THIRD WORLD AID TO FIRST WORLD COUNTRIES... The “Brain Drain”

PREAMBLE: In this issue we feature the "brain drain" (migration of professionals from low-resource settings to more developed ones) from sub-Saharan Africa. The report was developed by Juan Ramos, Program Coordinator of ProCOR, a web community focusing on cardiovascular disease problems in the developing world, that offers free-ranging debate on a range of related health and social issues (SEE: Recommended Links in sidebar, adjacent to June 1 blog below). The crisis is enormous, and some potential solutions are outlined in the report. It is to be hoped that there will be some practical response to these, such as striving for better compensation for indigenous health professionals, attention to policies that determine recruitment and retention of health professions in low income countries, fixing the ethics of western firms that raid poor countries to meet the service demands of rich ones, and finding ways to compensate third world "donor" countries for their loss of human resources. Through official inaction, "first world" countries benefit from a massive subsidy from the "third world", equal to the direct and indirect costs of their investment in this health human resource, and the opportunity costs entailed by its loss.

Also in the main section below we elevate an item previously presented in our sidebar: on "Corporate Hybrids". Your host, Pacific Health & Development Sciences Inc. (PacificSci), is an example of such an organization, now in its 4th year of operation.

In our sidebar: Once again we focus on Canada's political scene, with a brief capsule on Prime Minister Stephen Harper’s limited popularity, as revealed in a recent poll. We then focus on a troubling police action that may have been politically directed. Whether or not one agrees or disagrees with opposition on any given policy issue, the legal and democratic right to protest is supposed to be protected in our society. However, the recent undermining of a legal protest in a designated area adjacent to the “Security and Prosperity Summit” (involving the leadership of Canada, Mexico and the US) through use of agents provocateurs has alarmed our civil society. That Canada’s police forces were used to discredit the use of this right is cause for serious concern, and it is disturbing that the Honourable Stockwell Day, Minister for Public Security is ignoring calls for a public inquiry, issuing statements designed to diminish political accountability.

BRAIN DRAIN FROM SUBSAHARAN AFRICA
Significant numbers of African-trained health workers migrate every year to developed regions, leaving severely crippled health systems in countries where life expectancy is only age 50 and 16% of children die before age five. However, the critical shortage of health care workers in many parts of the world is beginning to receive attention from donors and international agencies. Donors are increasingly realizing that without enough trained workers to deliver drugs, vaccines and care, funding projects will not have the desired effects.

The population of sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. The continent bears 24% of the global burden of disease but has only 3% of the health care workforce and 1% of the world's financial resources. Africa suffers more from brain drain due to economic conditions, wage differentials, rapid population growth among young people and conflict than any other continent.The worker shortage derives from a combination of underproduction, internal maldistribution and emigration of trained workers. Sub-Saharan Africa needs approximately 700,000 physicians to meet the Millennium Development Goals. Many African countries cannot meet widely accepted basic standards for health care coverage by physicians, nurses and midwives. An additional 2.4 million physicians, nurses and midwives are needed, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.

Fewer health professionals from African countries than from other countries work in the US, according to the Least Developed Countries Report 2007. Data from the report demonstrate that the percentage of doctors practicing in the US relative to the total number of doctors back home range from 43% in Liberia to 10% in Zambia. This would not be a problem if the number of doctors remaining in their country of origin was sufficient to meet the needs of the population, but this is not the case. For example, Zambia has only seven doctors per 100,000 people, compared with the US level, which is close to 300. Even though the absolute number of professionals from the poorest countries working abroad may be small, the impact on professional services back home can be severe.

Efforts to retain workers focus on health care systems. For example, Swaziland provides HIV/AIDS services for health care workers who, practicing in high-prevalence areas with minimal resources for safety measures, are at an increased risk for occupational exposure. Other efforts build on the belief that providing workers with needed resources for care motivates them to stay and work in their home countries.Improved wages are also a key to retention. Salary support can help motivate health care workers to remain in their countries, even if it means working with fewer resources. Other types of inducements have been offered, such as lunch allowances, care loans and affordable housing.Some countries have begun to recruit trainees from rural areas. In South Africa, local students can receive scholarships for health care training on the condition they agree to return to their home district to practice. A study of the program found that trainees from rural areas were three to eight times as likely as those from urban areas to practice in rural regions after graduation.

