FINAL DRAFT Communiqué (Brain Drain) November 15, 2004
The Commonwealth Medical Association Urges the Commonwealth Secretariat to Engage the OECD and the G8 Countries to Identify Solutions to the African Brain Drain Introduction At the Joint Commonwealth Medical Association 20th Triennial Consultation/Conference and the 46th Annual General Conference of the Ghana Medical Association in Elmina and Cape Coast, Ghana, November 7-14, 2004, the Council of the Commonwealth Medical Association, representing 700,000 doctors from 35 Commonwealth countries, and the membership of the Ghana Medical Association called for a renewed effort by the UK, the OECD and the G8 countries to find innovative, sustainable solutions to the African ‘brain drain’ in the health sector. The President of Ghana, John Kufuor, in a speech read on his behalf by Dr. Kwaku Afriyie, Minister of Health, reiterated the call for a sustainable solution. The aim of this communiqué is to urge the Commonwealth Secretariat to take the lead on behalf of affected countries in urging the UK to spearhead a concerted political campaign to reverse the medical brain drain and seek far-reaching solutions using the UK chairmanship of the G8 summit in July 2005 as an opportunity to develop international consensus on the need for rational, long-lasting solutions that can be financed and implemented. Background Recognizing the seriousness of the international human resources crisis in the health sector and the vicious cycle in which developing countries continue to lose their health workers to HIV/AIDS, resulting in a decreased capacity to deliver adequate healthcare to patients, Commonwealth Health Ministers meeting in Geneva, Switzerland, in May 2002 adopted a Commonwealth Code of Practice for the International Recruitment of Health Workers. In a subsequent meeting prior to the World Health Assembly in May 2003, Commonwealth Health Ministers endorsed a companion document explaining terms and issues contained in the Code and once again called for increased action on sustainable solutions to the brain drain. Commonwealth Heads of Government meeting in Abuja, Nigeria, in December 2003, were urged to support using new strategies to increase the health workforce of Commonwealth developing countries that go beyond the implementation of the Commonwealth Code of practice. Education Ministers of Commonwealth Small States meeting in Stoke Rochford, UK, in September 2004, noted that Commonwealth Small States are particularly vulnerable to the loss of skilled human resources through emigration as well as ill health and death caused by HIV/AIDS. Commonwealth Deputy Secretary-General Winston Cox noted that the impact of both factors on the Commonwealth’s most vulnerable members is threatening countries’ efforts to achieve their Millennium Development Goals and that the human resources challenge needs to be addressed and new ways found to deal with the problem.
A seminar conducted by AfricaRecruit in Johannesburg, South Africa, in September 2004 on ‘Strategic Skills for Africa 2004: Transnational Expansion within Africa’, an initiative of the Commonwealth Business Council that works to promote sustainable development in Africa through the use of human resources, provided useful new insights on the nature of the problem but failed to offer new remedies for Africa’s loss of health workers. The accelerating exodus At the Ghana meeting, experts in human resource management provided startling new numbers and new information on the root causes and the dynamics of Africa’s brain drain and noted that the situation was deteriorating. Only 50 of the 600 doctors trained in Zambia since independence remain in the country. More than two-thirds (2/3) of young Ghanaian doctors are leaving the country within 3 years of graduating medical school. In 2001, an estimated 2,923 nurses from South Africa were working in the UK; in the same year, 2,114 nurses left for the UK, two and a half times as many as in 1998. In Ghana, 320 nurses were lost in 1999, equivalent to Ghana’s annual output of nurses; losses for 2000 totaled 600. It was noted that Commonwealth countries are especially hard hit as English-speaking health professionals are highly valued everywhere. Two recent reports from the Institute of Medicine and the United States Agency for International Development show that the number of health workers in many African countries is actually shrinking. A third study conducted by ABT Associates showed that the ‘critical lack’ of health workers will make it impossible for many developing countries in subSaharan Africa to achieve their HIV/AIDS treatment goals by 2013 despite increased funding from overseas. Participants concluded that fundamental new strategies were required to reverse the brain drain and help countries retain existing health workers by paying them more. The disruption caused by the ‘internal brain drain’ was also discussed and the need to correct the imbalances caused by the higher salaries and perquisites paid by foreign NGOs. The Commonwealth Code Participants noted that the Commonwealth Code of Practice was having little effect in stemming the brain drain if, according to a recent OECD report, the flow of health workers from Africa to the UK and other OECD countries had increased since the Code was adopted. This was attributed to loopholes in the Code, such as the failure to curb recruitment by the private sector, the lack of sanctions, and, above all, the lack of reciprocity by the United States and non-Commonwealth countries. It was noted that even if the Code were effective it is unpopular with doctors, possibly an infringement of human rights, coming at a time when dismantling barriers to regional recruitment was gaining favour. Recommendations Participants called for the urgent implementation and development of the following actions: 1. Resolution of the international human resources crisis at the highest level of government, targeting the next meeting of the Commonwealth Heads of Government in Malta end of 2005. 2. Commitment to increased infrastructure of training institutions in developed and developing Commonwealth countries.
3. Repositioning of public finances for health with a priority for human resources based on the Abuja Declaration which called for African countries to increase public expenditures on health to 15% of general government expenditures by 2007. 4. Expansion of salary support for health workers, including direct salary support from overseas, to help governments of developing countries attract and retain existing health workers. 5. Development of a comprehensive incentive package to reverse the ‘brain drain’ and persuade doctors and nurses who have emigrated overseas to return to their home country. 6. Development of equitable financial solutions to the brain drain, including mechanisms to reimburse developing countries for the cost of training health professionals recruited overseas, including an international system of student loans, payments and/or transfer fees to be paid by employers in developed countries. 7. Strengthening of the Commonwealth Code of Practice for the International Recruitment of Health Workers, including its expansion or replacement with an international agreement that would include the United States and other OECD countries. 8. The creation of a high-level Commonwealth Working Group that would move forward development of these initiatives and report back to the Commonwealth at the Commonwealth Ministers of Health meeting in May 2005 prior to WHO in Geneva. Next Steps The delegates to the Joint Meeting of the Commonwealth Medical Association and the Ghana Medical Association request that the Secretary-General and Deputy SecretaryGeneral of the Commonwealth convene an extraordinary meeting in January 2005 of Commonwealth Health and Finance Ministers to set the terms of reference for this Working Group. Delegates recommended that a subsequent meeting be convened with the participation of international bodies such as WHO, United Nations Development Programme (UNDP), the World Bank and the International Monetary Fund, and non-Commonwealth countries such as the United States, to find ways for OECD countries to repay the ‘debt’ owed to them (e.g., by investing in new medical schools or upgrading teaching facilities for health workers). In view of the gravity of the international human resources emergency, delegates called on the Commonwealth Secretariat to urge the UK to take the lead on developing a concerted political and media campaign on the same scale as the Campaign for Debt Relief. Delegates noted that UK chairmanship of the G8 summit in July 2005 in Scotland provides a unique opportunity to rivet attention to the problem and, in concert with countries most affected, develop rational, long-lasting solutions that can be financed and implemented.