COVID-19 drives a new African brain drain in medicine

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Western countries are luring African medical professionals and healthcare workers to migrate as they seek to bridge the gap in medical personnel created by the coronavirus outbreak, writes Wagdy Sawahel for University World News.  Is this a loss for Africa, or is it simply that are we entering into a different future globalised landscape?

In late March, the US State Department, Bureau of Consular Affairs tweeted the following call for applicants: “We encourage medical professionals seeking work in the US on a work or exchange visitor visa, particularly those working on #COVID19 issues, to contact the nearest US Embassy/Consulate for a visa appointment.”

As a result, 8,600 Egyptian doctors were accepted into the US, according to a 16 May news report by Arab News Network.

Other Western countries around the world have issued calls for foreign medics, including Canada, Germany and France. Some of these countries are reportedly specifically targeting Africans.

The African region already suffers more than 24% of the global burden of disease but has access to only 3% of health workers and less than 1% of the world’s financial resources, according to Global Health Observatory data.

The movement of physicians from lower to higher income settings has substantial economic and social consequences, prompting calls from academics for governments to develop retention strategies.

Retention strategies
“Before the rest of the remaining medical scarce resource leaves, governments should step in and figure out ways to retain them,” Laila El Baradei, professor of public administration at the School of Global Affairs and Public Policy of the American University in Cairo, Egypt, told University World News.

“Better pay is a crucial first step … Governments and universities should rethink the compensation package and benefits given to medical staff,” El Baradei said.

She said that in Egypt, underpaid medical staff, especially physicians and nurses, are forced to work in multiple hospitals and health facilities, which affects the quality of service they offer, drains their energy and detracts from the time they have available for developing their skills and doing research.

Sefaakor Ahiaku, vice-president of the Ghanaian Doctors and Dentists Association UK, agreed that a clear working structure and remuneration plan needed to be put in place for medical staff. “There needs to be evidence that African governments can and will uphold those structures. Looking from the outside in, seeing doctors who have worked but had pay withheld for months is incredibly disheartening,” she said.

Ifeanyi McWilliams Nsofor, director of policy and advocacy for Nigeria Health Watch, said a study by Nigeria Health Watch on the emigration of Nigerian doctors highlighted the search for better facilities and working environments, higher remuneration, career progression and professional advancement, along with better quality of life as some of the reasons doctors leave.

“The study recommended that the Nigerian government should improve remuneration, upgrade all hospital facilities and equipment, increase healthcare funding, and improve working conditions of health workers.”

“These results reflect similar conditions in other African countries and the recommendations sum up what African universities and governments should do to reverse brain drain,” Nsofor said.

World Health Organisation consultant Akhenaten Siankam Tankwanchi, clinical assistant professor at the School of Public Health of the University of Washington in the US, questioned the assumption that governments want to retain their health workers, saying: “I am aware that there are many jobless and underemployed health workers in several African countries.

“My bottom-line message to African governments is to listen carefully and try, to every extent possible, to respond favourably to the needs of their domestic health workers.

“Most African health workers will willingly choose to stay home or even return from abroad to offer their medical services if there is a political will to empower them and validate their work and life-affirming role in society,” Tankwanchi said.

Universities’ role
According to Graciano Masauso, founder, president, director and CEO of Africa Health Organisation-Zimbabwe, said while action to curb brain drain can be spearheaded by governments, which can put in place policies that encourage expatriates to return, part of the solution to retaining medical talent lies with the opportunities provided to them by Africa’s universities and their associated hospitals.

“This includes the chance to put their talents to use, advance in their careers, and make a difference in the lives of others, as well as the future of the continent,” said Masauso.

“The African Union Migration Policy Framework (2018-2027) made several similar recommendations. African countries, however, must implement such recommendations by adhering to meritocratic recruitment procedures and the provision of incentive mechanisms to attract and retain highly qualified African nationals.”

The COVID-19 pandemic and others, such as Ebola, have dramatically highlighted the need for medical academics and professionals in Africa, but do they need to be based on the continent for their expertise to be utilised?

Global brain capital
According to Adamson Muula, professor of epidemiology and public health at the School of Public Health and Family Medicine of the University of Malawi, the assumption that African doctors and academics must be on the continent at all times “assumes, perhaps erroneously, that African professionals are not part of the brain capital globally”.

