Saturday, July 09, 2005

Would you invest in this enterprise?

They neglected to account for the most important asset of all--human capital.

Compassion consistently clouds our judgment in deciding when to abandon a social endeavor. It is often claimed that it makes us uniquely human. On the contrary--reason makes us uniquely human. Compassion is what may ultimately be our undoing.


'Brain drain' puts Africa's hospitals on the critical list: Rich nations are taking the poverty-stricken continent's scarce medical staff, says Andrew Jack.

849 words
7 July 2005
Financial Times
London Ed1
Page 20
(c) 2005 The Financial Times Limited. All rights reserved.

The recently completed district hospital in Thyolo in southern Malawi would not look out of place in a more developed country except for one thing - a chronic shortage of medical staff.

The building - built with the support of the European Union - houses just 40 overworked nurses and eight clinical staff. It has no full-time doctor.

In the whole of Malawi, a country of 12m people, there are just 100 doctors and 2,000 nurses.

Malawi, one of the world's poorest countries, has always struggled to train the medical staff it needs. But now its plight has been exacerbated by a brain drain as staff are lured abroad by the prospect of higher pay in developed countries.

As the leaders of the Group of Eight industrialised nations meet in Gleneagles, Scotland, this week to discuss African poverty, Malawi's struggle to provide basic healthcare for its people offers a stark reminder to the world's richest countries that they contribute to the problems that many African nations face.

"Taking people away to other health services is killing our people," says Dr Hetherwick Ntabe, Malawi's health minister. He sees little hope of any solution in the near term.

Dr Atta Gbary, the World Health Organisation's Africa adviser on human resources in health, estimates that 23,000 of the best trained medical staff leave Africa each year for the developed world. He says that there are just 800,000 medical staff in the whole of Africa.

Given that the cost of training a specialist doctor in Africa is estimated by the United Nations to be about Dollars 100,000, the exodus represents a Dollars 500m annual subsidy from Africa to wealthy nations. In the UK last year there were more than 10,200 African-trained doctors.

Dr Ntabe believes Malawi should "bond" its medical staff, ensuring they serve several years in the local system once they have completed their training. He also wants foreign governments that hire Malawi's medical staff to pay compensation for the cost of training doctors and nurses to replace them.

The brain drain, says Dr Gbary, means the vacancy rate for nurses and doctors in Malawi is so high that even when donors offer funds "it is impossible to use them because the people are simply not there to work".

Some hospitals have resorted to hiring local staff out of retirement in a bid to make up the shortfalls.

But the lure of higher pay in the developed world is not the only reason behind the brain drain. With nearly 15 per cent of Malawi's adult population infected with HIV, many medical staff have themselves become ill with Aids or died.

The Aids epidemic has added to the burden on those who remain, which in turn has encouraged many in Malawi's state health sector to seek higher paid work and better conditions in private and non-governmental organisations - or even in different professions.

"It becomes frustrating working for the state," says Dr Roderick Narikungari, who quit after 10 years to join Medecins sans Frontie`res in Malawi. "There was a lack of resources . .. but I was being moved away from treatment into administration." He says many of his colleagues have left for richer neighbours such as Botswana as well as the UK.

Robin Broadhead, head of the College of Medicine in Blantyre, Malawi, says: "The brain drain is a sheer disgrace. But you can't expect to keep doctors here in artificial slavery."

Desperate government officials are now hunting for scapegoats. In particular, western academic institutions are being accused of luring talent away from treatment to research.

"Our people are rushing (to the institutions) where they are paid a lot more, do a lot less, sitting and filling out research forms," says Dr Ntabe. "It's ridiculous."

Such views now threaten a groundbreaking clinical trial planned by the University of North Carolina to test whether the Aids drug tenofovir can be used as a prophylactic. The trial is supported by the non-government group Family Health International.

Dr Francis Martinson, UNC's programme officer in Malawi, rejects such claims. "The government is always searching to blame everyone apart from itself. Most people have left the system because they don't like it."

He argues that UNC, which employs 70 medical staff in Malawi on salaries up to twice state levels, ensures nearly all spend substantial time on clinical work. It has also helped to fund facilities.

Ironically, while the WHO argues that Africa needs another 1m medical staff to meet basic health goals, it has recruited several of Malawi's top doctors. Others have gone into national politics and government, such as Dr Ntabe himself.

For now, Dr Ntabe and his colleagues see no obvious cure for the brain drain. Africa's efforts to improve healthcare will, it seems, continue to suffer.


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