The "poaching" of health workers from sub-Saharan Africa by rich, Western countries ought to be viewed as a crime, says a team of public health researchers from Canada and other countries.
The researchers, who include members of the B.C. Centre of Excellence for HIV-AIDS, say in an editorial in the medical journal The Lancet that the practice of actively recruiting doctors, nurses and pharmacists from such personnel-poor African countries as South Africa is "a violation of the human rights of the people of the people of Africa."
More than 13,000 doctors trained in sub-Saharan Africa are now practising in countries such as Britain, the United States, Canada and Australia, leaving behind colleagues struggling to cope with impossible caseloads.
The workers are often lured by Western hospitals, clinic and drug store chains with excellent pay, legal assistance with immigration and moving expenses.
The lead author of the editorial, Dr. Edward Mills of the B.C. Centre of Excellence for HIV-AIDS, says while health settings in the West fill their staff vacancies, they are leaving countries in sub-Saharan Africa with desperately low physician-to-population ratios (PPR).
They note that over half of sub-Saharan African countries do not meet the minimum acceptable PPR of one per 5000 - WHO's Health for All Standard. While the U.K., for example, has 2.3 doctors per 1,000 population, and the U.S. 2.56, Tanzania has just 0.02 and Ethiopia and Madagascar 0.03.
This is happening at a time when many of these African countries are not just struggling with infectious and chronic disease but are facing an epidemic of HIV/AIDS -- an epidemic that threatens to grow.
"Between 2006 and 2012, there could be an almost three-fold increase in the number of patients per physician (from about 9,000 to 26,000) and an overall decrease in the number of physicians treating patients with HIV from 21,000 to about 10,000," they write.
The authors say while many African doctors and nurses are leaving freely, others are being deliberately recruited.
"After putting in 15-, 16-hour days and getting text messages and being recruited by other physicians who come on vacation to Africa, we can understand why people at a particularly weak point should choose to leave," they write.
"We shouldn't be taking advantage of these people's weaknesses."
The authors concede that while the active recruitment of health workers from developing countries "may lack the heinous intent of other crimes covered under international law, the resulting dilapidation of health infrastructure contributes to a measurable and foreseeable public health crisis."
Mills and his colleagues say that countries that benefit from the recruits should "make amends" to the countries from which they "poach" by offering training, building and staffing new health schools and providing ways for health workers to stay in their own countries.
Late last year, a similar editorial appeared in the Canadian Medical Association Journal in which the authors accused Shopper's Drug Mart of engaging in the "unethical" "poaching" of pharmacists and pharmacists-in-training from South Africa.
In a piece titled "Shoppers Drug Mart or Poachers Drug Mart?" Amir Attaran, Roderick B. Walker and the CMAJ editorial writing team called for an immediate end to the aggressive recruitment of pharmacists from South Africa, so that these health workers could remain in their country.
"This behaviour is not just gauche; it is unethical," the editorial read. "It amounts to a Canadian corporation taking a free ride on South African taxpayers and the impoverished higher education system -- truly foreign aid in reverse."
Like the Lancet editorial, the CMAJ editorial called on Shoppers Drug Mart and other drug store chains in Canada to subsidize studentships at Canadian or South African schools of pharmacy to get the well-trained pharmacists they need.
