Health Workers Poaching From Sub-Saharan Africa Should Be Deemed a Crime: Experts

Canadian Press, February 22, 2008

TORONTO—The poaching of doctors, nurses and pharmacists from sub-Saharan Africa by developed countries ought to be viewed as an international crime, a group of public health researchers from Canada and other countries argue in a leading medical journal.

The researchers, a number of whom are from the B.C. Centre of Excellence for HIV-AIDS, say the practice of richer countries filling their health-care vacancies by recruiting in South Africa and other personnel-poor African countries is a violation of the human rights of the people of affected African nations.

“There are more Malawian physicians in Manchester (England) than there are in Malawi,” said lead author Edward Mills, a medical epidemiologist with the B.C. Centre.

“The problem is probably the biggest public health problem in all of Africa.”

Dr. Julio Montaner, the director of the centre—and the next president of the International AIDS Society—is the senior author on the commentary. It will be published Saturday in The Lancet.

Countries such as Canada, the United States, Britain and Australia are home to thousands of doctors, nurses and pharmacists from Africa. Some have chosen to immigrate themselves, but many have been lured to their new homes with offers of an enormous increase in pay, moving expenses and help to navigate the visa and citizenship processes.

The number of doctors from sub-Sarahan countries alone who are working in the four countries is staggering—an estimated 13,272.

Mills himself was on an operating table in South Africa last year after suffering an accident. He said the physician’s cellphone buzzed several times throughout the procedure; the doctor told him the calls were from recruiters.

When Canada or another wealthy country recruits in South Africa—as the Shoppers Drug Mart chain was attempting to do with pharmacists last fall—the effect is like tumbling dominos. South Africa in turn fills its vacancies by recruiting from other, less affluent African countries.

The problem in many countries is dire, with doctor to patient ratios that are completely untenable. In Malawi, there is one doctor for every 50,000 people, while in Canada there is one for every 500.

While the battle to get affordable antiretroviral drugs to Africans with HIV-AIDS is paying off, the health-care workers to deliver the drugs don’t exist, Mills said.

He noted that in Northern Uganda, nurses aides—people with a year or two of training—are now being trained to undertake the delicate task of starting HIV-positive infants on antiretroviral therapy. It’s a job best performed by pediatricians, but there are none to do it.

Many of the plundered countries have taken to training health-care staff to sub-optimal levels—medical officers instead of doctors—so they are less desirable to foreign recruiters, Mills said, noting it is the only way they can hang onto personnel.

He and his colleagues contend that the impact of this poaching of Africa’s health-care professionals constitutes an international crime that is contributing to the deterioration of essential health-care services on the continent.

Dr. Amir Attaran, a Canada Research Chair in law, population health and global development policy, sympathizes with the aim of the argument. But he said he does not agree with the position that poaching health professionals is a crime under international law.

“I don’t have any difficulty saying that it would be lovely and I would prefer to live in a world where it were criminal,” said Attaran, who teaches in the University of Ottawa’s Institute of Population Health and the faculty of law.

“But their argument is that already customary international law tells us that this recruitment should stop. . . . That is an incorrect understanding of what customary international law is.”

Attaran co-authored an article published in January by the Canadian Medical Association Journal which denounced Shoppers Drug Mart for recruiting in South Africa. He said Canada’s policy in the early 1990s to cut back enrolment spots in medical schools created a situation where this country can’t now—and won’t be able in the foreseeable future—meet its own need for doctors.

“If you want to look at it over a course of two decades, our management of health systems in this country has gone from nearly negligent to morally reprehensible,” he said.

“The negligent decision was we wouldn’t train, and it would save us a few dollars here and there. The reprehensible one is we go: ‘Oh, we should have trained. We didn’t. Gosh. Well, let’s just poach.”

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