Developed world is robbing Africa of health staff

Editor—Coombes says that the unwillingness of richer countries to train sufficient numbers of their own doctors and nurses is creating an international market in health human resources.¹ The resulting outflow of human resources from those countries with the highest disease burden is one example of how healthcare knowledge and capacity to apply that knowledge is being severely undermined. Another example is the agreement on trade related aspects of intellectual property rights (TRIPS), which effectively diminishes access to drug treatments by people who are least able to pay, but again, often in greatest need.

The debacle over the attempts of a consortium of 39 pharmaceutical companies to prevent South Africa from making generic drugs available to people with HIV/AIDS showed that moral outrage can be channelled productively. However, as long as outflows with high incentives and highly restricted inflows of health care and health knowledge continue, much more focus must be given to developing local solutions.

For example, in Malawi cadres of clinical officers and clinical assistants provide an important health force, and one that isn't offered the mobility conferred by an internationally recognised medical degree. In Ethiopia, local extension workers (who are not “health professionals”) provide crucial front line health care.² A study in Bangladesh found that again the use of local people—most of whom were not health professionals—dramatically increased children's survival.³ This achievement is beyond the ability of many other projects apparently “better resourced” with health professionals.

The gravity of globalisation, while pulling professional health workers further from those most in need of them, is also creating the necessary conditions for exploring new ways to deliver health care; ways that are possibly less expensive, more community focused, more empowering and, dare we suggest, possibly more effective.