Jul 3, 2010

Greener Pastures

With the recent graduation of medical doctors from the University of Zambia, there has been a spate of editorials re-emphasising the chronic shortage of medical personnel in the country, accompanied by the usual admonishments to the new graduates to be patriotic by serving their country and not leaving for proverbial “greener pastures”.

As a developing country it is obviously critical that we retain the best and brightest in all fields, but why the guilt trip? Contrary to conventional wisdom, leaving home is not always an easy decision made at the spur of the moment. It is often a gut-retching decision in which a person has to consider the fact that he/she will have to leave family members behind sometimes even children, to seek work that pays fair wages in a foreign land where they may face discrimination or prejudice for the chance to make a life that consists of more than just surviving! 

Life in the west or the east isn’t a walk in the park either because it often entails establishing oneself at the bottom and working your way up the ladder. But consider this; there is a scalable ladder as opposed to an environment where often times the ladder has been yanked away and disincentives are rife.

The balance between self-interest and national interest is not an easy road. And who are we to pass judgement?

So, instead of labelling others as unpatriotic for looking out for their wellbeing and that of their families, how do we create an environment in which economic benefits, remuneration levels and working conditions are conducive to progress? 

Doctors, nurses, surgeons, and other medical personnel are critical in any country no “ifs”, “ands” or “buts” about it. But what can be done to reverse the ill-effects of medical migration? Finding a solution will involve partnership between the developed and developing world.

Developed countries obviously have a need for skilled medical professionals with their aging populations and insufficient local talent available. The U.S. in particular has a system that unfairly discourages many from entering medical school with the high cost of attendance, and the pervasive elitist emphasis placed on more specialised areas of medicine such as surgery and not general practice. This in turn drives up the demand for nurses and general practitioners that can readily be found in developing countries.

If they were to increase medical attendance and train more general practitioners that could effectively reduce the cost through competition and deal with the supply issue. I am sure the same could be said for EU nations that face similar shortages.

Another area to look at would be reimbursing countries for the investment lost when their health professionals leave for developed countries. Their education is a costly endeavour and is often provided at subsidised levels. The reimbursements could be used to develop or improve existing health facilities making for a safer work and healing environment.

Health sector spending obviously needs to be increased but is often hampered by budget ceilings that are driven by microeconomic policies. The inadequate spending often results in hiring and salary freezes and continues the vicious cycle of an incapacitated system. Countries that spend more on health and education should not be penalised by the World Bank, IMF, and other donors for breaking their spending caps.

And finally, our governments need to understand and appreciate the economic benefits of investing in health and maintaining an adequate workforce in local and rural areas. 

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