There’s a CNN TV report on the shortage of qualified medical personnel in Malawi. I zapped into it yesterday. It shows the dire situation at Mulanje District Hospital and in a rural dispensary. They interviewed a volunteer doctor from Uganda, a midwife who works in rural villages, a couple of Malawian doctors that are working in Manchester, UK:
According to the report, at one point in time there were more Malawian doctors in Manchester than in the whole of Malawi.
I’ve seen some hospital wards and I agree that the task is daunting. The wards are overfull. Patients and their guardians often lie on the floor in the corridors, under the beds.
Regular readers of Chiperoni know that I’ve been pointing to various blogs and articles on this topic from time to time. The dire conditions described in the report are realistic.
How to stop the brain drain? This is not an easy topic, cos every employee will – and needs – to look at their personal situation. Although this is not only about money, the salary plays an important role. Cos one salary needs to supports a lot of dependents. As one of the UK-based doctors says in the report, he can support more relatives with the better UK pay. I read somewhere that the amount of money transferred by Western Union back to Africa exceeds the foreign aid provided by the US and the EU (cf Africa: Sending Money Home) and is probably a lot more effective.
I’m against policies that bar qualified Malawians from working in the US or in Europe as suggested in the report. That’s not the way to go forward on this. The better way is to improve the work conditions in Malawi. I believe that many Malawians would consider returning if some of the surrounding conditions would improve. Cos all is not golden in Europe.
In the 70s and 80s, most of Malawi’s doctors were trained in the US and in Europe. They had a hard time adjusting to the conditions they found when they returned back home. Many stayed in the West. In the 90s, medical schools were set up to educate doctors within the country.
Factors that influence a personal decision to emigrate:
- Work conditions (i.e. availability of modern equipment, labs and tests, qualification and number of co-workers, quality of management, further training, work load, working hours, holidays)
- Political situation
- Corruption within the workplace and outside
- Merit-based promotion
- Economic situation within the country
- Infrastructure (e.g. frequent power cuts, water supply shortages, very bad roads, no or very expensive telecommunication services)
- Crime rate (e.g. clever guys that steal telephone cables as they are installed and sell them for much less than they are worth, increase in burglary, armed robbery and mugging)
- Availability of good schooling for your children esp. in remote hospitals
- Changes in Malawi family tradition (e.g. the rules that quasi-dictate how and when you need to take of your family relatives encourage some to search for kms of distance)
I studied at the Malawi College of Accountancy in Blantyre and we often discussed the greener pastures of Botswana and beyond.
Some figures I found from 2005:
There are only 100 doctors and 2,000 nurses for Malawi’s 12 million people because many health care workers trained in the country now practice in developed countries, which pay higher salaries. Rich countries also provide better working conditions for doctors, as the HIV/AIDS epidemic in Africa has added a “heavy burden” to health care on the continent, the Times reports. In addition, many health care workers in Malawi have become sick with HIV/AIDS or have died. Nearly 15% of Malawi’s adult population is HIV-positive. Some hospitals in Malawi have resorted to hiring retired medical workers to fill the gaps, according to the Times. Atta Gbary, the World Health Organization’s Africa adviser on human resources and health, said the shortage of medical workers in Malawi means that when donors offer funds “it is impossible to use them because the people are simply not there to work anymore.” According to Gbary, 23,000 medical workers leave Africa annually and there are only 800,000 medical workers working on the continent currently. Malawian Health Minister Hetherwick Ntaba said the country should require its medical workers to serve several years in the country after completing their training. He also said that foreign governments that employ medical workers from Malawi should compensate the country for the cost of training new doctors and nurses. The United Nations estimates that it costs $100,000 to train a specialist doctor in Africa.
And from May 2007:
A shortage of health workers in Southern African countries is undermining access to antiretroviral drugs in the region, according to a Medecins Sans Frontieres report released on Thursday, the AP/Houston Chronicle reports. According to the AP/Chronicle, the report focused on the conditions in South Africa, Malawi, Mozambique and Lesotho.
The report found that South Africa has 393 nurses and 74 physicians per 100,000 people; Lesotho has 63 nurses and five physicians per 100,000 people; Mozambique has 20 nurses and three physicians per 100,000 people; and Malawi has 56 nurses and two physicians per 100,000 people. According to the report, Africa has increased access to antiretroviral drugs among people living with HIV/AIDS from 100,000 people in 2003 to 1.3 million in 2006. However, the shortage of health workers is preventing further expansion of drug access programs, the report found.
As Victor rightly points out, the CNN report is very one-sided, esp. regarding the images and the way the sick are portrayed. There are many Malawi doctors and nurses that serve their country conscientiously against all odds.