Brain Drain of African Health Workers: The Good, the Bad, and the Ugly
With thousands of young African professionals leaving the continent for greener pastures overseas, brain drain is one of the hottest debates on the continent right now. As a young African health professional, I understand the allure of emigration. As far back as I can remember in medical school, foreign licensing exams were popular among students. I also know that if we were all to leave, healthcare on the continent would crumble.
Recently in Nigeria, brain drain has been an issue of much-heated debate as more health workers leave for countries like the UK, Canada, and the US, which promise better working conditions, better remuneration, and work environments. The data is clear: Nigeria is hemorrhaging healthcare workers and COVID-19 has been a significant enabler of this trend.
In an attempt to stop the bleeding, Representative Ganiyu Abiodun Johnson introduced a bill in the Nigerian Senate - “Nigerian-trained medical or dental practitioners [will be prevented from emigrating by delaying their] full licenses until they have worked for a minimum of five years in the country.” For the bill’s proponents, this strategy reflects the urgency of preventing further brain drain. However, opponents not only is this bill unconstitutional but believe the bill fails to address the issue at its root.
The issues faced by Nigerian health workers are common to healthcare workers in other African countries including my native Tanzania. Whether it is inadequate infrastructure in the form of unstable electricity or clean water supply, absurdly low salaries, or criminally high income taxes; there is little reason for a young professional to prioritize staying. Despite all this, I and many more of my colleagues are still in Tanzania.
Interestingly, the focus tends to be more on the few who are leaving and less on the many who are staying. Government officials seem more willing to discuss the brain drain issues than focus on improving working conditions for those who are still in the country. Most health centers where I have worked in Tanzania lacked operating capacity and from my interactions with my colleagues, the same is true in other centers. This infrastructure deficit is responsible for imbalances in local workforce distribution (internal brain drain) where most specialists are in larger referral facilities in urban areas than in rural areas where the burden is greatest.
The solutions seem obvious to me: prioritize the well-being of healthcare workers via better allocation of resources and the improvement of working conditions. These actions must match the healthcare workers’ dedication to their patients and communities. The game plan cannot be to just clap and compliment health workers like we saw during the COVID-19 pandemic. While compliments and applause are welcome, they do not reimburse student loans, pay rent, or take care of a family.
These changes may be difficult given the current macroeconomic situation. However, with the right partnerships, the government can inch closer to improving working conditions. For example, the government can partner with banks to disburse loans to students and healthcare workers at preferential rates. This has been the case in my country Tanzania. Unfortunately, just like Nigeria, Tanzania policymakers have used these loans to infringe on the rights of healthcare workers. This threat has limited the use of such schemes and eroded trust.
More importantly, governments must invest in health facilities especially those at the district level. Improving working conditions for health professionals can only lead to better job satisfaction, service delivery, and health outcomes. I was pleased to listen to Dr. Ifeanyi Nsofor share his lived experience and research on the Global Health Unfiltered Podcast. Dr. Nsofor has conducted the largest study on the causes and volume of Nigerian health worker migration and is himself a diasporan. He admitted that the brain drain issue was a matter of urgent concern but he stressed that the proposed anti-brain drain bill in Nigeria was unconstitutional as it restricted the rights to free movement and was discriminatory.
Understandably, responses from healthcare actors were overwhelmingly negative. Proper consultation with such groups who would be most impacted by the bill would have resulted in more appropriate solutions.
Obviously, most healthcare workers are passionate about their jobs and genuinely love to take care of patients. Most would love to work in their home countries if things were different. If lawmakers want to truly address the brain drain crisis, then they need to put aside their hypocrisy, and sincerely seek to listen, understand and address the concerns of healthcare workers.
Undoubtedly, if lawmakers focus on genuinely addressing these challenges, then healthcare workers will choose to remain in their countries where they’d rather be in the first place. However, alienating them as the Nigerian senate did can only lead to a leakier pipeline as fewer aspiring medical professionals will choose medicine in the future.