The documented shortage of health care workers has inspired the American Public Health Association to pass a policy statement on "Ethical Restrictions on International Recruitment of Health Professionals to the United States." The policy addresses the role of the US in exacerbating the international crisis, calling on employers to adopt voluntary codes for ethical recruitment and on the government to contract only with employers who have done so. The future of global health and development in the 21st century lies in the management of the crisis in human resources for health.

More information is available from these resources on brain drain:
* "Providing the providers-remedying Africa's shortage of health care workers." N Engl J Med 2007; 356(25): 2564-67.http://content.nejm.org/cgi/content/extract/356/25/2564
* The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada (3.5 MB):http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf
* The Least Developed Countries Report 2007 (2.54 MB):http://www.unctad.org/en/docs/ldc2007_en.pdf

Source: Juan Ramos. ProCOR. Aug 9, 2007 Jramos3@partners.org
NOTE: To visit ProCOR, scan column at right to locate URL under “Recommended Links”.

CORPORATE HYBRIDS
“… organizations driven by both social purpose and financial promise that fall somewhere between traditional companies and charities…distinct from those operating in the government, business and non-profit sectors…Whatever participants call it, the fourth sector faces challenges. Current legal and tax structures draw strict lines between for-profits and non-profits… The social benefits that fourth-sector firm seek to unlock are not easily quantified and often take decades, not quarters, to attain.”

Reference: Stephanie Strom. The New York Times. May 6, 2007.

COMMENT: By definition, PacificSci is a hybrid or "fourth sector" organization. Ineligible for grants available to non-profits, nor driven by the bottom line as a purely business enterprise, nor financially underwritten by the tax payer as are universities, government bodies and international agencies, yet our contractual work, advocacy efforts and pro bono activities are all guided by our secular humanist mission: seeking solutions to the health and social impacts of development. Now in its 4th year, our philosophical model is proving operationally viable and productive.

OFFICIAL DEVELOPMENT ASSISTANCE AND GLOBAL HEALTH TRENDS

PREAMBLE: During our first 6 months, this report addressed the following global issues: climate change, child development, colonized minorities, food security, human rights, and other news and reviews. In most instances we also addressed the relevance of these issues to Canada, our home base. To locate these issues you may either scan down this issue to earlier issues, or Google search by combining the keywords just noted with the term pacificsci.

This June 2007 issue reviews the vexing issue of official development assistance from wealthy developed countries such as Canada, makes reference to a report on global social and economic trends, then selects reports from a discipline that is essential to understanding global health trends: Health Situation Analysis. This refers to information on health conditions, supported by vital and health statistics critical to strategic and operational development planning. Our selected examples include Africa, the State of the World Children, and Projections of Mortality and Burden of Disease to 2030.

Our sidebar addresses the emergence of “corporate hybrids”, freedom of speech and tolerance for intellectual opinions.

 G7 OFFICIAL DEVELOPMENT ASSISTANCE (ODA)
The most recent confirmed OECD data for ODA (2005) reveal that, although absolute amounts are higher, G7 countries allocate proportionally less Gross National Income (GNI) for international development: 0.30%, compared with .50% for non-G7 nations. Of 22 OECD nations only 5 met the UN target of at least 0.7%: Norway, Sweden, Denmark, the Netherlands, and Luxembourg, none of which are G7 countries. The lowest G7 allocation is made by the USA (0.22%; among 15 non- G7 nations, only Portugal and Greece give less than this), while Canada comes in slightly above the G7 mean at 0.34%. Clearly, both individually and collectively, the G7 should show more leadership.

Note: OECD rankings do not include Russia, a G8 country (G7 + 1).
Reference: Final ODA Data for 2005. http://www.oecd.org/dataoecd/52/18/37790990.pdf

 SERIOUS QUESTIONS ABOUT CANADA’s ODA
Questions are being raised about Canada’s ODA priorities eg., $30 million in 2006 to China, an emerging political and economic powerhouse. Parliamentarians urging increased aid to truly poor nations say the government’s refusal to support proposed new legislation to guide ODA reveals lack of commitment. “Canada used to be a leader and is now a… laggard” said Alexa McDonough, NDP foreign affairs critic. According to McDonough, the planned 2006 ODA of just over $3 billion represents 0.32 % of GNI, down from 0.34% last year and far off the 0.7% target that Canada helped set. Josee Verner, Minister for international aid, replied “spending in 2007-08 will increase by 8%, in line with the goal of doubling by 2011 the amount spent on ODA in 2001”.
Source: Sue Bailey. The Canadian Press. March 27, 2007
EDITORIAL: an annual increase in absolute expenditures in the order of 8% will simply maintain the status quo with little movement towards the target of 0.7% GNI