A 2017 article comparing physician emigration from Africa to the US between 2005 and 2015 showed that an estimated one fifth of African-born physicians are working in high-income countries and this is equivalent to about one African-educated physician migrating to the US per day over the last decade.

“I suggest that if Africans cannot contribute and be part of the global solution, then Africa should not expect professionals and academics from other continents to come to work on Africa’s problems,” Muula said.

“COVID-19 is a global pandemic and so the last thing we should be worried about is Africans serving from outside their countries of birth.

“We should feel non-apologetic as we serve humanity wherever humanity exists, but this should not be at the risk of exacerbating inequities,” he said.

Muula said the diaspora can be an important resource for the African continent, but this “should not be at the expense of communities in which the African in diaspora is living”.

“Africa is part of the global world and it is heartening that medical professionals of African descent have joined the heroes from other parts of the world in fighting COVID-19.”

A good example is Moroccan immunologist Moncef Slaoui, who was appointed by the US White House as the scientific director of Operation Warp Speed, a ground-breaking effort to prepare a vaccine for COVID-19.

Nsofor of Nigeria Health Watch said because COVID-19 appears less severe in Africa than Western countries, COVID-19 cases may not require the specialised care needed by cases in the West.

“Therefore, the benefit that the African medical diaspora can offer to their home countries in Africa would be to include academics from African universities in COVID-19 research currently going on in the West.

“This scientific alliance between the African medical diaspora and African academic community would help build local research capacity and create lasting networks between African universities and their counterparts in the West to enhance COVID-19 studies,” Nsofor said.

In some ways, therefore, COVID-19 had redefined the way knowledge is acquired, said Nsofor.

“African diaspora professors can support African universities through different capacity building programmes that can be delivered through video conferencing platforms such as Zoom.”

Brain circulation
Highlighting the strong tradition of international collaboration within medicine, Linda Semu, associate professor in the sociology department of McDaniel College in the US, said: “We need to view migration not in terms of brain drain or brain gain, but in terms of brain circulation that allows for exchange of knowledge and experience between places of origin and places of residence.”

Semu, who chairs the US-based Malawi Diaspora Network, said African medical doctors who are moving around the globe to gain further experience should be linked with their home countries through training and research or continuing professional development.

Masauso of Africa Health Organisation agreed, arguing that “one alternative – if not a solution – would be to use the academic brain power in the diaspora to teach courses in African universities. Such a circulation of skills would open new prospects for African countries at a time of inescapable globalisation”.

“For several years now, university and scientific networks have been set up between home countries and countries with an African diaspora,” Masauso said.

For example, the University of the Mountains-Cameroon has formed an alliance with the Dijon University Hospital and Paris 13 University in France – and with the University of Udine and the Centro Cardiologico Monzino in Milan, both in Italy.

Cameroonian pharmacists who have settled in Belgium have joined forces with Cameroon’s University of Douala to offer introductory courses in pharmacy. Since 2010, the Association of Cameroonian Physicians in Belgium has been organising professional conferences and public information and awareness-raising campaigns for Cameroonians.

“A continuation of this would keep African medical professionals within the region,” Masauso said.

“The integration of the African diaspora in the global skills market offers Africans some assurance that they will remain competitive, instead of experiencing the sclerosis they suffer if they stay in their country of origin – because of the poor working conditions and an environment that does not favour professional success … Now, more than ever, it is important to regenerate higher education and research to help health personnel combat the current coronavirus crisis.”

Global health-keeping force
In a profound nod towards internationalisation, Binod Khadria, former professor of economics, education and migration at Jawaharlal Nehru University in New Delhi, India, called for the creation of a global health-keeping force – along the lines of the UN peacekeepers.

Universities and governments “need to declare science, technology, engineering and medicine or STEM youth as the sixth ‘global common’ to be equitably shared by all countries,” he told University World News.

“Adoption and propagation of innovative models of dual, multiple and global citizenship among African medical diasporas including medical professors abroad to create a pool of ‘global health-keeping force’ along the lines of the ‘UN peacekeeping force’ – readily accessible to a crisis-hit country… would benefit the African countries,” said Khadria, who is the co-editor of the World Migration Report 2020, published by the Geneva-based UN International Organisation for Migration.

“These innovative initiatives would form a far more effective strategy to combat brain drain of African medical professionals than the often circumvented pleas by the World Health Organisation and the origin countries in Africa for practising ‘ethical recruitment’.”


University World News report

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