Community, Diaspora and Immigration

Can the Diaspora Impact on Africa’s Health? From Brain Drain to Brain Gain by Dorothy Mukasa

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The UK’s National Health Service is propped up by significant numbers of medical health professionals from countries in Asia and Africa. These are highly trained, highly experienced doctors, nurses, allied health professionals from countries where their medical skills, experience, seniority, professional networks and strategic planning abilities would be invaluable. Indeed the ethical dilemma of healthcare systems in developed countries, being heavily dependent upon a continued brain drain from developing countries is globally recognized with little comment.

It suits the developed countries in Europe and America and also suits the medical professionals involved, who are better remunerated abroad than they could dream of in their countries of origin. There is also a clearly identifiable professional career path.

African countries have ambitious strategic health plans. However, because of inadequate resources, the result is ineffective healthcare systems, and poorly managed primary and secondary health care. Challenges include the lack of equitable distribution of healthcare, inefficiency, poor patient centeredness, problems with medical ethics, risks to patient safety and health worker safety.

A significant factor is the running of healthcare systems without medical seniors.  The analogy would be an army made up of privates and corporals, with a lack of ranks above sergeants and majors and others. Newly qualified medical professionals lack several strata of people with 20-30 years’ experience, senior consultants able to be professional role models, and mentors to junior staff in hospitals and in the field. Perhaps not surprisingly, significant numbers of doctors with minimal seniority emigrate to developed countries for better conditions, good professional support and career structure. It’s said anecdotaly that there are more Ghanaian doctors in New York State alone, than there are doctors currently working in the whole of Ghana. Alas, the situation is replicated across many African countries. So how could this significant resource in the Diaspora have an impact on the Healthcare systems in Africa?

Over decades, many people have tried to support the weak healthcare systems in their countries of origin, but such help would benefit from strategic planning and support. We are all aware of people who make the effort to gather good quality incubators, profiling beds, theatre equipment, or other medical necessities in perfectly good working order, but discarded as obsolete from UK hospitals. At some expense people have sent equipment to African hospitals in the hope of improving patient outcomes.

Unfortunately many of these are futile efforts and frustrate the Diaspora.  The expensive equipment requires a level of technical know-how often missing in rural hospitals, the frequent lack of regular electricity, and the inadequate supervision can lead to valuable equipment lying redundant, being misused or stolen.

The World Medical Association is on a drive to strengthen National Medical Associations (NMAs), so that like the British Medical Association, the American Medical Association, the Japanese Medical Association, medical professionals begin to influence the health agenda and provide more effective professional leadership in African countries.

These Medical Associations could work in tandem with the efforts of medical professionals from the Diaspora and enable them to strengthen poor health systems.

However, only 15 out of the 53 African countries have Medical Associations registered with the World Medical Association.  Associations of Nursing and Midwifery, and Associations of Allied Health Professionals should all be mobilised  into  networks linking each country with the Diaspora and this may well impact the health of Africa.

On the 13 September, the East African Health Forum held a seminar in London, to explore the roles the Diaspora could play in this key initiative.  The potential for Time Banking initiatives, Telemedicine, Continuing Professional Development, and new approaches to effectively address Long Term Conditions and Infectious Disease  was considered.

The very distinguished panel of speakers included Dr Wangui Manguyu, Chair of the EAHF, Dr Abiodun Fakokunde, Medical Association of Nigerians Across Great Britain (MANSAG), Dr Margaret Mungherera, President of the World Medical Assocaition, Dr Vivienne Nathanson, Senior Director at the British Medical Association, Mr Ronald Lutaaya, East African Health Forum, Dr Julius Awakame, Africa-UK Telemedicine Working Group, Dr Sakib Rokadiya, King’s Sierra Leone Partnership, who shared the experience of working with a hospital in Sierra Leone tackling the Ebola epidemic.

Conference participants were originally from 9 African countries, the majority being UK medical professionals.  The event’s evaluation indicates that the most common concerns include how healthcare is paid for in Africa, the need to address continuous professional development, the poor health infrastructure, training opportunities and the lack of adequate or appropriate mental health care.

The East African Health Forum (EAHF) will continue to organize London seminars that consider how the African Diaspora can have a constructive impact on healthcare systems in Africa.
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Dorothy Mukasa  has been Commissioning Manager in the National Health Service for over 22 years with significant experience in non-acute Commissioning across the UK.

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