2000. Unofficial estimates put the number of professionals heading overseas at three times that stated by the government. A study of emigration to Britain, the United States, New Zealand, Canada and Australia by the Paris-based Institute for Development Research (IDR) estimated that 233,609 people left South Africa for these destinations between 1987 and 1997 - 41,000 of them professionals. One of the worst examples of the regional brain drain cited by the IDR is Zambia. A few years ago the country had 1,600 doctors, but there are now only 400 in practice. Zambian doctors have migrated to Europe, the United States and neighbouring Botswana, lured by higher salaries. In Zimbabwe, a large number of doctors and nurses are also leaving every month, according to a leading Zimbawean financial newspaper. The Financial Gazette reported that qualified nurses, who earn about US $281 a month after being certified to practice, are leaving mostly for Britain. An increasing number are also emigrating to countries such as New Zealand and Australia. Analysts said the main reason for the exodus of Zimbabwe's black professionals was the country's economic and political crisis. Political scientist at the University of Stellenbosh, Heidi Hudson, told IRIN that African governments could do more to halt the brain drain "rather than just becoming increasingly frustrated". While economic conditions "dictate that they cannot yet afford to pay western-size wages, they can ensure that the respect of basic human rights and law prevails over all", she said.