The flight of nurses and doctors from South Africa — and other African states — has long been a source of concern for the governments of these countries. And, the advent of Aids has sharpened fears about the effects of this migration.
IPS was not able to get comment on the matter from South Africa’s Department of Health. However, statistics from the British Medical Journal indicate that in the 2001/02 period, 2Â 114 nurses left South Africa for Britain (up from 599 in 1998/99). The picture for 2001/02 was less dramatic, but still worrying, for states elsewhere on the continent.
About 470 nurses left Zimbabwe, while 432 left Nigeria. Ghana lost 195 nurses to Britain, Zambia 183 and Kenya 155. Health workers who leave for greener pastures in Europe can net substantially larger salaries than they earn in their home countries.
African governments, pointing to the host of social needs that clamour for attention, could claim that they don’t have the money to compete with these salaries. Many are also following programmes set by the International Monetary Fund and other financial institutions that set limits on public expenditure.
All of this begs the question as to whether donor agencies and NGOs should start supplementing the salaries of health workers to keep them in South Africa and other African countries.
This might involve a marked departure from the areas of responsibility that these groups have traditionally set out for themselves.
Yet, it seems clear that the “brain drain” of medical personnel is as much a problem for NGOs that work to contain Aids and other diseases, as it is for governments. No matter how low the prices of anti-retrovirals go, the benefits of these reductions risk being undermined if there aren’t sufficient, trained health workers to administer the drugs.
“If donors want to achieve a small part of the target they set, they will need health workers to ensure all health-care interventions are implemented,” says Lucy Gilson, a researcher at the Centre for Health Policy at the University of the Witwatersrand in Johannesburg.
IPS sent numerous requests for comment on this matter to a variety of donor agencies and NGOs, including the Global Fund for Aids, Tuberculosis and Malaria, the World Health Organisation and Oxfam. However, none of the groups appeared willing to put its views on the record.
Part of this reluctance may stem from the fact that a well-meaning effort to supplement state salaries could get bogged down in politicking.
How would a donor agency be able to justify addressing staff shortages in a country where arms purchases are continuing — or where endemic corruption is visibly depleting the financial resources that might otherwise be spent on health matters?
Certain commentators have also indicated that a debate about this type of intervention is fruitless, because the effectiveness of donor agencies depends, in part, on the fact that they are clearly seen not to meddle in the internal affairs of the states that they assist.
However, Gilson does not think agencies and NGOs will “aid and abet” poor governance by boosting the salaries of doctors and nurses: “If they made direct payments to individuals, the governance problem would be theirs, not that of the government.”
The flip side of this argument is that donor funds for salaries might not be sustainable over the long term.
Damaria Senne, communications manager of the Charities Aid Foundation Southern Africa (Cafsa) says as yet, there has been no formal discussion with regard to donor funding specifically for the salaries of health workers.
“But I have heard comments at conferences and meetings where people and organisations have complained bitterly of donors’ unwillingness to fund administration and salary costs [for aid projects].”
Cafsa is a non-profit organisation that provides financial expertise and other assistance to NGOs.
Senne says funders sometimes cap the allocations for project administration and salaries at 20% of the total aid package, leaving these projects understaffed.
Poor salaries are not the only reason why nurses seek employment abroad, however, as Thembi Mngomezulu, chief negotiator for the Democratic Nurses Organisation of South Africa, points out.
She says some want the adventure of working in a foreign country. Others leave because of poor or insecure working conditions, bad management, a lack of training opportunities — and the sense that nursing offers little in the way of career advancement over the long term.
Mngomezulu believes that donor funding could be used to provide occasional incentives for nurses — rather than a permanent addition to their salaries.
“Salaries need to be sustained once introduced, therefore foreign funding will pose a special challenge in this regard,” she says. “However, special allowances can be introduced to attract certain skills to underserved areas.”
Gilson agrees that the dissatisfaction of health workers extends far beyond the matter of what is in their pay packets.
“It is about giving people a sense of calling and purpose, making them feel valued and acknowledging their hard work. These are all important — though to different degrees for different people,” she says.
This complicates the matter of hiking up salaries to retain staff.
“Higher salaries probably would be a factor, but what level of increase is required we just don’t know,” notes Gilson.
She adds that increases that put South Africa and other African states on a par with European countries are also unnecessary. This is because the cost of living in Africa is generally lower than that in European countries, “so you should be able to buy more with your salary here than there”. — IPS