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Last Updated: Friday, 11 March, 2005, 13:36 GMT
Plugging the 'brain drain'
Africa needs to train an extra one million health workers
Africa's health workers are deserting the continent's poorer countries
The much anticipated report published on Friday by the Commission for Africa is calling for an extra one million health workers to be trained in Africa by 2015.

The commission wants the world's richest nations to provide $7 billion to develop Africa's health infrastructure.

But who exactly is going to benefit from this investment when a large number of Africa's skilled health workers leave the continent to work abroad?

Currently, African health systems are in the grip of a "brain drain": In Zimbabwe, three-quarters of all doctors emigrate within a few years of completing medical school.

The number of doctors trained in Ghana but now registered in the UK has more than doubled between 1999 and 2004.

BBC Africa Live asks: Are Western countries exploiting Africa by poaching its skilled health workers? How can Africa curb this drain on its much needed resources?

What drives African health workers to look overseas? And what would it take to keep them at home? Are you an African doctor or nurse working in the West? Or do you prefer to stay at home? Share your experience with us.

Join the BBC Africa Live debate on Wednesday 16 March at 1630 & 1830GMT.

Use the form to send us your comments - and your personal stories - some of which will be published below.

If you would like to take part in the discussion, e-mail us with your telephone number, which will not be published.


Here is a cross-section of your emails:

The 'health service' in Cameroon is so chaotic it cannot absorb the few professionals it trains!
Sam, UK
I have three highly trained health professional siblings from Cameroon. One has been out of medical school for two years and another for one year, but they still can't find jobs in the health service of that country. One finally gave up hunting three years after training and now works in the UK. The 'health service' in Cameroon is so chaotic that it cannot absorb the few professionals it trains!
Sam, UK

As an African mother, I am tired of all the good intentions: all this expert advice from brilliant Harvard and Oxbridge graduates and yet Africa still cannot boast positive results. I worry about my children growing up, thinking we do not have African solutions to our problems. If the West and the Commission are really honest about stemming the brain drain, then let them use part of the $7billion to be raised to pay all doctors and other skilled workers 50% of what they are earning outside their home countries and see if Africa will not be flooded with their best brains. I have children who are doctors and we do discuss this issue daily. The problem is low and discriminatory wages.
Djielo Aryee, New York, USA

Africa needs to recognise her medical workers and pay them well. As long as there is someone to offer a better price for their services, they will continue to migrate. African countries have the capacity to offer better salaries for medical workers; they do not need new investments for that. All the African governments need to do is to put their priorities in order.
Mukasa Sam Farouk, Kampala

The problem is not low wages. If African authorities want to stop doctors from going abroad, they should create better medical training schools for doctors. These schools should have affordable fees and be open to all.
Marcel, Douala, Cameroon

In Bangladesh, a junior doctor earns around $80 to $125 per month. Even an uneducated businessman can earn five times that.
Dr. Arif Musabbir, Dhaka, Bangladesh
It is not only African governments but also Asian governments that their neglect doctors. In Bangladesh, a junior doctor can only earn around 5000 to 8000 taka per month, which is approximately $80 to $125! Even an uneducated businessman can earn at least five times more than that. A junior doctor's pay is not sufficient to live a basic life.
Dr. Arif Musabbir, Dhaka, Bangladesh

It is cheap to condemn the health care and social services in African countries; do people really realise that African's problems do not lie within Africa alone. How do you expect better services when a huge part of the money is spent servicing foreign debt? We should ask who benefits from Africa's problems? Which countries have better services because of Africa's brain drain? Something should be done about this. Simplying condemning does not hold water!
Melvin Omodon, Nigeria/USA

It is up to Africa's skilled workers to to harvest in their own nation rather than deserting it for green pastures. If Africans are running away from taking care of their own people, then who else can take care?
Nekuma Hifilemona, Saint-Petersburg,Russia

I submit to you that the so-called 'brain drain' is another term for recolonising Africa. How can one explain the hypocrisy by the West in hiring away our well-trained doctors, nurses, teachers, engineers, and other workers who are much needed by poor African countries? Many of us make the painful decision to migrate to the so-called "greener pastures" in the West because we're victims of gallons of rhetoric of how "green the other side is". If only many of us knew better, we would have stayed home in Africa where we are really wanted and needed. Africans, especially those who are convinced that the West will one day suddenly solve all our woes, are own worst enemy.
Kuria Githiora, Kenya/USA

Poor working conditions for health workers are enough to ensure the drain will continue for a while to come.
E Kalu, Port Harcourt, Nigeria
Two of my siblings are health workers - one a doctor, the other a dentist. Both have left for western countries, and undoubtedly are not coming back anytime soon! And I wouldn't encourage them to return either. The pitiful economic state in African countries, the lack of decent wages and facilities, and the poor working conditions for health workers are enough to ensure that the drain will continue for a while to come. Africa needs health workers, but the US, Britain, France and other western countries not to talk of the Middle Eastern countries also have a shortage of well trained health workers. Guess who'll win?
E Kalu, Port Harcourt, Nigeria.

