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

2. 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

3. 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

4. Dispersion of Doctors 5 Years After Graduation

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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