[afro-nets] Ghana lost 12,365 Health Professionals 1993-2002 (8)

General afro-nets
1

Ghana lost 12,365 Health Professionals 1993-2002 (8)
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Dear Edward,

This is a timely exercise and as someone working in this area I
am interested in knowing following the process and certainly the
outcome of such an exercise. Health worker migration is a major
international challenge that requires considered solutions. Its
not an easy topic but that is no reason for not tackling it.

Best wishes,

Charles Hongoro, PhD
Lecturer in Health Economics
Health Policy Unit
Department of Public Health and Policy
London School of Hygiene and Tropical Medicine
Keppel Street , London WC1 E 7HT
Tel. +44-207-927-2930 (O)
Fax: +44-207-637-5391
Mobile: +44-7876708986
Tel. +44-20-8558-2560 (H)
mailto:charles.hongoro@lshtm.ac.uk
mailto:hongoro@hotmail.com

2

Ghana lost 12,365 Health Professionals 1993-2002 (10)
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Hello,

I think there have been quite a lot of studies into migration of
health workers and some organizations like the International or-
ganization for Migration has been looking at Diasporal resources
for some time now. Recent studies - (Vujucic 2004) have looked
at wage differentials and the disparity is huge between the main
source and recipient countries. there are some resources that
can help with information:
http://www.eldis.org/healthsystems/dossiers/hr/
http://www.human-resources-health.com/articles/browse.asp

are two that can provide some information including articles on
migration(World Bank, WHO should also have items).

WHO Africa Region just completed a study - in depth for 6 coun-
tries including Ghana mainly looking at workers intending to mi-
grate and some of the factors. It is quite extensive and should
be published soon. Any addition from purely a diasporal point of
view will be welcome I guess. Major problem is not knowing what
will make people stay but whether it can be afforded and sec-
ondly, whether it was only the pay that mattered - No, several
other factors also influence migration and some are very diffi-
cult to tackle including what was mentioned of the politics,
ethics and conflicts in our regions for example.

In addition a Joint World Bank, WHO and Rockefeller Foundation
"joint learning initiative" is examining Human Resources issues
around the world - clearly something is generating the huge de-
mand in industrialized countries so a broader view is needed -
It is a complex and difficult area.

I hope the above sites gives you some information on some of
what has been done.

Sincerely,

Dr. Dela Dovlo
Accra, Ghana
mailto:dovlod@yahoo.com

3

Ghana lost 12,365 Health Professionals 1993-2002 (12)
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Dr Dovlo:

You are certainly right that this is a very complex topic, but
certainly no more complex that most of the problems addressed by
health economists in the past. Ideally, it requires a systems
approach. One will want to address the political issues as well
as social conflicts. The Bank and WHO, as well as other agencies
have done quite a lot of work which can provide the foundation
for a future research on this topic.

I will look through some of the sources you provided. They look
interesting. The issue is, given all these studies, why is the
problem getting worse by the year? Have they implemented these
studies? Do we have any studies showing the minimum package of
incentives (pay, working conditions, supplies, etc.) it will
take to retain a young graduate of University of Ibadan or Le-
gon, for example, to decide to practice at home? There ought to
be such a package, which research can identify.

How about the diaspora? Even if you cannot encourage people to
go back to Africa completely (which may not be necessary in the
short run) there ought to be a condition under which many ex-
perts spend significant time between their new adopted country
and Africa in order to assist in curtailing the brain drain
problem.

You see, if you ask the right questions, economics has way of
giving you useful solutions. If we do not work on practical so-
lutions, the health professional brain drain in Ghana will be
30,000 in a couple of years. One thing that does not work is to
rely on moral suasion or altruism. I intend to work on finding a
market solution which is affordable (else it will be purely aca-
demic).

Regards,

Edward Kwaku Mensah, PhD
Professor, Health Economics and Information Management
Director, Public Health Informatics Program
School of Public Health
Division of Health Policy and Administration
University of Illinois at Chicago
mailto:dehasnem@uic.edu

4

Ghana lost 12,365 Health Professionals 1993-2002 (14)
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Dear All,

Thanks for your robust contributions to this very important
topic. I have interviewed health professionals from Zimbabwe,
Zambia, South Africa, Malawi, Swaziland and Botswana concerning
their move to the United Kingdom. While certainly issues of pay,
working conditions etc. are important, there are other issues
that I have found are even more important i.e. issues relating
to good governance, quality of life, opportunities to educate
their children etc.

If we fail to address these issues which relate to socio-
economic conditions, the harder it will be to retain our health
professionals. Unfortunately issues of governance, quality of
life etc. tend to be the very issues that we as professionals
are unable to influence.

Regards,

Richard Matikanya
mailto:rmatikanya@yahoo.com

5

Ghana lost 12,365 Health Professionals 1993-2002 (15)
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Dear Prof. Mensah,

Thanks you for your lucid respond. I have no doubts that further
work will enrich the knowledge and discussion on the subject. I
was just trying to point out what has been done so far so that
we don't duplicate efforts. Of course there are economic solu-
tions as well as social and political ones, and indeed as raised
by one commentator on this list, the issue of remittances
(though some studies show senior health professionals/doctors
tended to uproot more completely, unlike mid-level workers who
tended to remit more heavily - but more studies needed, I
guess).

There is also globalization, structural adjustment and the wider
health labour market changes, some a result of demographic
changes in industrialised countries that affects the leaving of
health workers, and so it is not too clear to me at this time
whether remuneration, even if we can match the recipient coun-
tries will work - the politics of demand there may simply mean
even greater value being placed on health workers and then the
goal post shifts and the difference remains.

So, quite a lot of thinking and understanding, experimenting,
revising and learning from experience is needed as even some of
the wealthier African countries (South Africa, Botswana and Mau-
ritius) face similar if not higher loss of health workers.

On the issue of remittances - will remittances back to a country
without health workers improve the health of its citizens and
its economy? Can be debated and the value of remittances needs
to be juxtaposed against the possible harm?

On the diaspora, the IOM website (www.IOM.org) will probably
help you with some clues. They have had the "Return of Qualified
African Nationals (RQAN)" programme for some years and now run a
"MIDA" (Migration for Development of Africa) that is using the
utilization of diasporal resources rather than a simple return
to origins (temporary lectureships, investment consortiums) etc.
The NEPAD HR Cluster I understand has agreements with IOM on
some of these arrangements and a series of meetings are taking
place between governments and citizens in the diaspora.

In January 2003 Commonwealth African countries in East, Central
and Southern Africa met and for once specifically looked at the
coping strategies which countries had tried or were considering
- quite interesting but impact even in richer countries remain
to be seen. Others have used locally developed cadres that are
not internationally marketable to replace doctors (Tanzania, Ma-
lawi, Mozambique) with some interesting successes - which I
guess is also an economic solution.

On moral suasion, I agree it is useless as a sole strategy and a
number of international bodies, Commonwealth, WONCA, ICN, etc.
have agreed Codes of Ethics/Conduct in international recruitment
from developing countries but so far this as you rightly sus-
pected has showed little effect but remains part of the solu-
tion.

Thanks again for the inter-change of ideas and information.

Best regards,

Dela Dovlo
mailto:dovlod@yahoo.com