I left a good job in Harare because I could not afford to live there any longer on my pay. I saw aid workers doing simple jobs that any Zimbabwean could do, or doing jobs to replace "brain-drained" Zimbabweans. However, the expats were on fantastic US Dollar salaries and had lavish perks. Why don't third world countries insist that aid organisations should bring back some of the country's nationals (on the same terms as expatriates) when they recruit in the donor country? Most Zimbabweans would return like a shot if they could get an expatriate contract!
Dave, Oslo, Norway

The 'brain drain' has intensified in recent years because of the overt recruitment campaign by certain western countries, the UK in particular. Skilled people have been migrating from time immemorial, but the recent aggressive recruitment of health professionals in Africa by the UK has worsened the problem.
Asante, Sydney, Australia

Health care workers too often find themselves in remote and under resourced facilities and quickly become de-motivated.
Dr Michael Smalley, African Medical & Research Foundation, Nairobi, Kenya
Investing in training health professionals will help create a sustainable and healthy Africa. But it is also true that health delivery systems are under-resourced and not focused on delivering health to the poorest people. Health care workers too often find themselves in remote and under resourced health facilities and quickly become de-motivated and lacking in up to date health knowledge and practices. My Foundation backs up its training with continuing community health education; a quality assurance service for remote laboratories; and relevant and affordable health manuals. Most importantly, we work behind the scenes on advocacy campaigns with the governments with whom we work. Creating an environment and continuing learning opportunities for health staff is as essential as training if the continent is to retain its health personnel.
Dr Michael Smalley, African Medical & Research Foundation, Nairobi, Kenya

As an African health professional who emigrated, I suggest Africa needs to put its house in order to solve the "brain drain". But it can't be done by putting restrictions on movement. It's a human right to move to "greener" pastures. And stop pussy-footing around; we all know what aspects of the house needs to be put in order. Get rid of tin-pot dictators, install human rights, free speech, democracy etc. Until that's done, aspects like the "brain drain" won't improve. We emigrants didn't move because we disliked our native country - it is the most beautiful continent.
Joe Mandebvu, Australia

Sadly we get too much lip service from African governments about the 'brain drain'. One only has to look at a country like Zambia where members of parliament become rich as a result of parliamentary privileges and remuneration, while doctors get paid much less. The politicians should be seen to sacrifice for their countries if they want to reduce the effects of 'brain drain'. In Zambia, it makes more sense to be a wheeler dealer than to be the person with a degree. Education and training has lost value in Zambia. Hospitals do not have the equipment to help doctors and nurses carry out their jobs efficiently. In a nutshell, let the politicians change their attitudes towards education and professionals of all kinds and maybe the 'drain' will start to close up.
Nkandu, UK/Zambia

If a qualified health care worker has the opportunity to make a better life for themselves, most will take the opportunity.
Stefanie McDonald, Mzuzu, Malawi
African countries need to take responsibility for their "brain drain". If these African governments are not creating an environment that will retain qualified health care workers, the brain drain will continue. Some of the conditions and facilities are absolutely appalling. If a qualified health care worker has the opportunity to make a better life for themselves and their family financially, and in addition to work in state of the art facilities, most will take the opportunity.
Stefanie McDonald, Mzuzu, Malawi

The West needs the medical professionals from Africa due to the aging of the baby boomers. This is globalisation at work; the market forces of demand and supply. We need to make our countries in Africa more competitive to attract real investments that will jump start economic growth and development of the continent. The role of Africans in the diaspora in poverty reduction through remittances cannot be ignored, however the West must seek a credible private sector mechanism to intervene and improve the conditions in Africa. It is a moral burden.
Toochi Uchendu, Lagos, Nigeria

I currently work for the UN in Afghanistan and what I earn in a month is the equivalent of my annual salary in the Gambia. Unless there is a mechanism to pay professionals a decent wage, the brain drain will continue because it is a choice between taking care of my family and trying to take care of my country. The former is highly feasible and the latter a bit beyond my control. In 2003, as head of a rural development organisation and speaking at an education forum, I asked for international funds to be used to pay for teachers, nurses, doctors and police, as well as the schools, clinics, and infrastructure required for social health, development and justice. If nurses, teachers and police continue to earn on average $20 a month, all our dreams for development will remain wishful dreams.
Musa Jallow, Banjul, Gambia/Afghanistan