 REPORT FROM 8TH GLOBAL DEVELOPMENT CONFERENCE, Beijing. For up-to-date social and economic trends, visit the Global Development Network April 2007 newsletter. Topics include: the rise of Asia in the global economy; growth and poverty in Latin America; structural transformation opportunities in Africa and the Middle East. http://www.gdnet.org/pdf2/research_monitor/2007-April_conference%20edition_Research%20Monitor.pdf

 HEALTH SITUATION OF SUB-SAHARAN AFRICA

The health situation of Sub-Saharan Africa (SSA) is the least favourable of all regions. Following steady declines until the mid-1990s, adult mortality sharply reversed, with the disease burden increasingly dominated by HIV/AIDS superimposed on already heavy burdens from endemic malaria, water-borne diseases, vaccine-preventable diseases, nutritional deficiencies, and other preventable conditions. In some settings, this was compounded by war and civil strife, with consequent increases in violent death, food shortages, poverty and displacement of people, further fueling a rural to urban migration for economic survival. In parts of SSA, adult mortality rates are at their highest in 3 decades; a rapid drop in life expectancy (LE) is seen in 38 countries (LE age 40 or less in 8 of these). Without HIV/AIDS, LE at birth would have been almost 6.1 years higher in 2002. The slippage is not only due to HIV/AIDS: for example, despite major gains in immunization coverage during the 1980s, these have reversed since, reflecting a loss of capacity to deliver primary health care. In the meantime, the health profiles of Africa and the world are not standing still: the pattern is shifting with a steady increase in Non-Communicable Diseases and injuries. Even given Africa’s preoccupation with infectious diseases, which still dominate the disease burden, planners must now be alert to this emerging and future disease burden.
Source: The foregoing brief report is a paraphrased extract from a health situation analysis carried out by PacificSci for an assignment in East Africa completed in 2006.

 THE HEALTH OF THE PEOPLE: THE AFRICAN REGIONAL HEALTH REPORT: A fully comprehensive situation analysis has recently been published by the WHO Regional Office for Africa. http://www.who.int/bulletin/africanhealth/en/index.html

 THE STATE OF THE WORLD’s CHILDREN 2007

This UNICEF report focuses on the discrimination and disempowerment experienced by women and girls. It discusses how gender equality will move the UN Millennium Development Goals forward, and how investment in women’s rights will ultimately produce a dual dividend: advancing the rights of women and children. Seven interventions are advocated:

1. Abolish school fees and invest in girls' education
2. Invest government funding in gender equality
3. Enact legislation to create a level playing field for women and to address domestic as well as gender-based violence
4. Ensure women's participation in politics
5. Involve women's grassroots organizations in policy development
6. Engage men and boys on the importance of gender equality
7. Improve research and data on gender issues.
For the full report as a PDF document: http://www.unicef.org/sowc07/report/report.php

 PROJECTIONS OF MORTALITY & DISEASE BURDEN TO 2030

Revised global and regional projections of mortality and burden of disease by cause for 2005, 2015 and 2030 are now available from the World Health Organization. Principal investigators (CD Mathers & D Loncar) applied separate projection models for males and females, stratified into 7 age groups. The website below offers online access to the article, a working paper, and references to papers on data sources and methods. Detailed results for projected deaths and DALYs can be downloaded as Excel spreadsheets. The analyses were carried out at country level with aggregation into regional or income groups. The investigators used socio-economic projections to model future mortality and morbidity patterns, assuming slower and faster rates of development and population growth, taking into account independent variables: income, education, time, and tobacco use. The results suggest that, from 2002 to 2030, life expectancy will increase throughout the world, with an upward shift in the age of deaths, with considerably fewer younger children dying, while deaths due to cancer and heart disease will increase. Deaths from infectious diseases will decline overall, while mortality from HIV/AIDS will continue to increase. http://www.who.int/healthinfo/statistics/bodprojections2030/en/index.html

Acknowledgment: In constructing our summary, a review by Robert Goldberg on ProCOR (Recommended link in sidebar) was helpful, including his note of caution regarding the quality of data used to develop the predictive models and assumptions utilized.

THANKS FOR VISITING PacificSci GLOBAL PERSPECTIVES!