Imagine that you live in a desperately poor country. A country where a child at birth has the same odds of survival as one born in medieval England.
Where children die of treatable diseases such as malaria, respiratory infections and diarrhoea. Where life expectancy now stands at under 50.
This country needs more nurses, more doctors, more education and more healthcare. So, despite its poverty, it invests in healthcare. It trains nurses and doctors – but they leave.
This country is Malawi. Here, and in many other countries in Sub-Saharan Africa, 50–70% of nursing posts are unfilled. Despite heroic efforts, targets are missed and lives are lost. The human cost of healthcare migration is high. Those who pay the price of this migration are those who can least afford it.
In 2005 the BMA hosted an international conference. Those attending agreed that all countries should strive to attain self-sufficiency in their healthcare workforce without generating adverse consequences for other countries. They agreed developed countries should assist developing countries to train and retain nurses and physicians.
A G8 summit agreed. In 2006 the WHO revealed a worldwide shortage of almost four million healthcare workers.
Sub-Saharan Africa needs a million more if they are to meet targets and save lives.
The UK employs more healthcare workers trained overseas than any other European country. A third of doctors in the UK trained overseas – in France it’s only 5%.
In the last four years, an average of 30% of newly registered nurses were trained abroad. If the UK reaps the benefit of healthcare workers from developing countries, should we pay the price?
When healthcare staff move to rich countries, they lose, we gain and we give nothing back. It costs an average of £100,000 to educate a registered nurse in the UK. Should we introduce an annual levy so organisations that employ healthcare staff pay back some of the money developing countries have invested?
It’s not a perfect solution but it might help. It might help ensure antiretrovirals don’t sit on shelves because there are not enough staff to test and treat. It might help ensure that a million fewer children die of malaria. It might be more morally acceptable than taking from those who can least afford to give.
Linda Nazarko is a nurse consultant at Ealing PCT