Let's give our doctors a good salary, job security and good living conditions.
Kisanya Vincent, Nairobi, Kenya
African governments have neglected doctors. I salute the West for recognising that health comes first. Let's give our doctors a good salary, job security and good living conditions and no doctor will leave Africa. The Commission for Africa has to address the cause of the 'brain drain' before asking for funds to train a million health workers who will otherwise end up overseas after training.
Kisanya Vincent, Nairobi, Kenya

Western countries are exploiting Africa's natural and human resources. The health 'brain drain' in Africa is created by the same countries who say they want the world's richest nations to provide billions of dollars to develop African health infrastructure. This is a double standard. The extra one million health workers to be trained in Africa will soon be deserting the continent and looking for greener pastures in the West; thus ironically the report is not for Africa but for the West. African health workers need better remuneration and better working conditions just like their western counterparts. Many African governments who enjoy western donor aid spend less than 20% of their budget on health. African leaders need to prioritise health and health workers in order to stop the health 'brain drain'.
Yussuf Dayib Ali, Nairobi, Kenya

Western countries are not exploiting Africa by poaching its skilled health workers. They are only covering up what Africa has failed to do for its intellectuals; that is to guarantee them a safe working environment and a good remuneration. In the DRC for instance, the university graduates have lost their dignity as they are the poorest in society and people tend to believe that education is meaningless. Human beings, in spite of their patriotism, tend to hunt for a better and more secure life and most African countries don't offer that because of rampant corruption, lack of good policies and the selfishness of African leaders who behave as if the country they rule is their private property. African leaders have to learn to have the interests of their countries in their heart if we really want to change the situation for the better.
Kapinga Ntumba, Harare, Zimbabwe

It is their right to look for better living conditions, but it is equally selfish of them to leave the institutions where they trained.
Hamid Alsharief, Khartoum, Sudan
The main cause of the brain drain is the health workers themselves. It is their right to look for better living conditions, but it is equally selfish of them to leave the people who established and sustained the institutions where they trained. The way to stop the drain is to: improve pay; better equip hospitals; and enable the doctors to do what they know best, which is treating patients and preventing diseases.
Hamid Alsharief, Khartoum, Sudan

How can a doctor who is caring for his people earn $50.00 a month and live in a village where there is no electricity and pipe borne water, while government officials run around in big cars? These doctors and nurses want to help their people, but if the only place they can get the money is out of Africa, they will surely go after it.
E. Julu Swen, Monrovia, Liberia

Job satisfaction, or lack of it, is often the cause of the brain drain in Africa. The governments - federal, state and local - just do not care about properly equipping hospitals. Imagine the frustrations of being a surgeon or cardiologist when your whole region does not have the appropriate functional equipment. I have witnessed the death of an asthmatic, pregnant lady because the hospital's pharmacy and emergency room was out of stock of the necessary drugs! It's not just money that frustrates our African professionals.
Gbenidion, Asaba,Nigeria

The reason behind the flight of many skilled African doctors to the West is not only poverty in their home country, but also the inappropriate policies of donors and creditors. Development is still encouraging many of our African leaders to line their pockets to the detriment of skilled professionals aspiring to earn a sustainable salary. Unless donor countries and creditors are more sincere in tackling this, the problem will linger.
Haile Tewelde, Asmara, Eritrea

These health workers do feel guilty for opting to go when their people are not adequately catered for. But what else can one do?
Shuttie F.N.Libuta, Kitwe, Zambia
What is more enjoyable than being on a big jet plane en route to an overseas country as a professional emigrant? All the same, these health workers do feel guilty for opting to go and better the lives of foreigners when their people are not adequately catered for. But what else can one do? Yes, there should be a sense of loyalty to the poor governments that spent so much on their training, but they are not the only ones who have to sacrifice for their country. These politicians who are getting rich barely two seconds after being in power may only have been to school up to ninth grade as compared to a doctor's long years of school and training. He has brains and he uses them to manoeuvre, hence the brain drain and you can't blame him or her for this. As for the richer nations, it is only right and fair that they contribute to this training project because the West has been the biggest beneficiaries of the 'brain drain'.
Shuttie F.N.Libuta, Kitwe, Zambia.

What ever happened to the free trade mantra that I was taught in college while pursuing an economics degree? If African governments continue to sit and perpetuate corruption in every aspect of governance and fail to create a conducive working environment, then why should health workers trained in Africa stay in Africa when they can make more somewhere else?
Kiplimo Arap Murgong, USA/Kenya

The main drive for most African health workers to look overseas is economic. I believe that while most people are patriotic and prefer their own countries and cultures, the realities of how to feed their families tend to come first. Given the poor salaries that these people get, it's no surprise they look abroad for the answer. On a brighter note, some do save money and return home to successfully run their own clinics. So the way I see it, it doesn't always have to be 'brain drain'; it can be 'brain cycling'.
Ngum Ngafor, Manchester, England

