Doctors Without Borders

February 26, 2008

The latest issue of Lancet crossed my desk today, and emblazoned across its cover was this dispiriting statement:

“Africa carries 25% of the world’s disease burden yet has only 3% of the world’s health workers and 1% of the world’s economic resources to meet that challenge.”

The stats were pulled from an essay on the brain drain of health-care workers from poor regions of the world to wealthy places like the United States. And the situation in many regions is dire, note Mary Robinson and Peggy Clark, both with the Health Worker Migration Global Policy Advisory Council, here in Washington.

Some 600 doctors—roughly half of those in Ghana—fled for better working conditions and pay over the decade beginning in 1993. One-third of that nation’s nurses also left. Of course, Africa is by no means the only source of these health-care migrants. You need only spend time visiting someone in an urban hospital or nursing home to encounter staffs boasting a range of skin colors and accents. Cultural diversity is alive and well throughout U.S. medicine.

Robinson and Clark acknowledge that “health workers have a clear human right to emigrate in search of a better life.” However, they add, the sick they leave behind also have a right to health care. And therein lies the rub: how to guarantee care in the wake of a tidal wave of emigrating physicians.

Norway’s solution is to embrace a policy of self-sufficiency in health care. If domestic workers can handle the sick load, there will be no big campaigns to lure foreign help in with signing bonuses or translocation subsidies. Last year, PacificIsland countries took a different tack. They signed a code of conduct for member nations to “promote the retention of health workers in [their native] countries” with policies that will include “monetary and non-monetary incentives.”

The trick will be to create incentives that don’t anchor health-care workers to hopeless environments, but instead encourage people to stay because it makes sense for them—for whatever reason.

Robinson and Clark concede they’re still looking for those incentives and welcome suggestions. Got a good idea? Pop it along to Clark (, who works out of the Aspen Institute, some 2 blocks away from our office here at Science News.
Janet Raloff

Janet Raloff is the Editor, Digital of Science News Explores, a daily online magazine for middle school students. She started at Science News in 1977 as the environment and policy writer, specializing in toxicology. To her never-ending surprise, her daughter became a toxicologist.

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