DOREEN NAWA, Lusaka
MIGRATION of skilled health professionals from sub-Saharan African countries has significantly increased in this century, with most countries becoming sources of migrants.
Despite the growing problem of health worker migration, which has affected the functioning of health care systems, there is a remarkable lack and incompleteness of data to show how many professionals exit Africa annually.
Hence, it is difficult to determine the real extent of migration from, and within Africa, and thus develop effective forecasting or remedial policies.
The global overview and most data indicate that the key destinations remain the USA and UK, and that major sources are South Africa and Nigeria, but in both contexts there is now greater diversity.
Migrants move primarily for economic reasons, and increasingly choose health careers because they offer migration prospects.
Migration has been at considerable economic cost. It has depleted workforces, diminished the effectiveness of health care delivery and reduced the morale of the remaining workforce.
Countries have sought to implement national policies to manage migration, mitigate its harmful impacts and strengthen African health care systems but nothing seems to work out best.
Recipient countries have been reluctant to establish effective ethical codes of recruitment practice, or other forms of compensation or technology transfer. Hence migration is likely to increase further in the future, diminishing the possibility of achieving the now United Nations sustainable development goals (SDGs) and exacerbating existing inequalities in access to adequate health care.
But not all hope is lost, in August this year, Association of Medical Councils of Africa (AMCOA) member states signed a protocol with an aim of facilitating the maintenance of adequate, accessible, available and competent health workforce for a strengthened health system within member states.
And this protocol has been endorsed to spearhead the possible solutions to this challenge of migration of health professionals in Africa.
This was done at a two-day meeting from October 27 to 28, 2016 in Mombasa, Kenya at the Sarova White Sands. The meeting was attended by AMCOA members and other health professionals from Zambia, Uganda and Kenya.
AMCOA is comprised of Uganda, Kenya, Zambia, Botswana, Ghana, Lesotho, Malawi, Mauritius, Namibia and Sierra Leone. Others include Zimbabwe, Swaziland, South Africa and Tanzania.
Members of AMCOA have agreed that health professionals in Africa who wish to migrate to foreign countries will be required to first register with their respective medical councils.
Beginning next year, all health professionals will be tasked to fill a standardised application form indicating why they are migrating, where they are moving to, and where applicable how much they will be paid.
â€œGood data and effective operational research and program evaluations are needed most in order to address the migration and retention challenges. These are essential to inform policy makers and senior managers and to guide much-needed efforts to develop an effective health workforce that can assure the health of populations in our countries,â€ says Health Professions Council of Zambia registrar Dr Mary Zulu.
During this meeting, it was discussed that issues of retention and migration have not been a feature of research in developing countries, Africa inclusive.
In Zambia, according to Zambia Nursing Council registrar Beatrice Zulu, 322 doctors and 2,376 nurses have migrated from Zambia to other countries in the last five years; a thing that has negatively affected health service delivery in the country.
The situation is not different in Uganda and Kenya, too. Migration and retention of health professionals have adversely affected the delivery of quality healthcare to the population.
Uganda Medical and Dental Practitioners Council (UMDPC), Ssentongo Katumba said the challenges faced in optimising human resources for health are numerous, starting with the need to identify basic healthcare issues regionally and nationally. Hence the need to find ways to provide integrated care.
Dr Katumba noted that the introduction of the registration process for those that wish to migrate will be of help to all African countries.
This information will be compiled by each country to understand the factors that drive away health workforce within and from their mother countries to other countries so that governments can address the challenges to retain them.
He said the tool is aimed at managing medical tourism through benchmarking governments to provide incentives for workers to stay in their mother countries.
â€œUganda loses over 100 medical doctors who choose to work in foreign countries every year. He says that most of these have migrated to Australia, Botswana, Canada and the United Kingdom, among others.
â€œThe medical council has a challenge of knowing where its medical personnel have migrated to. Previously, the medical council would only offer a letter of good conduct for workers seeking employment outside the country,â€ Dr Katumba said.
And in Kenya, the Kenya Medical and Dentists Board representative, Dr Kelly Nyaim, said although the Kenyan government invests in training health workers, most of these migrate to other countries before serving their country, thus Kenya losing investment.
â€œCurrently, Kenya has declared a shortage of nurses. It is gratifying to note that we have agreed to introduce a system to address the migration challenges. The new system will also look at controlling migration of health workers from the rural to urban areas,â€ Dr Nyaim said at the meeting.
Dr Nyaim said the system is aimed at reducing the shortage of health personnel and recognising that accessible health workforce is essential for the provision of quality health services.
Given the current crisis of human resources in the health sector in sub-Saharan Africa, the health-related SDGs are arguably difficult targets for most African countries to attain. However, the SDGs are useful in highlighting underlying problems or constraints hindering their attainment.
To make remarkable progress in addressing the human resource challenge, AMCOA recommended that African governments should focus on instituting a consultative process in which all stakeholders collectively develop strategies to address the crisis facing the health workforce.
Furthermore, African governments should recognise the importance of aligning health sector, civil service and macro-economic policies and their objectives to improve the health workforce and health sector performance.
Acknowledging that African countries must offer internally competitive wages and benefit packages to retain highly trained staff is also key to addressing the current human resource crisis in the health sector in Africa.
The limited availability of human resources in Africa is likely to singularly determine the pace of scaling up services and to limit the capacity to absorb additional financial resources. More importantly, it is likely to be the most significant impediment towards the attainment of the health-related SDGs.
Possible solutions to health professionalsâ€™ migration challenge
DOREEN NAWA, Lusaka