BriefingBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7188.3 (Published 03 April 1999) Cite this as: BMJ 1999;318:S3-7188
It is perhaps naive to hold the belief that aid workers are necessarily selfless altruists: market metaphors ruled at last week's International Health Exchange annual meeting. Non-government organisations compete fiercely for money and staff at home and for participation in schemes abroad, and IHE recruits health workers for many of them.
To examine these issues is to be presented with the very clear injustices that exist between north and south. There is considerable disparity in the terms and conditions of employment for expatriate and local health workers: expats are flown home if illness or war strikes, while local health workers take their chances, for much less money. Doctors who have left southern countries for further training tend to acquire skills and attitudes that make them less useful in their country of origin. And even if the gradient of economic incentive to return were shallower, there is evidence to suggest that in situations of war and civil instability, locally employed health workers are often singled out for violent treatment, and are at higher risk of death than either the local population or expatriate health workers.
These factors explain the irony that while more than 100,000 expatriate health workers work on the African continent, more than 250,000 Africa-trained health workers work elsewhere than Africa. The International Organisation for Migration (http://www.iom.int/> ) has a campaign to encourage health professionals from Africa to return. It has had some success among the many refugee health workers who are unable to practice in their country of refuge because of local registration criteria.