"African governments have a great responsibility to ensure that brains remain in the continent; otherwise, in 25 years' time, Africa will be empty of brains."
This quotation by Dr. Lalla Ben Barka, the Deputy Executive-Secretary of the Economic Commission for Africa, expresses more than clearly the dramatic situation of Sub-Saharan African countries when it comes to their most valuable human resource needed for development their brains.
Migration and the resulting brain drain are a global phenomenon and universal problem. Especially in the health sector, there have been significant shifts of human capital from Europe to the United States, leaving a gap which is quickly filled by high-skilled immigrants from the Southern part of the world. (PSI, 2003).
According to the WHO (2006), Africa remains the sole continent still struggling with insufficient development in all fields: education and the health sector continue to deteriorate and cannot keep up with the rising demand due to an annual population growth of about 3%; HIV/AIDS is spreading fast and inexorably, further weakening the countries' systems and economies and increasing the demand for a functioning health system even more. In this context, brain drain is continuing steadily, which deprives developing countries in the Sub-Saharan region of their skilled human capital at costs comprising of their lost value and productivity in their home country but also of their training and education costs.
This paper deals with migration and it motivations as well as its impact on the African health sector. Moreover, it will be critically discussed which of the concept brain drain or brain gain is prominent in the African health sector and will show some possible strategies to overcome the serious under-supply of health workers in the region.
Particularities concerning the African health sector and migration
Migration of health has had a huge impact on African health systems. Generally spoken, a global shortage of health workers exists, which significantly raises demand. In this context, African countries are one the key suppliers of workers in the field. However, shifts of worker do not only happen externally, meaning emigration of workers to another country, but also internally. Health workers also migrate from rural to urban areas or from the public to the private sector, or they completely withdraw from the health sector. (WHO, 2006).
According to the (IOM, 2006), main reasons for an insufficient supply of health workers include underinvestment, high work intensity, working conditions, and insufficient remuneration. It is clear that concerning remuneration, developed countries can offer higher incentives for health worker to work in countries in the North. Developing countries are simply not competitive, that is why migration rates of skilled health workers are not likely to decrease in the near future, leaving developing countries in devastating situations. Schrecker & Labonte (2004) state that "a nurse in the United States can expect to earn $3,000$4,000 per month, as compared with $300800 per month for a doctor in the Philippines" (p. 411). Mass migration has then serious effects on global distribution of health services. Global average in health services is accounted to be 4 health workers per 1000 inhabitants, however, North America's worker base is 10,9 workers in comparison to Sub-Saharan Africa's worker base of 1.0 workers per 1000 inhabitants. (WHO, 2007). With his concept of the "global conveyor belt", to be seen in Annex 1, Schrecker and Labonte argue that migration of health workers in Africa not only works internationally but also intra-nationally, with workers moving "from public to private health systems, or from less to more desirable work situations or regions [with serious consequences]. Nairobi has one doctor per 500 people, while Kenya's remote Turkana province has one doctor per 160.000 people". (2004, p....