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Brain drain worsens health care crisis in Africa

by Cesar Chelala

I started traveling to Africa on health-related missions at the beginning of the 1980s. From the beginning, Africa caught my interest and my imagination. It is, after all, the continent where my father was born — when my Lebanese grandfather went to work providing food to miners in Transvaal. That I went on public health missions was a big advantage since it allowed me to go to places and see situations that no tourist normally sees.

From the beginning I realized that there are two Africas: one normally portrayed in the media, a land of poverty, disease and war; and the other, a vital, energetic continent of hardworking men and women, a continent of beautiful children and young men and young women, a continent of humor and a continent of hope.

Today six of the 10 fastest growing economies in the world are in Africa.

I thought about this while reading President Barack Obama’s statements on new U.S. policies aimed at helping Africans. Among the issues Obama discussed with South African President Jacob Zuma was U.S. interest in renewing and improving the African Growth and Opportunity Act (AGOA), which was initially approved by the U.S. Congress and signed into law by President Bill Clinton in May 2000.

According to the legislation, the U.S. president should determine which Sub-Saharan countries are eligible for AGOA on an annual basis. The AGOA, which Obama said will be renewed in 2015, has created thousands of jobs in some African countries and led to a positive balance of trade for some of the participating countries.

Despite progress, important problems remain such as youth unemployment. It is estimated that 70 percent of the population in Sub-Saharan Africa is under the age of 30 and that 60 percent of the unemployed are also young people. New policies should be developed to incorporate them into the labor force. To do that, it is important to provide them with the basic skills that would enable them to live up to their earning potential.

UNESCO and the International Labor Organization (ILO) have recommended that governments, international donors and the private sector develop integrated policies to create jobs for young people and ease the transition from school to work.

In the health area, although considerable progress has been made in the fight against HIV/AIDS (South Africa will become the first African country to fully manage its HIV care and treatment program in a few years), other challenges remain. HIV/AIDS, however, is not the only concern.

South Africa has the highest tuberculosis death rate per capita worldwide, followed by Zimbabwe and Mozambique. The situation is worsened by the high number of cases of multidrug-resistant tuberculosis in several countries. In addition, diarrheal and respiratory infections, malaria, measles and malnutrition represent big threats to children’s health. Malaria is the leading cause of death among children under 5.

The continuing exodus of physicians and nurses to industrialized countries makes health problems even worse. The World Health Organization estimates that 23,000 health care workers leave Africa annually. Malawi, a country of 15.38 million people, has a severe shortage of doctors and nurses. There is only one doctor for every 40,000 people in the country, according to WHO.

Health problems in Africa cannot be considered in isolation. Foreign technical and financial assistance is needed. More efforts must be made to increase access to primary health care, especially in rural areas, accompanied by health promotion, disease prevention and improved health education activities.

Effective aid must bypass corrupt governments and find ways of helping people directly. Aid to Africa should be aimed at strengthening civil society and community-based organizations.

African governments need to provide education for all age levels, and they need better trade conditions for their products. They need financial assistance given in a carefully planned and responsible way.

Cesar Chelala, M.D. and Ph.D., is an international public-health consultant. He has carried out health-related missions in 50 countries, many in Africa.