Cesar Chelala
A physician and writer

Brain drain exacerbates health care crisis in Africa

The emigration of professionals and young people from “source” countries to “destination” countries abundant in resources and modern technology has been called “brain drain,” and has been happening for the last several decades. The emigration of professionals from Africa, while considerably benefiting “destination” countries, has had a deleterious effect on the health situation and economies of African countries.

Since 1990, Africa has been losing 20,000 professionals annually; over 300,000 professionals reside outside of Africa; there are more African scientists and engineers in the U.S. than in the entire African continent. According to the United Nations, “emigration of African professionals to the West is one of the greatest obstacles to Africa’s development.”

In the health area, although considerable progress has been made in the fight against HIV/AIDS, other challenges remain. It is estimated that more than two million children under five are HIV-positive and there are more than 12 million AIDS orphans, placing social services under enormous stress. The coronavirus pandemic underscored the shortage of doctors and the weakness of the health infrastructure in several of the affected countries.

South Africa has the highest tuberculosis death rate per capita worldwide, followed by Zimbabwe and Mozambique. The situation is worsened by the high number of cases of multidrug-resistant tuberculosis in several countries. In addition, diarrheal and respiratory infections, malaria, measles, and malnutrition represent big threats to children’s health. Malaria is the leading cause of death among children under five.

Malnutrition, particularly in children, is widespread. On April 17, United Nations officials warned that as many as 48 million people across West and Central Africa will probably go hungry soon due to food insecurity provoked by armed conflict, Covid-19, inflation, and the worsening climate emergency. This confirms previous estimates that the number of hungry people in West and Central Africa will reach record high numbers in 2023 if effective solutions are not implemented soon. But food prices continue to increase as a result of the war in Ukraine, which is driving up the costs of fuel and fertilizer, and trade restrictions across the continent.

The continuing exodus of physicians and nurses to industrialized countries exacerbates the health problems Africans experience. The World Health Organization (WHO) estimates that 23,000 health care workers leave Africa annually. Malawi, a country of 19.89 million people, has a severe shortage of doctors and nurses. All African countries are currently afflicted by a dearth of surgeons, a problem exacerbated by the emigration of African surgeons and the limited training capacity of some that remain.

WHO estimates that 23 health care workers per 10,000 people is the minimum ratio needed to maintain a health system working properly. Most African countries fall short of this threshold. According to WHO data, there is only one doctor for every 40,000 people in Malawi. Liberia has 51 doctors for 4.5 million people and Sierra Leone has 136 doctors for 6 million people.

A most concerning aspect of medical brain drain is its impact on already deficient health care systems: as a health care system worsens, experienced physicians and health care workers tend to leave, and as more of them leave, the more weakened the health system becomes.

A 2011 study conducted by a group of Canadian scientists led by Edward Mills, chair of global health at the University of Ottawa, found that the lost investment of domestically-educated doctors migrating from sub-Saharan countries to Australia, Canada, the United Kingdom, and the United States was of around $2.1 billion. They also estimated that the financial benefit to the UK was of $2.7 billion, to the U.S. 846 million, $621 million to Australia, and $384 million to Canada.

WHO estimates that of the 57 countries with critical shortages of health care workers, 36 are in sub-Saharan Africa. Some African countries have lost more than fifty percent of doctors they have educated. In addition to doctors, however, a wide array of professionals and technicians have left their countries of origin.

Dr. Lalla Ben Barka, from the UN Economic Commission for Africa (ECA) said, “In 25 years, Africa will be empty of brains.” By working together with “source” countries, particularly conducting relevant local training of professionals, industrialized countries can promote policies that encourage medical providers to stay in Africa and share their talents and skills to benefit its citizens.

César Chelala, M.D. is an international public-health consultant and award-winning writer on human rights issues. He has carried out health-related missions in over 50 countries, many of them in Africa.

About the Author
César Chelala is a physician and writer born in Argentina and living in the U.S. He wrote for leading newspapers all over the world and for the main medical journals, among them The New York Times, The Washington Post, The Wall Street Journal, The Japan Times, The China Daily, The Moscow Times, The International Herald Tribune, Le Monde Diplomatique, Harvard International Review, The Journal of the American Medical Association, The Lancet, Annals of Internal Medicine, and The British Medical Journal. He is a co-winner of an Overseas Press Club of America award and two national journalism awards from Argentina.
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