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Africa’s Nursing Shortage Puts Health Care System on Verge of Collapse - 2004-07-19


Overworked and underpaid nurses are leaving jobs in Africa for opportunities in Europe and other wealthy nations. A new report by Physicians for Human Rights highlights the severe shortage of health care professionals in Africa and details how basic health care needs, let alone treatment and prevention for longer-term problems like HIV, aren’t being met. VOA’s Serena Parker has more.

Imagine you’re a nurse working in a primary health care clinic in South Africa. A never-ending stream of patients waits for basic medical care, but government financial constraints prevent the clinic from hiring more staff. And now with HIV/AIDS wreaking havoc on the country you find yourself struggling to meet those basic needs and treat people infected with the virus. For all the work and emotional suffering that comes with the job, the average South African nurse makes about five to seven thousand dollars a year.

Now imagine you get an offer from a public hospital in Great Britain, where you can earn $30,000 a year plus benefits like paid vacation and health care. The new job carries a workload that is far less demanding and made even easier by the fully stocked supply cabinet and pharmacy. What would you do? Like many South African nurses chances are you would take the job in Great Britain.

“Nurses are emotionally exhausted. They are burnt out. I mean if you are dealing with the huge number of people with a disease like HIV/AIDS, it takes its toll on you,” says Nomathemba Mazaleni, a South African nurse who works for an American non-governmental organization in Boston. Like so many others, the highly trained Ms. Mazaleni left South Africa for a better paying job.

This trend isn’t confined to South Africa. Nurses, doctors and pharmacists are leaving sub-Saharan Africa in droves for better paying jobs in Great Britain, the United States and other industrialized nations.

Holly Burkhalter, policy director for Physicians for Human Rights, says the exodus of a country’s best and brightest isn’t new. However, the sheer number of health care workers leaving Africa has put a severe strain on the medical system.

“The shortage of trained personnel really translates into terrible, terrible suffering, for example, of women in labor who need a trained birth attendant and just don’t have one,” she says.

Holly Burkhalter says the nursing shortage has led to an increase in mortality rates. To draw attention to the problem, Physicians for Human Rights just issued a new report with proposals to prevent brain drain and create more equitable health care systems in Africa.

There is no simple solution. Instead, the report urges a massive infusion of resources to improve working conditions and salaries of health care workers across the continent. Physicians for Human Rights also say wealthy nations that insist on hiring nurses from Africa should provide reimbursement of some kind.

One proposal is for donors to fund workers’ salaries, something they have been reluctant to do. Instead, for decades they have focused on what is known as technical assistance -- a paid consultant travels to a developing country, trains local staff in proper techniques, and then leaves. This is no longer considered sufficient given the depths of the problem.

But the issue of funding nurses and doctors’ salaries is complex, according to Mary O’Neil, a human resources specialist with Management Sciences for Health, a non-profit international health consulting firm.

“One, it’s costly. And there are lots of questions that have to be answered,” she says. “Do you fund just people who are providing HIV/AIDS services? Are we going to improve salaries for the janitors and for everybody who works in the health system? And for how long? How long are we going to have to be subsidizing?”

If donors are wary of paying health workers’ salaries, Holly Burkhalter says there are other ways to help. “You could provide health care or health insurance or paid vacation or paid sick days or a car or any number of things that could be done to help retain nurses and doctors in these programs,” she says.

Another remedy for the nursing shortage is improving the management of health care systems. Mary O’Neil notes that in most African countries health care suffers from a division between the capital and local communities.

“So for example, right now in a hospital where I was doing an assessment in Mombassa, they have 300 vacancies in their nursing staff,” she says. “But they have to wait for this civil service commission to approve that they can fill some of these positions. But then all the actual practice of recruiting and hiring goes through the central office. So it’s extremely cumbersome. It takes a long time – it could take up to a year to fill a position.”

Mary O’Neil and other health care professionals say if no solution is perfect, as many as possible should be tried to avert a human catastrophe.

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