Impact of Health Professional Migration on Health Delivery (2)
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Dear Colleagues
The human resource dimension of the health sector is very impor-
tant. While your colleague's study of the impact of health pro-
fessional migration on health delivery might be interesting, a
more interesting and valuable understanding would be WHY there
is migration and WHAT must be done about it.
From what I know of the health sector and the budget and eco-
nomic situation in Africa the financial crisis and the lack of
financial resources to pay health professionals and buy essen-
tial supplies is a big part of the WHY there is health profes-
sional migration.
WHAT must be done about it is emergency reform in the economic
and financial sectors so that resources are available to pay
health professionals and buy essential supplies.
Just after the independence of Namibia, I was involved with the
"development planning" that was taking place. Later I was in-
volved with "aid coordination" for the new government. I saw all
the offers of assistance made by the donors in that first year
of independence. Every donor offered what they wanted with lit-
tle or no reference to the priority needs of the country, and
almost everything had big benefit for the donor and little or
nothing for Namibia. It was a sad state of affairs. Donors loved
to use their nationals to study things, and the individuals had
the opportunity to learn a lot. The value to Namibia, however,
virtually nothing (except perhaps the macro-economic impact of
renting a hotel room and paying for meals!)
I did some work on AID coordination in Mozambique some years
ago. It was interesting to try to reconcile what the donors said
they were doing and reporting to (and reports of) the DAC or the
OECD (Development Assistance Committee) with what was being done
according to the project information in the country and reported
in the UNDP's DCR (Development Cooperation Report).
The bottom line is that the donors (including the international
financial community - World Bank et al.) seem to have no inter-
est in helping to figure out a way to finance what is absolutely
essential to have a viable health sector that can pay for the
professionals and the essential supplies.
I talked about this with a group in New York a few days ago and
the remarks were not welcomed. I was called a socialist and a
liberal (dirty words for this group) because in part they would
not take time to think through what can be done and must be
done.
Africa's resources are being bought for pennies on the dollar
through the contracts between governments and international com-
panies. Most of these contracts favor the parties to the agree-
ments but not the people and not the nation. They need to be
looked at very carefully and decisions made about how to go for-
ward. Africa's resources should be paying for Africa's health
needs.... and the fact that they are not is all to do with the
way they are being, and have been managed. This is what must
change, and it is an emergency. America is willing to do any-
thing when it is in the national interest and a matter of na-
tional security. What is the equivalent in the African national
situation. Bad health sector financing is killing more Africans
than terrorism is killing Americans... but Africa is not doing
very much to change this terrible status quo.
The Afrifund Database is evolving. We are getting ready for an
initiative about transparency, accounting and accountability,
and effective Monitoring and Evaluation (TAAME) so that we can
know much more about how scarce development resources are used.
When this is going, it will be apparent that maybe as much as 80
cents in every dollar of development assistance has no direct
benefit for Africa. Is this a surprise? No. What is surprising
is that there is no outrage about it. TAAME will also make it
possible to show systemically that humanitarian emergency assis-
tance is now dominating the donor's assistance budgets, but is
doing virtually nothing to help developing countries emerge from
endemic poverty and economic crisis. A lot of people have their
hearts in the right place, but they have little understanding of
the dynamic of development economics.... and the result is a
continuum of disastrous failed development.
If I was a health professional in Africa.... and could get a job
in the NORTH... I know what I would do under the present state
of the health sector in Africa. But if the health sector was
properly organized and funded, then there would be little reason
to migrate.
There is work to be done....
Sincerely
Peter Burgess
in New York
Tel: +1-212-772-6918
mailto:mailto:peterb@afrifund.com
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