China, where COVID-19 originated, has reported a decline in new cases. As this happened, Europe and the United States became new epicentres of the pandemic. The COVID-19 cases in African countries are on the rise. As of the time of writing, over 31 million cases had been reported globally.
United States, India, Brazil, and Russia have reported more than the global cases of COVID-19. Earlier, in the pandemic, in May, Russia, United Kingdom, Spain, and Italy accounted for more than half of the global cases. These countries have borne the highest burden in terms of mortality. In the UK, there are rumours of a second lockdown.
The burden of the pandemic is challenging the Western healthcare system that has always been thought to be the best in the world. Even as the west faces the potential epidemic of healthcare workforce shortage as a result of aging, it has not trained enough new healthcare workers or there is a high turnover of the already trained. To make up for the shortage, the west has always looked up to the global south to push up the numbers.
In the United States, 16.5% of the entire of healthcare workers are immigrants. From the immigrant group, Nigeria contributes the tenth largest healthcare workers. On the other hand, the UK has 13.3% of immigrant health workers. It was reported in 2018 that EU nurses were leaving NHS in England in good numbers. This might leave a gap for supply of nurses from other regions of the world especially English-speaking ones.
Now as the COVID-19 pandemic wages on, at least the U.S. Department of State: Consular Affairs has issued a circular encouraging any ‘medical professional seeking work in the U.S. on a work or exchange visitor visa (H or J), particularly those working on #COVID19 issues, to contact the nearest U.S. Embassy Consulate for a visa appointment’. This could be detrimental to the already strained health systems in Africa.
The current global health infrastructure in many ways resemble the colonial arrangement of asymmetrical power structure that is entirely dominated by western countries. In this case, capital, professional advancement, and symbol status have become a point of attraction or pulling factors for healthcare labour from Africa.
The unequal economic power leaves African countries struggling to retain the healthcare workers that they train. For example, a 2004 World Bank report suggested that more than 20% of medical professionals in Organisation for Economic Cooperation and Development (OECD) countries were immigrants with ‘more Ghanaian-born doctors living in London than in Ghana’.
Furthermore, between 50% and 75% of Ghanaian medical doctors emigrated in 4.5 and 9.5 years after graduation respectively between 1985 and 1994. Countries like Sierra Leone, Tanzania, Mozambique, Angola and Liberia lose more than 50% of the health workers that they train whereas South Africa, Nigeria and Egypt are among the top Non-EU countries providing UK with medical doctors.
The continuous migration of healthcare workers form Africa worsen healthcare investment inequalities. The countries invest in the education of its health labour force but when they emigrate, the countries are not restituted. The western countries benefit from their skill and save on the investments that they should have made in training their own force.
In 2005, a report by Medact, a UK charity for global health, suggested that the UK might have saved more money in recruiting Ghanaian health workers than it gave the African country in aid for health.
In many Africa countries, the high turnover of healthcare workers creates a cycle of understaffed health system, over-worked and underpaid staff which in turn might lead to different waves of health workers emigration. This might have negative consequences on the attainment of the Universal Health Coverage. The World Health Organisation acknowledges that adequate size and skills of a health workforce is important for the attainment of the Sustainable Development Goal of good health and well-being.
Globally, there is the need to train more health workers. But the health worker gap between Africa and the rest of the world is staggering. The recently released State of the World’s Nursing report demonstrates this point. Europe and the Americas have a nurse-population ratio of 81 nurses per 10,000 people. That of the Western Pacific is 36 to 10,000 people.
But in Africa and South-East Asia and the Eastern Mediterranean have 8.7 and 16 per 1000 people respectively. The situation occasioned by COVID-19 will most likely lead to wider unequal distribution of healthcare workers as they emigrate.
In many African countries, the government remains the biggest employer of healthcare workers. When the economies of many African countries took a nosedive in the mid-1980s, the World Bank and the International Monetary Fund (IMF) were consulted and they introduced the structural adjustments programme (SAP).
The programme encouraged austerity and downsizing of the public sector. It affected the health sector too. It resulted in health budget cuts and freeze on public employment. The hope was that the private sector would absorb the ‘surplus’ workers but that did not happen. Many of the workers emigrated.
At the turn of the millennium, as many of the African countries exited the World Bank and IMF programme, they opened up their economies, trained and employed more workers. For example, Ghana opened many training institutions and bonded nurses to a 5-year period.
But Ghana returned to the IMF in the 2010s. The IMF introduced a variant of the SAP which froze public sector employment and encouraged only limited employment. The nurses’ bond was reversed. As a result, there is high health worker unemployment.
This is not only true to Ghana. Similar nurse unemployment trends have been reported in Malawi, South Africa among other countries. This might constitute a pushing factor that might urge health workers from African countries to emigrate.
As the COVID-19 rages on in the west and it opens up to employing more health workers from overseas to augment its healthcare force, unemployment conditions such as the one currently playing out on the continent might encourage another wave of brain drain. In a way, history has a way of repeating itself, somehow.
By Kwabena Agyare Yeboah