Elsevier

The Lancet

Volume 365, Issue 9474, 28 May–3 June 2005, Pages 1893-1900
The Lancet

Public Health
Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK

https://doi.org/10.1016/S0140-6736(05)66623-8Get rights and content

Summary

The already inadequate health systems of sub-Saharan Africa have been badly damaged by the emigration of their health professionals, a process in which the UK has played a prominent part. In 2005, there are special opportunities for the UK to take the lead in addressing that damage, and in focusing the attention of the G8 on the wider problems of health-professional migration from poor to rich countries. We suggest some practical measures to these ends. These include action the UK could take on its own, with the African countries most affected, and with other developed countries and WHO.

Section snippets

Numbers of health professionals

The figure shows that, although some other countries—Nepal, Bhutan, Papua New Guinea, Afghanistan, Cambodia, and Indonesia7—seriously lack doctors, the problem is especially severe in sub-Saharan Africa. Although many of these countries have made considerable efforts to train their own doctors, the rate of loss by migration often outstrips production. In sub-Saharan Africa, 24 of the 47 countries have only one medical school; 11 have no medical school at all.8

It has been estimated that 60% of

Existing measures or codes of practice

In an illuminating report last year, sponsored by the UK's Department for International Development (DFID),22 James Buchan suggested that the UK Department of Health's Code of Practice for recruitment has very significant weaknesses and loopholes. Principally, the problem is one of ease of circumvention by various indirect means, and the code's failure to cover private employers and recruiting agencies. Measures intended to make good some of these deficiencies were announced by the Health

How could we slow the flow and mitigate the effects?

The UK, as a major beneficiary of health professionals from sub-Saharan Africa, has a responsibility to give a lead in tackling the problem of health professional migration, and has exceptional opportunities to do so in 2005. The measures we suggest are aimed at restriction of both pull and push factors. Some strategies are specific to the UK; others would require joint agreement and bilateral action between the UK and the African countries most severely affected. Important steps also need to

Conclusion

We have attempted in this paper to focus attention on the problems UK recruitment of health professionals is creating for the countries of sub-Saharan Africa, and to suggest measures to radically reduce the migration. We believe our suggestions to be achievable, uncontroversial and capable of early implementation. Experienced health professionals and administrators in Africa, in the UK, and internationally will have the knowledge and skills to tackle the problems of implementation. First, there

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