Bulletin of the World Health Organization

Should I stay or should I go?

The answer for most health-care workers in developing countries is easy: go. Higher pay and better working conditions are luring more and more health personnel abroad leaving their native health systems stripped of staff.

28 May 2004

There has been an alarming surge in the number of health workers leaving their own countries to benefit from better pay and working conditions offered by richer countries, according to WHO and The World Bank. Whilst this has increased the flow of remittances — and in some cases, expertise — back home, it has also triggered staffing crises in many countries.

According to The World Bank, remittances wired by migrant workers through the banking system alone totaled US$ 90 billion in 2003, up from some US$ 88 billion in 2002 and US$ 72.3 billion in 2001. The International Organization for Migration (IOM) estimates that at least as much again is remitted outside the banking system. In the United Kingdom 50% of newly registered nurses came from abroad in 2002, compared with 25% in 1998.

“It’s not surprising when salaries in Zambia, for example, are 25 times lower than in the UK,” said Barbara Stilwell, Programme Coordinator from WHO’s Human Resources for Health department.

WHO and World Bank officials warned governments in January that the health staffing gap in developing countries had become a major obstacle to achieving the UN Millennium Development Goal to reduce poverty by 2020. A World Health Assembly resolution followed in May calling on WHO’s 192 Member States to better manage the migration of health workers in order to avoid damaging health services in poor countries.

Some receiving countries, like the United Kingdom, have begun to recognize the damage wrought by their recruiting strategies and are adopting ethical recruitment policies in line with those of the Geneva-based International Council of Nurses, a federation of national nursing associations representing millions of nurses worldwide. The UK’s National Health Service now discourages recruiting from certain developing countries in order to safeguard their health-care systems, for example.

In some donor countries, improving the organization of health staffing services could help address staff shortages, explained Stilwell. Malawi, for example, has nursing vacancies and yet has 1200 unemployed nurses. In other countries such as Ghana, however, the situation is different. Ken Sagoe, Director of the Ghanaian health service’s Human Resource Development Division, told news web site, Ghanaweb, that Ghana had lost 1032 nurses and 166 doctors last year and nine health centres had been without a medical officer since January.