For example, the UK National Health Service has been accused of poaching doctors and other health professionals from developing countries that can ill afford to lose these people. According to the Mail on Sunday, 19 foreign governments, including China and Ghana, have complained about the aggressive recruitment of thousands of overseas medical staff.
Of the 330,000 nurses in the UK, 15% are from overseas, and, if anything, the rate of recruitment has stepped up in the last few years. This recruitment drive reflects the worldwide shortage of medical professionals, estimated to be about 4.3 million.
Using independent recruitment agencies, governments from developed countries are looking far and wide for trained doctors and nurses. It is an attractive economic proposition, because by not having to put graduates through expensive training programs at home, developed countries can make considerable savings, estimated to be $552 billion a year, according to a report produced by the International Organization for Migration.
“Emigration of health care professionals is a cause of particular concern for Africa with developed countries deliberately recruiting health personnel from the region, partly to offset domestic shortages,” said the report by Ndioro Ndiaye, Deputy Director General of the International Organization for Migration.
There are more doctors from Benin working in France than at home, more Ethiopian doctors in Washington D.C. than in Ethiopia and more Malawian doctors practicing medicine in Manchester than in Malawi. Then there are at least 25,000 Nigerian doctors now working in the US and UK whose education was financed by the Nigerian government. Then there is South Africa, which lost almost half its doctors to Britain and Australia but makes up these losses by taking health professionals from its poorer neighbors.
The list of distressing statistics goes on. In Zambia, 550 out of 600 nurses the government had trained migrated to where they could earn a better salary. The Philippines loses more nurses than it trains. In Malawi, out of every four nurses who complete their education, one migrates, one takes a better paying job outside nursing, one dies of AIDS and one remains active in nursing.
Unfortunately, there are strong economic incentives for medical professionals in poor countries to answer these advertisements. For a doctor in a poor country, his or her medical degree is a passport to a better life.
For example, a Filipino doctor earns less than $4,000 per annum at home. Compare this to what he or she could earn in the US, which is in the vicinity of $200,000. Even if Filipino doctors cannot upgrade the qualifications to meet US requirements, they could take jobs as nurses, earning $60,000 and putting them well ahead of what they would have earned at home.
Yet the greatest need is in those poorer countries, which have abysmal doctor-patient ratios. For instance, in Malawi, there is one doctor for every 100,000 people, whereas in Ghana the ratio is 1 to 20,000 people. In the UK, there are 164 doctors – as opposed to 279 in the US and 607 in Italy – for every 100,000 persons.
To make matters worse, health problems in poorer countries are much more pressing. Facing malaria, tuberculosis, AIDS, high infant mortality and illness from waterborne diseases, they are in desperate need of doctors and nurses.
In pure economic terms, developing countries lose in many ways. They lose professionals in areas in which they have acute problems. They also lose their investment in training those health professionals. And, finally, they lose their brightest graduates from countries that need educated elites to get ahead.
The World Health Organization produced a Global Code of Practice for the International Recruitment of Health Professionals in 2006. Unfortunately, this code is vague and has been largely ineffective and is yet another illustration of the inadequacies of the global legal architecture.
Sadly, this migration is the logical outcome of globalization, in which poorer countries find themselves, once again, on the losing side.