Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime.pdfVIP

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Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime.pdf

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Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime.pdf

Viewpoint Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime? Edward J Mills, William A Schabas, Jimmy Volmink, Roderick Walker, Nathan Ford, Elly Katabira, Aranka Anema, Michel Jo?res, Pedro Cahn, Julio Montaner Shortages of health-care sta? are endemic in sub-Saharan Africa (table).1 Overall, there is one physician for every 8000 people in the region. In the worst a?ected countries, such as Malawi, the physician-to-population ratio is just 0·02 for every 1000 (one per 50 000). There are also huge disparities between rural and urban areas: rural parts of South Africa have 14 times fewer doctors than the national average.2 These numbers are very di?erent to those in developed countries: the UK, for example, has over 100 times more physicians per population than Malawi.3 Furthermore, almost one in ten doctors working in the UK are from Africa. The insu?ciency of health sta? to provide even basic services is one of the most pressing impediments to health-care delivery in resource-poor settings. The consequences are clearly shown by the inverse relation that exists between health-care worker density and mortality.4–6 High-income countries, such as Australia, Canada, Saudi Arabia, the USA, the United Arab Emirates, and the UK7,8 have sustained their relatively high physician-to-population ratio by recruiting medical graduates from developing regions, including countries in sub-Saharan Africa.9 In contrast, over half of the countries in sub-Saharan Africa do not meet the minimum acceptable physician to population ratio of one per 5000—WHO’s Health for All standard.3 Nurses, pharmacists, and other health workers are systematically recruited from a region struggling with the greatest burden of infectious and chronic illness6,8 and the speci?c challenge of HIV/AIDS.10 Several recent reviews of health workers employed in Australia, Canada, the UK, and the USA have shown the extent of the brain drain. An estimated 13 272 physicians traine