Africa -China Review Africa -China Cooperation and Transformation
By: Mweusi Karake
Recently, I came across an angry letter written in the South African Medical Journal, criticizing the United Kingdom (UK) for hiring so many African health workers; read doctors and nurses. The good professionals, point out that a recent report by the UK’s General Medical Council (GMC), actually believed that it would be wise to increase the recruitment. The GMC report stated that the UK will require “a continuation of the large number of doctors from overseas joining our workforce”. They pointed out that in 2019 nearly 35% of doctors licensed to practice in the UK had obtained their qualifications overseas. About 8,241 were from Nigeria, 4,192 from Zimbabwe, 1,719 are from South Africa, 806 from Kenya.
What is the common factor? All the above countries are former British colonies, so the UK knows well the medical training standards. They are equivalent to UK’s, however when they are searching for jobs, they can be blackmailed into believing that their standards are inferior and therefore, have to be paid less. Unfortunately however “the less” is bigger than what they can earn at home.
And this recruitment was before Brexit! Now with Brexit, it is going to be more bureaucratic, for Britain to hire more medical practitioners from Europe, after all, why should a doctor from Germany or France , go through the work permit bureaucracies, when they can more or less earn the same at home?
The House of Commons reported that the proportion of non-EU nurses at the NHS rose from 8% in 2015 to 22% between 2019 and 2020. “Non-EU” nurses, when Brittan was still part of EU! So what next and who is to blame?
Our governments and socio economic set up are to blame.
We all know thatbrain drain can be extremely harmful to any country, and is a serious to African nations that already have a limited pool of qualified professionals to begin with.
A 2020, report by the Guardianrevealed that, despite Nigeria being the biggest African Economy, Nigerian Doctors were among the worst paid in the world, yet they were still better paid than a good number of African countries. Yet, despite this revelation, Nigerian doctors (lowest salary of $320) per month are better paid than their counterparts in other African countries: Sudan ($66), Cameroon ($300), Egypt ($157), Guinea Conakry ($102), Zimbabwe ($83), Uganda ($300), Algeria ($265), Burundi ($100), and Ethiopia ($300).
So should this surprise anyone that brain drain is and will continue to take place? We may be tempted to cast doubts on why then do we have many Nigerians and Zimbabweans flocking to Britain, as opposed to Sudanese or Burundians doing the same job. The Answer is simple, qualifications from both Nigeria and Zimbabwe are more acceptable in Britain than these counterpart. What about South Africa and Kenya that does not even figure among the above ten lowest paid? We should not forget the non-pecuniary issues in any profession.
Last year, a strike by Zimbabwean doctors over pay and poor working conditions lasted more than four months, paralyzing the country’s healthcare sector. What was the solution by government? Go back to work or get fired!
Ironically it took Zimbabwean billionaire Strive Masiyiwa , a private citizen who lives in the UK, who seceded to fund the doctors for six months through a fellowship programme run by his Higherlife Foundation, a charitable organisation. He offered to pay up to 2,000 doctors a subsistence allowance of about US$300 a month to help them with transport and living costs. Well this is indeed patriotism, but what will happen after the six months? A Zimbabwean permanent Secretary may also earn $100 per month, but subsidy provided by regular travel allowances where daily subsistence allowance (DSA) can be as much as $500 (five month salary) per day is not a bad subsidy. A doctor or nurse has no such mission to subsidize his/her household.
In January this year (2021), the Kenyan government dismissed 86 doctors who had refused to resume work amid a strike that had been on since December 2020, against poor working conditions during the coronavirus pandemic. The doctors were quoting, among other grievances; a number of their colleagues who had died of corona related illness due to insufficient protection. So if dismissal by politicians is the answer to our medical professionals, should we really accept them to simply live on patriotism? A Kenyan MP is paid as well (more than $10,000 per month), if not better than his/her British counterpart. Not to mention that the MP might have studies social sciences or never went to any university, and therefore is not likely to be the target of brain drain.
