By Alison Duncan
“Brain drain” is a phrase which has come into common use in recent years, as it refers to an issue which is of increasing importance throughout the developing world, particularly on the African continent. The issue interests me because it has a huge impact on the functionality of many countries’ economic, educational, and health care systems. The case study represented here, by Malawi, is paralleled in countries all over the world. I found it particularly interesting to compare its situation in Malawi to that of South Africa, a much wealthier nation in the same region. Without ever explicitly stating so, the article challenges our society to find a solution to this growing problem which is often overlooked when considering health care challenges and crises.
This article was printed in the South African newspaper The News and Guardian and addresses the brain drain crisis in Malawi, though the issues brought up are by no means exclusive to that country. It starts out by giving a personal story of a Malawian nurse who has decided to leave her home country in order to make more money in Britain. Cases like hers are becoming increasingly common in Malawi, according to the article, where an estimated 120 registered nurses have migrated to Britain and the United states every year for the past ten years. The article implies that this brain drain is due to salary, stating that the “Health Ministry is unable to even begin to match the wages on offer abroad.” Malawi’s crisis is particularly acute because there is such a need for health professionals given the HIV/AIDS epidemic in that region, which makes it all the more upsetting when those who are able to provide services choose to leave.
The article notes that “14% of the country’s population is infected with HIV,” and that it has only “56.4 nurses and 2 doctors for every 100,000 potential patients.” This is well below the World Health Organization’s recommended minimum of 100 nurses and 20 doctors per 100,000 people, and that recommendation does not take into account the added strains of such a large population infected with HIV. By comparison, South Africa has 393 nurses and 74.3 doctors per 100,000, which is more than adequate. In the rural areas the crisis is at its worst, with a vacancy rate for nurses at 60% according to a survey by the Ministry of Health.
Interestingly, Malawi’s government recognized the problem three years ago and “launched an emergency plan… which saw health workers receive an average 52% pay rise… and aimed to strengthen training capacity, repatriate professionals and fund recruitment of foreigners.” The Malawian Health Minister Marjorie Ngaunje noted that “there are serious problems…Malawi needs to train 1000 nurses annually if we want to arrest the situation.” She pointed to the necessity of increasing intake at nursing colleges as a primary solution. Doctors without Borders is concerned that the Malawian government’s plans to provide free anti-Aids drugs are going to be compromised given the healthcare worker shortage. They are quoted as saying that “it is evident that the rapid scaling-up of ARV therapy… will be limited by non-availability of adequately trained nurses, clinic officers and doctors.” In all, the article convincingly illustrates the severity of the problem and the urgency with which it must be dealt.
I always associate the issue of the brain drain with the healthcare worker shortage because the two are directly and inextricably linked, as the Malawi case clearly demonstrates. The cyclical nature of the brain drain is underscored all the more by Malawi because of the exacerbating effects of the AIDS epidemic there. Essentially, healthcare workers leave to get higher pay, which shortens the staff in over-crowded hospitals and clinics, which then causes healthcare workers to leave in order to recognize a pay increase and escape the pressures of being short-staffed, which makes healthcare workers want to leave, and so on. To my mind, the key to solving this problem is not to get bogged down in the cyclical parts of being short-staffed and over-worked, but to tackle the primary cause. This article suggests that a desire for an increase in wages is the main causal reason that nurses and doctors leave their countries. If this is true, then it seems obvious that the salary discrepancy between countries must be eliminated and benefits drastically increased. I was also struck by the idea that healthcare professionals in these countries are seemingly no longer satisfied with their jobs intrinsically, because they are seeking extrinsic benefits overseas as opposed to within their own countries where they could be of greatest help. In my opinion this is a very big problem, as it indicates a decrease in healthcare workers’ genuine interest in administering aid to needy patients. As far as dealing with that issue, I am not sure what the solution is, or even where to begin. If our healthcare providers are no longer interested – at their core, regardless of pay – in providing healthcare, then we are indeed in trouble: not just Malawi or other developing countries suffering from the “brain drain,” but the world as a whole.
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