Health economist Professor Gavin Mooney has had a longstanding concern about the flow of health professionals from poor to wealthy countries.

In the article below, he proposes a plan for how Australia might address its responsibilities to countries like South Africa. Instead of the “unethical” practice of draining poor countries of health professionals, we should be exporting our own, he says.


A plan for a fairer deal for South Africa

Gavin Mooney writes:

I have recently returned from South Africa where I had been invited to talk at a conference on the future of that country’s proposed National Health Insurance. That has got me thinking again about the ‘stealing’ by Australia of health workforce personnel from sub-Saharan Africa and what might be done about it.

In South Africa, for example, there is a chronic shortage of doctors, especially in the public sector. There is also a major health crisis and a major health care crisis.  Poverty and inequality remain massive killers; sadly, and so disappointingly, South Africa is now one of the most unequal societies on the planet and more unequal today than it was in the apartheid years.

The health care crisis is not just one of underfunding per se but quite incredible inequity between public and private sectors – read between poor and rich and again read in essence black and white.

Thus the government’s Green Paper states:

“The 8.3% of GDP spent on health is split as 4.1% in the private sector and 4.2 % in the public sector. The 4.1% spend covers 16.2 % of the population … largely on medical [private] schemes. The remaining 4.2% is spent on 84% of the population  … in … the public healthcare sector.”

Yet Australia (and other rich and healthy countries) continues to steal South African doctors and nurses.

While in South Africa, I spoke with Ms MP Matsoso, the Director General of Health. I promised her that on my return home I would raise the issue of the flow of doctors and nurses from South Africa to Australia.

The current situation is unethical and unconscionable. We in Australia have a shortages of skilled health workforce but such shortages pale into insignificance alongside those of sub Saharan Africa.

The ‘opportunity cost’ –  the benefit foregone – in an HIV/AIDS-torn, desperately poor South Africa – of every doctor pinched by us is to be measured in far greater human terms of sickness and death than any health gain we may have. (And, in any case, if a poor country like Cuba can export doctors, why can’t we?)

Further, in South Africa, as this BMJ article notes:

“The estimated government subsidised cost of a doctor’s education [is] $58 700… The overall estimated loss [to South Africa] of returns from investment for all doctors [trained in South Africa] currently working in [Australia, Canada, the US and the UK] was … $1.41bn.”

At the International Federation of Medical Students’ Association (IFMSA) Congress in Mandurah in 2007 which was attended by a great bunch of socially-conscious medical students, many from poor countries, I cringed as Tony Abbott, the then Health Minister, appealed to these starry eyed, future doctors to come and work in Australia. His message was clear. Never mind the sick and lame and dying back in your own home countries. Move here where you can earn much more. (Fortunately the students resoundingly rejected his sordid appeal.)

More recently, however, there has been a very different appeal from a very senior voice in Australian health policy.

Dr Andrew Pesce, towards the end of his tenure as President of the AMA, in a speech at the World Medical Association Symposium in Sydney in April last year asked:

“What right do … wealthier countries have to address their own health workforce shortages with recruitment policies that worsen workforce and skills shortages in developing countries?”

And he went on: “Unfortunately, our health planners have hidden their own workforce planning failures by importing trained doctors and nurses. Inevitably developing countries are most at risk of a net workforce loss.”

Well said, Andrew, and now that we have a new Health Minister who does seem to have a concern for social justice, perhaps we can hope for change in Australian Government thinking on this front.

What is needed?

Well I suggest a four-point plan.

1. That to curb health workforce stealing, Australia enter into an agreement with South Africa similar to that which was negotiated between the UK and South Africa in 2003.

2. That for each doctor we do steal (or have already stolen?) we pay South Africa the estimated cost to that country of the training costs and the opportunity cost to them of each exported doctor.

3. That such payment be made by providing the South African public health care system with support in kind to build a better management system and train good managers (which are crucial if the proposed NHI is to work).

4. That we look at adopting a medical and nursing workforce plan that results in our not stealing from poor countries but exporting to poor countries.

When I was at the South Africa conference, I spoke of how a national health insurance scheme there would not only help to bring about a healthier population but also be a social institution that would assist in building a less divided, more united country – a more decent society.

At the start of this New Year, following one where there have been many signs of hope for a better, more decent world globally yet a pettiness and narrow mindedness here at home, how better to kick off Australian health policy in 2012 than for our new health minister to adopt the four-point plan above?

Now wouldn’t that be the act of a decent society!