The frustration can be worse, if medical equipment are not functioning well which is very common in a number of African countries, or when diseases are politicalized. Can you imagine what a doctor in Tanzania must have been feeling when he is told to substitute the 5 to 7 years of medical training, with prayers, which his/her grandmother who cannot read and write can easily do?
The above scenario also explains why a doctor in South Africa, reasonably well paid compared to other African countries is likely to go to UK, US or Canada.
Of course it is not just the medical professionals that are being poached, Engineers, ICT and software experts. But the medical field has been singled out, partly because I started with “an angry letter written in the South African Medical Journal” and because medicine hits where it matters most.
ICT is very important for modern development. But for an African mother whose under five child is likely to die of malaria, her urgency is not ICT, it is medical.
Shortage of medical personnel makes all of us cry.
We have over the years, know that Africa was medically starved, but the movement and crisis has been mostly demonstrated by the recent COVID 19 crisis and its predecessor Ebola, which highlighted the continent’s doctor and paramedics shortages.
For example, back in 1973, there were close to 8 doctors per 100,000 people in Liberia but by 2008 it had dropped to 1.37 doctors in 2008.
Close to home in East Africa, Uganda has less than 5,000 doctors and 30,000 nurses for a population topping 35 million people. The World Health Organization (WHO), the UN body responsible for promoting international public health, puts Nigeria’s doctor-to-population ratio at 0.3 per 1,000 persons, which is grossly inadequate. The country needs at least 237,000 doctors.
In a 2011 article published by The Lancet, a British medical journal, it highlighted that “High-income countries, such as Australia, Canada, Saudi Arabia, the US, the United Arab Emirates, and the UK have sustained their relatively high physician-to-population ratio by recruiting medical graduates from developing regions, including countries in sub-Saharan Africa. Very depressing indeed!
Remedial measures: Intra African movement of professionals
Nairobi, the Kenyan capital is actually the medical hub of East Africa , and Kenyan doctors are the best paid in East Africa, yet they still move in large numbers to Europe and USA, even more to South Africa. A paradox taking into account the facts that their South African counterparts move to US and Canada.
Personally I don’t have a big problem with African professionals like medical doctors moving from one African country into another, ideally this should be, a step towards African integration agenda.
Indeed my Country, Rwanda has removed work permit for most professionals from the continent; and has removed travel visa for all Africans.
Experience has shown that professionals working in fellow African countries, tend to visit their countries of origin more often and tend to invest at home, whereas quite often those moving to western capitals tend to go forever. A one way traffic. In any case “free movement and free establishment” is part of the African Union integration agenda.
China’s lesson: Invest in retaining and repatriating professionals.
Let us face the facts, Africa is not going to ask our daughters and sons to stick around just because of patriotism. I have written this before in my previous articles. 70 years ago, china was as poor as some of the supposedly well to do countries in Africa like Ghana. And poorer than Nigeria. Today China is the second largest economy in the world. China like Africa, sent its citizens for training outside China, and like Africa it suffered brain drain. But China made a bold move. Hire them back at a high wage.
In my past writings I have indicated how China went out of its way to get back Chinese experts from all over the world, by bravely putting up a fund to win back the Chinese in diaspora and pay them what they earned out there. An expensive venture but it worked.
China took a bold step. It investigated remuneration of the Chinese’s diaspora vis a vis cost of living. Invited Chinese working in western capitals and paid them the amount they were paid out there. Thus attracting back its diaspora instead of depending on expatriates.
African governments have to make such bold decisions, if we are willing to pay X amount for a Western foreign experts, let us say a cardiologist, why don’t we ask our nationals in foreign capitals to compete for the same position?
This is how china won back their internationally trained expert, by bold decision not by simply crying foul. As they dear mother Africa, “Determination determines destiny”. It is determination that removed China from a third world country in late 1940’s to the second largest economy in the world in 2020. The ball is in our courts.
Mweusi Karake, is veteran journalist, and former Head of Public Relations/Corporate Communication at the Common Market for Eastern and Southern Africa, (COMESA), currently based in Kigali, Rwanda.
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