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UK policy to reduce skills drain from Africa is ineffective

London Zosia Kmietowicz

The UK government’s policy of banning healthcare staff who are actively recruited from the world’s poorest countries from working in the NHS is unlikely to help achieve the goal of boosting the number of doctors and nurses in the developing world, says a development specialist.

Dr Lola Banjoko, chairwoman of the Africa-wide recruitment and employment agency Africa Recruit, believes that the code of practice, which aims to restrict recruitment of healthcare professionals from 150 developing countries is well meaning. But she says that the policy cannot work in isolation. “Trying to stop people from moving from one country to another for work is not practically workable and is an infringement of people’s human rights,” said Dr Banjoko. Africa Recruit aims to boost professional capacity throughout the continent.

Dr Banjoko called for an international strategy to tackle the drain of skills from developing countries. This should deal not just with the movement of trained health professionals, she argued, but it should also seek to improve the health infrastructure and working environment necessary to attract medical staff.

“It is not just about money—although better salaries can help retain professionals in developing countries,” she said. “But what doctors and nurses want above all is safe practice and for certain infrastructures and systems to be in place.”

The United Kingdom is currently the only country in the world with a code of practice banning active recruitment of healthcare professionals from the developing world into the public health service. Since December 2005, the UK has tightened a loophole in the policy and extended the ban to include the private agencies that supply nurses to the NHS.

Gareth Thomas, the parliamentary under secretary of state for the department of international development, declared the ban was already proving a success, with a 28% fall in the numbers of nurses recruited from 25 of the world’s poorest countries in the last year—from 14 122 in 2003-4 to 11 477 in 2004-5.

He also said that 11 agencies had been removed from the NHS approved list for breaching the ban. But Mr Thomas said that the ban on its own would not the solve the problem of the drain of skills from developing countries. The drain is leaving countries such as Malawi with 90% of its doctors’ posts vacant and two thirds of nursing position unfilled. Mr Thomas’s department is funding a programme to double the number of nurses and triple the number of doctors in Malawi by increasing pay by 50% and using volunteers to train trainers in the country, he said. “That programme is beginning to make a difference: 700 new health staff and 38 doctors have been recruited in the country since July 2004,” said Mr Thomas.

Dr Banjoko dismissed the current policies, however: “What is happening is that people are being trained for export,” she said. She explained that the code of practice only applied to the public sector, which means that nurses and doctors can still be recruited into the private sector and after a period of work they are able to work for the NHS. “Similarly, if people find their own way to the UK they are not going to be refused a job in the NHS,” said Dr Banjoko.

“We want to see the many African health professionals based in the UK who want to work in Africa on a voluntary basis to be able to go back to their country for some time, say three months, and be guaranteed their job when they return,” she said. “We also want to see a system where there is greater understanding on both sides of the fence, to reduce the need for people to leave their countries and make the situation more attractive to recruit new people to developing countries so that there is a balance of traffic of skilled people in both directions.”