Band aid for medical brain drain

New laws introduced by the British government this week are unwittingly giving the southern African region a temporary reprieve from the brain drain of medical staff.

The new laws stipulate that employers in Britain will only be granted work permits for foreign nurses if they can prove that no suitable British or European Union candidate can be found.

Regional nursing associations in southern Africa said the new legislation, which tightened employment regulations in the United Kingdom (UK) for nursing staff from 150 countries would not address the "push factor" that was the underlying cause of the malaise.

The British government said the law would safeguard jobs for its local nursing staff. Reports said 80 percent of Britain's qualified local nurses were unable to find work in their profession, which coincides with employment data showing that unemployment levels are flirting with the politically sensitive one million mark.

English language skills in many southern African countries, combined with nursing skills, make the region a major recruitment ground.

The exodus of medical staff from Zimbabwe has been particularly severe. The country is in the grip of an economic meltdown, with unemployment at more than 70 percent and inflation hovering at about 1,000 percent.

Zimbabwe's community development minister, Eunice Chitambira, said between 70 percent and 90 percent of university graduates, mostly in the fields of medicine, education and engineering, had left the country.

Vanzai Majada secretary-general of the Zimbabwe Nurses Association, praised Britain's new legislation, but said the benefits would be minimal and short-term. "Such restrictions would help our country because we are still losing intermediate and experienced staff to the UK. The effect has been to leave the newly qualified nurses without mentors. This has resulted in a drop in the quality of care."

Government incentives of subsidised transport and meals had failed to retain nursing staff. "The problem is that we live in a hyperinflationary environment, so the money is never adequate. Cross-border traders earn much more than health professionals in this country," Majada said.

A representative of the Zimbabwe Hospital Doctors Association, who declined to be named, said the primary cause of medical staff migration were the "push factors" of low salaries and poor working conditions - the cure for the brain drain was in the hands of the region's governments and not Britain's new laws.

"There may be a slowdown in the rate of migration because most people prefer the UK, but this will be short-lived because very soon people will be looking for other destinations," he maintained.

"Those who want to leave the less-paying and more stressful jobs in Africa can still go to Canada, Australia and New Zealand, where the demand for health staff is equally high and better packages are still on offer. What the UK did is like closing one hole and leaving a maze of others wide open."

A Botswana Nursing Association (BNA) member, who did not wish to be named, echoed his Zimbabwean colleague, saying, "The problem is that beyond talking, our government is doing nothing to improve salaries and working conditions. People will move as long as grievances are ignored."

The BNA leadership was not available for comment.

Prof Sheila Tlou, Botswana's health minister, said the drain on medical resources began with students, who went on courses abroad and refused to come home after they had finished training. "They are now shunning us a nation, saying we are ravaged by HIV/AIDS, government is underpaying them and that we offer poor quality treatment compared to where they are."

Botswana, with a population of 1.8 million people, had an HIV/AIDS prevalence of 37 percent in 2003. The government has said that for its HIV/AIDS programme to succeed it would require 1,500 new medical staff including nurses, pharmacists and laboratory technicians.

Although South Africa draws healthcare staff from the region, more than 10,000 South African nurses are working in the UK, with many others in New Zealand, Australia, Canada and the United States. The ratio of nurses to patients is about 577 in South Africa's richest province, Gauteng.

The international relations coordinator for the Democratic Nurses Association, Siphokazi Philip, welcomed the legislation if it meant "more of our nurses stay and those who are already out there come back when they can't get their permits renewed."

In terms of the new legislation nurses have to re-apply for their positions once their work permits expire, and preference will be given to British and EU nurses.

Britain's new law was unlikely to have any impact on Namibia's healthcare crisis, which was so acute that the government was importing nurses from Kenya and recalling others from retirement.

Health minister Dr Richard Kamwi said nursing shortages were felt most in the rural areas, but this was not necessarily a consequence of the brain drain.

"Our own qualified registered nurses do not want to operate in rural areas. They choose the urban areas instead, saying they are close to the shopping centres for transport and convenience. But I think some of these excuses are quite shabby.
The honeymoon is over because these nurses were trained with government resources and we are encouraging them to spread their commitment to the regions as well," he commented.

The nursing shortfall in the remote regions was being filled through the use of volunteer nurses from the United States, Austria and Cuba.

Executive director of the United Nations Children's Fund (Unicef), Ann Veneman, said recently that the brain drain in the health sector was hampering Sub-Saharan Africa, which has 3 percent of the world's healthcare workers and was struggling against poverty, high child mortality rates, malaria and the HIV/AIDS pandemic.

"I have travelled to Africa and it [brain drain] is a key issue," Veneman said. "They [health workers] are migrating not just to Europe, but also to South Africa, to where the salaries are better. This forces countries to train at a faster rate. I don't know how you can stop them from leaving."