One of the biggest challenges faced in the health sector is the difficulty experienced in managing Human Resources for Health (HRH), amidst undersupply of healthcare workers. Outright scarcity of health care professionals especially in a developing country like Uganda is primarily due to under investment in human capital for health.
Whilst the Ugandan government has registered progress in approving and filling posts for required health facility staffing, undersupply is prevalent, and staffing rate has persistently remained below national target in the Health Sector Strategic and Investment Plan. Out of the 57,050 total approved posts in public health facilities, only 35,903 are filled, representing a staffing gap of about 37 per cent. This kind of gap is widening with exodus of health workers. The state of affairs is likely to be worsened by recent government proposal to export healthcare workers. Before diagnosing the viability of such an export scheme, it is important to first understand what triggers health worker exodus or mobility.
Mobility of health professionals is explained by both local and global forces that drive health workers to migrate. The migration can take place locally through inter-sectoral mobility (e.g. from the public sector to well-resourced private facilities), rural-urban movement, and international mobility or export. The International Organisation for Migration (IOM)ontends that due to health care globalisation, international mobility of healthcare workers is here to stay and is an indispensable part of the contemporary world, a global phenomenon requiring cognisance of policy makers. Research has shown that international migration of health workers is mainly catalysed by “push and pull forces”. Health care workers are pushed out by appalling conditions in their own countries such as: inadequacy of jobs or underemployment, inadequate medicine and equipment, burnout, and low or non-payment of salaries. On the other hand, health workers are pulled into the importing countries by captivating factors like: availability of gainful jobs, fairness in promotions, reasonable workload, higher pay and ability to save, safe working environment and appropriate medical equipment.
Recent demographic trends in many industrialised nations, characterised by ageing population and low fertility rates among others, are increasingly exacerbating the exodus of healthcare personnel from developing nations. This is widening developed nations’ healthcare labour market supply-demand gap, exerting immense pressure on a developing country like Uganda, and further pulling health workers to migrate.
Recently, in Uganda, there has been a proposal by the Ministry of Foreign Affairs to export about 283 well-skilled health workers to Trinidad and Tobago. This requires careful decisions to be made with evidence concerning the costs and benefits of such a proposal to the economy. The move has nonetheless attracted serious criticisms. The plausible reason aanced is that it poses a serious threat to the delivery of essential health services, and may undermine efforts towards the renewed focus on Universal Health Coverage.
Some positive aspects associated with exporting health workers do exist as well, although marginal. The key macroeconomic benefit is financial transfers to the country of origin through remittances, which is a source of foreign exchange expected to contribute in propelling economic development. Other probable benefits are non-financial, for example transfer of knowledge, skills, and technology back into the country. Conversely, loss of human capital due to brain drain retards development in the country of origin. Uganda in particular encounters hefty illness burdens (for instance due to malaria and HIVAids) and exporting healthcare workers can worsen the healthcare system, with aerse ramifications on the availability, cost, and quality of care. Economic losses present in the form of foregone tax contribution of exported health workers, and this can slow down economic growth. Additionally in the long run, the exporting country loses its initial capital investments used for educating and training the exported workers.
Countries that have supported the idea of outflow of their workers (e.g. Philippines and India) do so with the aim of reaping big from foreign capital via remittances. Nevertheless, it has been observed by IOM that the value of remittances hardly counterbalances the lost talent and skills, particularly if exported workers don’t return home. From a cost-benefit analysis perspective, health worker export seems not to be a viable scheme, given that the ultimate economic impact is a net capital outflow for the exporting country. For instance empirical evidence has shown that annual inward remittances for both nurses and doctors are less than annual government investment in training doctors alone (excluding nurse’s training costs), which yields a benefit-cost ratio of less than unity. Also, the source country’s health system does not benefit from remittances, hence failure of remittances to compensate for the losses or gaps created in the health system due to health worker migration. Others have argued that developed importing countries reap more gains than poor exporting countries, through the “pervasive subsidy” mechanism, where the amount of money saved by the destination (importing)ountry as a result of employing imported health workers exceeds the amount of development assistance channeled for health to the exporting country.
Uganda should, therefore, consider balancing its national interest by taking into account national health requirements, and the economic implications of exporting health workers, prior to embarking on the healthcare personnel export scheme. It is incumbent on policy or decision makers to rethink the export scheme, and focus should instead be put on resolving the “push and pull forces”, in order to retain healthcare professionals in the country and avoid the negative socio-economic impact of healthcare worker expatriation. Lastly, it is proper to meaningfully invest in the health care system, and pay particular attention to establishment of a comprehensive incentive-based approach to development of HRH.
Mr Odokonyero is a researcher with Economic Policy Research Centre, Kampala. firstname.lastname@example.org
SOURCE: Daily Monitor