Africa Losing Nurses to Britain (11)
------------------------------------
Dear Colleagues
I would like to thank Dr. Sharif for his message and expand a
little more on the points he has raised.
Some of the list members may know my background, but some may
not. I did my undergraduate studies in the UK in engineering,
and then studied economics and then became a chartered account-
ant. I migrated to the USA and had a fast track corporate career
combining technical understanding with financial analysis. By
the time I was in my early thirties I was the CFO of a US based
international company operating in 26 countries around the
world. I then switched career into consulting and started doing
"development" work for the UN, the World Bank and private agen-
cies.
I am more than a little disappointed that "development" has
turned out to be such a failure. What has gone wrong? What is
broken and what can now be done to fix things?
Dr. Sharif: There is a lot of debate of Africa losing nurses to
Britain and how this has affected health services in Africa.
Peter B.: Economic migration has a very long history. Thousands
of years. In some ways it is more difficult now than in prior
eras because of "immigration" rules and regulations. Free flow
of people is heavily constrained at this point in time. The
NORTH should remember that it has liberated immigration rules
whenever it needed to.... as for example when the UK National
Health Service was originally implemented and medical staff from
all the Commonwealth were used to staff the system...... and as
for example whenever the USA has medical staff shortages .
Dr. Sharif: However this is not really an issue in Kenya. It is
not the nurses migrating to Britain which is causing a nursing
crisis in Kenya. There are enough nursing schools in Kenya to
cater for the country's needs. The training for nurses is car-
ried in government institutions, mission hospitals, private hos-
pitals and other non profit hospitals and organizations.
Peter B.: Over the past thirty years, the biggest "success" in
development is the education sector. There are far more Afri-
can's now educated and trained. But the failed economics of Af-
rica mean that this education and training has essentially no
value for Africans in Africa, but only a value when used outside
Africa. A pretty silly situation.
Dr. Sharif: However there is a shortage of nurses in public hos-
pitals. This shortage is due to the fact that the government has
not employed all the nurses who have graduated from the nursing
colleges due to lack of adequate funding and a lot of nurses
posted to remote areas do not take up the jobs because the pay
is low.
Peter B.: Government is in a big bind. The International commu-
nity (and academic and development experts) keep asking (tell-
ing) government to do more and more without also coming up with
ways to pay for it. The whole issue of public finance is a com-
plete disaster. It is far more than the "debt" or the "corrup-
tion" or the primacy of politics over economics. The underlying
fact is that the economic foundation of Africa cannot support a
modern society without also reworking the value chain of almost
all of the big industries that make money in Africa.... energy
(oil, gas, etc.), mining (gold etc. etc. etc.), timber, fisher-
ies, tourism,... the list goes on. Development experts have
spent the last thirty years telling government to do more and
more and have yet to address the issue of how Government can
balance recurrent expenditures with recurrent revenues. Sadly,
most development experts (including the NORTH government ex-
perts, the World Bank and the IMF) seem to have little apprecia-
tion of the fundamental difference between earned revenues and
borrowings and grants. Having cash in the Central Bank does not
mean there is a healthy economic and public finance situation.
In health there is an HIV-AIDS crisis. In economics, the equiva-
lent is bankruptcy of the African productive economy and public
finance. In both cases leadership has failed terribly.
Dr. Sharif: Thus we have a situation where there are qualified
nurses who cannot be employed by the public sector and yet there
is a shortage in public hospitals. A large number of mission
hospitals are facing a financial crisis and cannot employ the
nurses as per the workload thus a shortage of nurses in mission
hospitals.
Peter B.: A good development plan with a 20 year framework can
solve a lot of problems permanently. It should start of with the
idea that ALL resources should be best used for local benefit
(value creation). There needs to be a lot of analysis of how the
scarce money resources are used.... remembering that a nurse in
Africa is being paid (What is it? $100 equivalent a month) while
a medical researcher in the USA is going to be earning a lot
more (What is it? $10,000 or 20,000 equivalent a month). A good
junior government officer in Africa gets paid (What is it? $200
equivalent a month) while a UN or World Bank staffer gets paid
(What is it? $10,000 equivalent a month). We have to do some
triage to get scarce money in the right places. And we need to
look hard at what is needed to put Africans to work so that
their learning and experience can be used in the most valuable
way.
Dr. Sharif: Instead of putting restrictions on nurses and blam-
ing the West, let the African governments correct the fundamen-
tal issues and that is to pay nurses a decent wage and employ
all the nurses qualifying from the nursing colleges.
Peter B.: The African governments are in a fix. I was in an Af-
rican country some few years ago and had a number of high level
meetings. It is fairly common for nurses and teachers to get
paid low salaries and to get paid late. In this case the govern-
ment's financial problems also meant that the soldiers also were
not getting paid. Three months later the President was assassi-
nated! The economic problems of Africa are part government, but
they are also international. The economic terms of trade have
not favored Africa in the last thirty years. Foreign direct in-
vestment is a business model that impoverishes Africa more than
it enriches the continent. The resource are huge and immensely
valuable.... and Africa is hungry! What is wrong? The problem is
more than just government. The problem is that almost nothing
done by the international community on behalf of Africa, actu-
ally leaves much of value behind in Africa.
Peter B.: There is an urgent need to have "management informa-
tion" about the economics and business of Africa. We have got to
stop fund flows into useless activities and get the scarce money
flowing into doing things that have both short term and long
term value for Africa. I do not know as of this moment of any
source of this "management information" that is reliable and
easy to access. The UNDP is meant to produce a "Development Co-
operation Report" every year for every member country of the UN
system (a resolution of the UN in 1978) but nobody wants to co-
operate in producing this information and this report because,
to put it bluntly, it would show how bad the "development pro-
ject" portfolio is in most countries with both government and
donors implicated!
Peter B.: In the last few months the Afrifund Group has started
to pull together some of the information needed to have a "man-
agement information" system for the development space. In its
first phase it is merely a Wiki where information can be put "on
the record". In particular the database makes it possible for
good small things to be visible and perhaps it will be possible
for these good small to replace one day the big bad.... and the
small bad. By being independent of the official development com-
munity, maybe the database can influence development performance
favorably. A perhaps the database can also give wealthy well
wishers in the world the comfort level that will make it possi-
ble to get much more funding and get the funding where it will
do the most good.
Peter B.: Again, thank you Dr. Sharif. If people have jobs and
get paid, then the work needed to be done in Africa can get
done.
Sincerely,
Peter Burgess
in New York
Tel: +1-212-772-6918
mailto:peterb@afrifund.com
http://www.afrifund.com/wiki/index.pcgi?page=AfrifundDatabase
http://www.afrifund.com/wiki/index.pcgi?page=DDIssueMigrationaaa