East Africa is one of the regions in Africa worst hit by the exodus of health workers — mainly to Western countries — and inadequate state funding.
A new report Stop the health worker crisis by UK-based NGO Health Poverty Action, says that for example health spending in Uganda has never exceeded 10 per cent of total public expenditure, and is far below the 15 per cent Abuja Target agreed by African countries.
It adds that Uganda has only around 1.2 doctors and 14.5 nurses, midwives and nursing assistants per 10,000 people and is therefore classified by WHO as one of the countries that has a critical shortage of health workers and is unable even to cover essential health services.
But the situation is even worse better in some East African countries. Rwanda has just 0.6 physicians and 6.9 nurses and midwives for every 10,000 of the population, and Tanzania fares a mere 0.1 physicians and 2.4 nurses and midwives, according to data from the WHO.
Kenya is doing marginally better at 1.8 physicians and 7.9 nurses and midwives. Health, is one of the services that is being devolved to the counties. But because it is not being managed clearly, it could end up pushing doctors out of the public service — increasing the brain drain and defeating the very purpose of devolution.
“It’s a scandal that 80 per cent of interns leave the public service after finishing their internship. Some join the private sector and others leave the medical profession altogether,” said Dr Sultani Matendechero, secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union.
“But under devolution, things could get worse... For example, we have received templates of doctors’ salaries from the counties, and in them salaries are being slashed by more than half. This is illegal and unconstitutional,” said Dr Matendechero.
According to Dr Matendechero, the ongoing uncertainty between the county governments and central government is pushing doctors away from the public sector, where they are needed most.
The shortage of health workers in the region has resulted in persistently high maternal, infant and under-five death rates, despite some improvements in the past few years.
On average, only 42 per cent of births in Uganda, for example, are attended by a skilled health professional, and only 9 per cent of under five-year olds sleep under a mosquito net despite malaria being the leading cause of death in Uganda, followed by HIV/Aids and pneumonia.
But government funding to the health sector is just 10.8 per cent of the government budget in Uganda, 11.1 per cent in Tanzania, 8.9 per cent in Burundi and a mere 5.9 per cent in Kenya, forcing hospitals to turn to other sources of funding to meet the bills. Only Rwanda meets the target of the Abuja declaration with 23.7 per cent of the government budget going to health.
Because medical insurance is only taken up by a minority, most patients are forced to pay for health care from their own pocket — data from WHO shows that in 2013, half of global private spending for health care came directly from patients.
In East Africa, this out-of-pocket expenditure stood at 64.8 per cent for Uganda and Burundi, and in Kenya it was 76.6 per cent.
This means that falling sick is a luxury few can afford in the region, as having to buy medicine could mean cutting back on the household food or education budget, and missing a few days of work could even cost one their job.
According to the latest available global estimates, the world faces a shortage of 4.2 million health workers with countries in Africa hardest hit by this crisis.
Africa is home to only 3 per cent of the world’s health workers who are fighting 24 per cent of the global disease burden, with less than 1 per cent of world health expenditure according to the WHO. Among the 57 countries identified with a critical health worker shortage, 36 were in sub-Saharan Africa.
The lack of resources and skilled medical personnel mean that most African countries are not on target to hit the three health-related Millennium Development Goals on reducing child mortality, improving maternal health, and combating HIV/Aids, and malaria.
Now Health Poverty Action and other health related international NGOs are calling for internationally co-ordinated efforts to tackle the global shortage of health workers, before recent improvements in global health are reversed.
“Unless urgent action is taken the situation will worsen as life expectancy in wealthy countries increases and pushes up demand for doctors and nurses,” the report says.
Health Poverty Action identifies a number of “push factors” that have been shown to regularly rank high among health workers’ reasons to migrate, including poor pay, bad working conditions, poor facilities, discrimination, lack of funding, limited career structures, poor intellectual stimulation, lack of security, the wish to provide a good education for children, an oppressive political climate, and persecution of intellectuals.
These “push factors” in source countries are complemented by a number of “pull factors” in destination countries, such as higher income, greater security and better training opportunities.
The report also says that given this skills “debt” owed by the Global North to the source countries of the South, (through poaching critical health workers), some critics have argued, destination countries have an obligation to compensate source countries though the payment of restitution.
By Paul Redfern and Christine Mungai