Introduction

Africa has been losing professionally trained health workers—the backbone of the continent's health system—for many years. Faced with an increasing burden of disease and compounded by a massive exodus of health workers, many African nations' health systems are at risk of paralysis. Several studies have suggested policy options to reduce brain drain from Africa. This article aims to review possible policies that could mitigate the impact of this brain drain.

Brain Drain in Africa

Brain drain occurs when a country suffers from a shortage of skilled workers due to emigration. Highly skilled health workers often migrate from poor to rich countries, leaving behind systems with acute staff shortages, worsening already existing health inequalities. The result is a global imbalance in the distribution of health workers: countries with the greatest disease burdens have the fewest health workers, while those with relatively low health needs have the most. Sub-Saharan Africa, for instance, needs a 140% increase in health staff to meet adequate levels.

With ageing populations in developed countries, the demand for skilled health professionals is expected to rise, worsening the distribution of health workers in favour of wealthier nations. According to the latest United Nations health report (2023), Africa bears 25% of the world’s disease burden, has only 3% of the world’s health workers, and controls just 1% of the world’s economic resources. Given these alarming statistics, urgent corrective action is needed to address this ethical and social injustice.

To manage the outflow of health staff from Africa, several policy initiatives must be considered at the regional, international, and global levels, along with the full implementation of recommendations from previous studies on health professional brain drain. These policies must be directed towards health workers, who are the most crucial element of the health system. Pouring money into Africa’s health system will yield little change if health workers are unavailable, unmotivated, unskilled, or unsupported.

Potential Policy Solutions

1. Remuneration One of the primary reasons health workers migrate is poor remuneration. Improving salaries could reduce brain drain. However, many African countries struggle to sustain decent salary packages, making this solution challenging to implement successfully.

2. Regulatory Mechanisms

Some African countries, such as South Africa, have introduced regulatory mechanisms like recognising overseas qualifications, which can encourage the immigration of foreign health professionals willing to work in Africa.

3. Compensation

Several studies highlight the substantial financial losses African countries incur due to the migration of health professionals. For example, a Kenyan study reports lost revenue of between USD 205,750 and USD 4,515,869 per nurse. While it seems logical and ethical for recipient countries to compensate source countries for the costs of producing these professionals, no successful reimbursement programmes were identified in this review. Some countries, like the United Kingdom, Canada, and Australia, have not signed the Commonwealth Secretariat’s Code of Practice for International Recruitment due to clauses related to compensation.

4. Bonding

Bonding involves requiring health professionals to work in government institutions for a period equal to their years of training. While Zimbabwe successfully implemented bonding for some health professionals, its struggling economy has hindered the government’s ability to employ all graduates. South Africa’s Certificate of Need programme requires newly qualified graduates to serve in areas of need before they are allowed to migrate.

5. Political Stability

Political stability is a key factor in retaining health workers. One study noted a slight reduction in brain drain in Kenya following the election of President Kibaki in 2002, with many health professionals returning home after the 24-year rule of President Moi.

6. Importing Health Staff

Importing health professionals can provide immediate relief from shortages. For example, Zimbabwe, after losing 840 out of 1,200 trained physicians between 1990 and 2001, responded by importing 300 Cuban doctors annually.

7. Training More Health Professionals

Increasing the number of trained health professionals could also mitigate the impact of brain drain. Some studies emphasize the need for destination countries to participate in the training of health workers in source countries. However, there are concerns about market failure, where the state bears the costs of training, but the benefits are privately accrued abroad.

8. Remittances

Remittances from African expatriates could theoretically strengthen economies and, if reinvested into the health system, benefit the continent. However, most remittances do not enter the formal banking system, making it difficult for governments to utilise these funds. Cape Verde stands out as a success, with remittances contributing 20% of its GDP.

Task Shifting: A Promising Solution

Several studies demonstrate the success of task shifting, where responsibilities are transferred from higher-level health workers to lower-level cadres. Task shifting has proven effective in HIV/AIDS care, obstetrics, and psychiatry, with lower-level cadres often associated with improved health outcomes. Unlike other policies, task shifting does not infringe on workers’ rights and is often community-driven. However, non-governmental organisations sometimes lure these lower-level workers from public health systems, undermining the policy’s gains.

Discussion

Our review aligns with other studies on health worker brain drain from Africa. A common finding is the scarcity of substantial literature on successful policies that reduce the impact of brain drain. Most data come from high-income settings, which may not be applicable to developing countries. Task shifting is a policy option applied in many low-income countries, suggesting its feasibility in addressing health professional shortages.

Conclusion

There is significant consensus that task shifting is the most appropriate and sustainable policy option for reducing the impact of health professional brain drain in Africa. Implementing this policy in source countries is feasible, as it costs less to train lower-level cadres. While few studies focus on specific policy options for reducing brain drain, the literature on brain drain itself is extensive.