Africa’s public service and health sector brain drain

AFP PHOTO / SIMON MAINA

A report the other day by the Mo Ibrahim Foundation that Nigeria and other countries in Africa are losing about $2 billion annually via brain drain in the health sector is another badge of dishonour for a continent that has constantly been a symbol of shame and suffering.

The Foundation stated in its 2018 Report titled, “Public Service in Africa” that no sound governance in Africa would be achieved without strong public services and health care delivery is one that is abysmally, shamefully low, of all public services.

It, in fact, dominated discussions at the 2018 Ibrahim Forum held in Rwanda recently where African leaders gathered under the aegis of the African Union (AU).

According to the report, only three countries – Libya, Mauritius and Tunisia, have at least one doctor per 1,000 people in Africa, far beneath international standards as that ratio is.

Besides, the same report notes that covering the void left by public services, private security, private education, and private health have been rising exponentially, with the risk of widening inequalities on the continent.

Furthermore, it shows that five out of the 10 African countries with the largest public health expenditures as a percentage of total government expenditure were also among the 10 countries with the highest share of external financing of their total health expenditure.

“Personal Safety is the most deteriorated of the 14 sub-categories in the Ibrahim Index of African Governance, over the past decade.”

It continues, “twenty-two per cent of Africa’s population who had contact with a public service in 2015 said they paid a bribe, mostly to the police and the courts, among others.”

Besides, “In e-government, Africa lags far behind the global average, except in Rwanda, where the delivery time of an emergency blood supply with drones is reduced to 30 minutes from three hours by road.

“Many indices point to a low and decreasing level of open government practices in Africa. Over the past decade, the African average for the Accountability of Public Officials has deteriorated, with the pace of decline worsening over the last five years.

“Most African citizens are in favour of paying for public services. Only seven African countries have a complete birth registration system,” the report states.

The Chairman of the Foundation, Mo Ibrahim, specifically described “public service” as the main pillar of governance. The influential Sudanese businessman and philanthropist also stated that without strong public services and committed public servants, there would be no efficient delivery of expected public goods and services, nor implementation of any commitment, however strongly voiced.

The Foundation’s findings show that on average, African public services display a continent-wide lack of capacity.

“They remain a relatively small employer, at a cost higher than in other regions, with large country disparities. In health, education and security, public supply is far from answering the demand.”

“Partly to answer the exponential demand, partly to substitute failing public supply,” the report indicates that a growing range of non-state actors have become key providers of public goods and services, to an extent that many have sometimes prevented national governments from owning public policies.

From the report also comes a revelation that public employees in Africa are on average better educated than those in the private sector and are also twice older on average than the population they serve.

Meanwhile, the gripping report indicates too that job motivation is mainly about job security rather than wages. Just as mobility within or outside public service is almost non-existent, political dependence is strong, working equipment is scarce, corruption is among the highest at global level, “ghost public servants” populate many services, while too many of the best-trained choose to work abroad.

And so, there is a correlation between inefficient public services and health sector brain drain in Africa. It is only a strong public or civil service that can sustain experts in the sector that has been disrupted too by the combined effects of globalisation and global competiveness.

Specifically, Nigeria’s own health sector challenge has become a bad ulcer that thrives on medications applied to it. Yet, there has been no recent indication that the country’s leadership is about to address the reproach.

Which was why, the other day, stakeholders in Nigeria’s health sector blew an alarm on the rate at which Nigerian physicians have been trooping abroad in search of greener pastures.

The stakeholders shed light on the urgency of the situation, calling on the Federal Government to do more to save the nation’s health infrastructure and personnel.

It is estimated that at least 2,000 medical doctors leave the country yearly for the United Kingdom, United States, Canada, Australia, United Arab Emirates (UAE), and South Africa.

This is cataclysmic, given the fact that currently, contrary to the World Health Organisation (WHO) standard of a ratio of one doctor to 600 patients, Nigeria has a ratio of one doctor to 6,000 patients.

This poor doctor-patient ratio is regrettable when compared to that ratio of India (1:2083) and the United States (1:500).
Figures released February 2018 by the British government indicate that no fewer than 5,405 Nigerian-trained doctors and nurses are currently working with the British National Health Service (NHS) in the United Kingdom (UK).

This means that medics of Nigerian extraction constitute 3.9 per cent of the 137,000 foreign staff of 202 nationalities working alongside British doctors and nurses.

It is thus regretted that even in Africa’s so-called largest economy, fresh doctors no longer see a bright future within the shores of the country because the conditions of work are pathetic.

The facilities are poor and the remunerations are poor.

What is more, most of the nation’s leaders, including the president, always fly abroad for medical care, an unacceptable situation in a country that once boasted of having one of the best four hospitals in the Commonwealth.

The government needs to take healthcare seriously and make it a major priority in view of its critical importance to the citizens’ lives. The amount of money budgeted for health must be increased.

In fact, health care requires remarkable investment, not just increased funding. Better investment will certainly translate to more remuneration for health workers, increased training opportunities for doctors, availability of equipment and other infrastructural facilities.

Even basic diagnosis is unreliable in this country. Radiologists, for instance, reportedly face frustration and embarrassment owing to lack of imaging equipment to hone skills and provide quality service confidently. For most professional laboratory scientists, knowledge of modern equipment is at best theoretical and these inadequacies turn their professional lives into one of hard labour and frustration.

It is given that trained health professionals are needed in every part of the world, and so when healthcare professionals lack opportunities for professional development, lack enabling environment, cannot fully use their skills and find that the quality of their lives is woeful, compared to their peers in more advanced countries, they have no choice but to flee abroad. Until Nigeria places the highest premium on healthcare, this exodus of doctors will not end.

And as a matter of urgency, African leaders must instill confidence in and show willingness to improve healthcare services by enunciating necessary health laws that are capable of increasing funding for the sector and ensuring that the funds are properly managed.

Better political commitment to health care; better appreciation of the worth of medical personnel, along with better and competitive wages; better working conditions and inspiring work environment; better security and access to social amenities; attractive and globally respected postgraduate training programmes for health workers will not only stabilise the healthcare delivery system, it will stop the current brain drain.

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