Exporting Nurses as Prescription for Sick Economy
1st Decmber 2010 Ethiopia joined the rest of the world in marking Global AIDS Day, with its 1.1 million people living with the virus and an epidemic prevalence rate of 7.7 percent for urban dwellers. The historical town of Axum was selected to host the commemoration events, including speeches vowing to continue the battle to eradicate the disease in the coming year. As on similar occasions, politicians urged the people to further their efforts, despite the fact that all participants seemed to forget the larger picture regarding the health issues of the country.
Beyond all rhetoric, one can easily understand how fighting AIDS and other epidemics is a daunting task in today’s Ethiopia. Physician, nurses and health workers are removed from the domain of advocating for better health transformation. According to the latest World Bank report, 26.4 and 29.7 percent of physicians and nurses, trained have fled their homes and toil for other nations.
Scholars have offered many explanations for why highly skilled workers, like physicians, leave the country. Among the many competing factors, job satisfaction, remuneration, work environment and professional freedom are the major ones. It is almost unanimously agreed that “push factors” such as lack of professional freedom and inadequate salaries have negatively affected the country’s skilled labour pool.
To further exacerbate the problem, the government has recently introduced another element to deepen the problem. As heard from Addis Ababa this week, the government has unveiled a plan to export nurses from within its already meagre stock of skilled health workers. According to The Reporter, a bi-weekly Amharic newspaper, the government is preparing to send 200 nurses to other nations.
It would be foolish to conceive of, let alone rush, such trading. But it is hardly surprising. The EPRDF has long experimented with the spontaneous implementation of a number of questionable policies. For a country with an extremely poor healthcare system, exporting nurses – who could not even fill 10 percent of the sector vacancies at home – will likely result in significant national losses.
To be involved and competitive in such skilled labour trading at the international level, a nation must first be endowed with well-resourced institutions, capable of training enough high calibre professionals to meet domestic needs and ready to establish strong linkages across different sectors. Theoretically, the comparative advantages of exporting skilled workers must be carefully considered before engaging the planning process.
Unfortunately, Ethiopia does not have comparative advantage in this regard. If humble observations focus on the number of skilled physicians and nurses alone, it is simple to conclude that the country is lagging behind the rest of the world. According to the 2010 World Health Organization report, the ratio of the number of health workers to total population is below the sub-Saharan average. A physician should serve 20 000 people, while a nurse is expected to serve 5000 averagely. Whereas an environment and social health workers are expected to serve 10000 people.
Based on many research findings, experts raise the importance of retaining skilled workers within their own countries by limiting the push factors and implementing appropriate policies. Developing nations, in particular, suffer from the migration of their professionals. For instance, Africa alone loses 20 000 of its skilled men to developed nations, a trend that costs the continent $4 billion USD a year.
Meles’ “Developmental State” is clearly missing the point. Rather than forwarding well-researched and organized sets of policies, the government prefers its arbitrary proposals, as usual. For EPRDFites, it is apparently fashionable to propose contradictory ideas under any circumstances. Under their ambitious Economic Growth and Transformation Plan, improving the quality of health is an important target. However, the sector is already suffering from a shortage of professionals. For instance, 16.8 percent of nurses born in Ethiopia have left the country. There is simply no surplus labour within the health sector. Yet there are official plans to export the remaining few, although the majority of them are have not even received proper training.
The main aim of this agenda is to earn foreign exchange, at the expense of millions of people who are suffering from a lack of basic health services. This is a weak target when accompanied by such ill instruments. Like windfall gain, the government may be lucky in achieving short-term earnings. But in the long run, the losses will be very high.