The Challenge of Health Worker Migration in Africa Current Responses and Gaps Joachim Osur Solomon Orero Dona Anyona Daniel Yumbya

Background World population that lives in Sub-Saharan Africa = 12% Burden of disease in Sub-Saharan Africa = 27% Global health workforce that lives in Africa = 3.5% Proportion of physicians who live in Sub-Saharan Africa = 1.7% Inadequate health workforce is a main contributor to the weak health systems in Africa

Scope of Health Worker Migration Programming Urban to rural migration – inequitable distribution Public to private sector – inequitable distribution Out of the country but within Africa – lowering the numbers Out of the continent – lowering the numbers Abandoning the profession – lowering the numbers Reverse migration – difficulty in being re-absorbed/ensuring quality

Dispersion of Doctors 5 Years After Graduation

Case Examples of Migration: SSA to USA In a review in the USA of Physicians: 23% trained outside America of which 64% were from the LIC 5334 were from Africa which is equivalent to 6% of doctors practicing in Africa 86% of the doctors practicing in the USA are from : Ghana, Nigeria and South Africa Of the doctors in the USA from Africa 79% trained in 10 Medical schools African governments spend a big proportion of their budgets training health workers

Example: Average Salary of Doctors Reasons for Migration Terms of service – salary, allowances, recognition, promotion, career development Work environment – lack of tools for the trade, management issues, infrastructure for staff and family Example: Average Salary of Doctors COUNTRY SALARY USD (2004) SALARY USD (2014) Uganda 67 700 Kenya 250 1400 Malawi 151 610 South Africa 2836 7282 USA 10554 15000

Our Intervention Based on the fact that: African countries generally lack a database for monitoring health worker migration, no evidence to base their actions Weak or no policies to mitigate the impact of migration Countries do not report on the WHO Code of Ethical Practice on the International Recruitment of Health Workers No clear interventions to help manage health worker migration

Our Intervention: Improving Data for Policy Making Partnered with Association of Medical Councils of Africa (AMCOA) Developed a Protocol on Health Worker Migration in Africa Protocol already signed by 15 countries The protocol mandates countries: To monitor and share information on health worker migration Advise host governments on how to manage migration to limit harm to the health system Harmonized data collection tools developed, being pre-tested in Kenya, Uganda and Zambia Annual reporting of progress to AMCOA

Our Intervention: Stimulating Discussion Between Health Worker Associations and Government Country level analysis of health worker migration Convening and providing information to associations of doctors, nurses, midwives, pharmacists on health worker migration Convening government agencies, providing information Hosting joint discussions between health worker associations and governments

Our Intervention: Next Steps Supporting governments to formulate and implement appropriate policies to mitigate the impact of health worker migration at all levels Supporting governments to report on the WHO Code of Ethical Practice on the International Recruitment of Health Workers Encouraging governments to initiate bilateral discussions with countries that import/export health workers to them so as to ensure mutual benefit