We have everything needed to make things right, but our leaders have failed us in all areas.
Sunday Alerebo, Gold Coast, Australia
The fundamental principle of this debate rests on the African leaders themselves. Unless our leaders stand upright to tackle the present infrastructural problems, the entire continent will still stay in jeopardy. I believe we have everything needed to make things right, but our leaders have failed us in all areas of administration.
Sunday Alerebo, Gold Coast, Australia

In most developed countries, health care is often ranked amongst the four most important priorities of the nation. In Africa, health care is not ranked amongst the first forty. If western nations want to ameliorate the brain drain from Africa's health care institutions, they should send some of their trained professionals to Africa for a year or two.
Emmanuel Ngwa, Cameroon/USA

One way to curb the ever-rising brain drain is for African governments to sign agreements with African professionals abroad so that, when they return to Africa, their student loans will be paid by the government. There are many African professionals living abroad not because they make more money but because they owe student loans. I hear from my colleagues everyday: "We could return today or tomorrow but we still have to pay the federal student loan that financed our education."
Kehleboe Gongloe, Liberian in the USA

Lots of health equipment and buildings are not being used due to the absence of medical personnel.
Keneni, Niamey, Niger
The major reason for the brain drain is purely economic. Some of the money destined to develop the health infrastructure has to be geared towards paying skilled health workers to stay in their home country. (Incentives, fringe benefits, etc.) Lots of health equipment and buildings are not being used in many countries in Africa due to the absence of medical personnel. New international cooperation has to focus on maintaining skilled workers in Africa. Period!
Keneni, Niamey, Niger

Until Africans demand better living conditions by unilaterally rising against poor governance, greed, tribalism and helplessness, no amount of intervention or money will stem the "brain drain" tide. All the "brain drain" beneficiaries have done is to establish institutions that function and allow their citizens to thrive, which in turn has attracted those who are determined to grow. It is self-serving and disingenuous to dwell on how desperate Africa remains while ignoring the root causes of her problems, which squarely rest with the attitudes of Africans themselves.
Ed Magana, Chester Springs, USA

Why wouldn't doctors go overseas after graduating from medical schools in Africa when, for example, in a country like Cameroon its military officials earn many times the salary that the doctors earn? If the government would respect their services and match it with decent salaries, then the medical brain drain as it relates to Africa would end.
Valabam, NY, USA

The cause of the brain drain is much more than economic; there are also social and security dimensions. Can the health system at home manage age-related illnesses, and could the education system sustain the learning of one's kids if and when they return home. These are the phobias that taunt absent friends in the diaspora.
Felix Jona Muchinani, London, UK

Our political class has taken away the trust we had in our health system and our health workers. When our politicians fall sick, they seek treatment abroad; so why should they care about our health system? Plugging the brain drain means instilling esteem in our health services, which can start by the political classes seeking medical treatment in their home countries.
Weru Macharia, Brighton, UK

Besides remuneration, one other major factor behind the brain drain in the health sector of African countries is decrepit equipment and health institutions. In the absence of the right tools of trade to work with, doctors and nurses feel a lot of frustration, which in turn drives them outside their countries.
Ben Obeng, USA

The brain drain is not all negative: Africans outside the continent send billions of dollars back home.
Levai Babaya, Minnesota, USA
I agree that the major reason for the brain drain is economic. It is however fostered by the lack of opportunities in Africa and the huge demand for skilled labour in Europe and America. What Africa can do to slow the problem is to put its house in order. This means fighting corruption, slowing the export of raw materials through higher taxation, and slowing capital flight to Europe and Asia. The brain drain issue is not all negative. Africans outside of the continent send billions of dollars back home. These remittances are much more useful to African nations than the loans that these nations get, send half back to the loaning nations in interest, and misuse the rest. Remittances are the life blood of most African nations.
Levai Babaya, Minnesota, USA

No doubt, the brain drain cripples Africa's economy and lessens its human resources. Many skilled Africans who emigrate to the West do not think of returning to the continent because of a lack of opportunities back home. The policy of accepting skilled Africans, especially nurse and doctors, is actually a ploy by the West to make Africa remain the poorest of the poorest under the earth.
Peter Tuach, Minnesota, USA

That the commissioners are well-intentioned is beyond doubt. But good intentions have never produced good results. Most of this report is already well known: that Western countries have poached skilled health workers; and that most of the foreign aid given to Africa has ended up in banks in Zurich and London, deposited by our corrupt leaders. Africa lacks the basic foundations from which to advance its economic progress. It needs social security numbers for all its citizens, otherwise how do you account for anything. And it needs competence in government, so more money needs to be put into training current and future leaders. Lastly, give local people the power, not government. Foreign aid should be organised into a capital fund to boost small and mid-size businesses. This will act as a catalyst for local economic growth.
Abraham Temu, New York, USA




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