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International News

Recruitment of Health Workers in Sub-Saharan Africa Weakening Health Systems, Inhibiting Efforts to Fight HIV/AIDS, Article Says

February 25, 2008

The practice of recruiting trained health personnel from sub-Saharan Africa to work in developed nations is weakening health infrastructures and undermining efforts to fight HIV/AIDS in the region, according to an article published in the Feb. 23 issue of the Lancet, Reuters reports. The article was authored by Edward Mills of the British Columbia Centre for Excellence in HIV/AIDS and colleagues from Uganda, South Africa, Ireland and Argentina (Fox, Reuters, 2/21).

"Although active recruitment of health personnel in Africa may lack the heinous intent of other crimes covered under international law, the resulting dilapidation of health infrastructure contributes to a measurable and foreseeable public health crisis," the authors wrote, adding, "The practice should therefore be viewed as an international crime."

According to the article, more than 13,000 health workers trained in sub-Saharan African countries now practice in Australia, Britain, Canada and the U.S., AFP/ reports. Recruiting agencies use workshops, advertisements, e-mails and Web sites to attract health workers, according to the article (AFP/, 2/21). The agencies generally offer to pay higher salaries, cover moving expenses and provide assistance navigating the visa and citizenship process, Toronto's Globe & Mail reports (Branswell, Globe & Mail, 2/22).

The authors cite Ghana as an example of the effects of health personnel recruitment, Reuters reports. According to the researchers, Ghana spent $70 million training health professionals who then left to work in the United Kingdom. In comparison, the United Kingdom saved about 65 million pounds, or about $130 million, in training health care costs between 1998 and 2002 by recruiting Ghanaian doctors, the authors write, adding that the country's contribution to service provision is estimated at around 39 million pounds, or $80 million, annually.

Implications on HIV/AIDS
The recruitment practices could have a significant impact on the fight against HIV/AIDS in sub-Saharan Africa, according to the authors. They project that between 2006 and 2012 "there could be an almost three-fold increase in the number of patients per physician" -- from about 9,000 to 26,000 -- and an "overall decrease in the number of physicians treating patients with HIV from 21,000 to about 10,000." The doctor-to-patient ratio in the U.S. is about 2,000 patients annually to each doctor, they note.

Developing countries "are systematically seeing their recruits being enticed away," Mills said, adding, "What we are saying is that if one of these countries that is being systematically poached were to pursue it as a crime, contributing to unrest ... then they would have some leg to stand on" (Reuters, 2/21).

Amir Attaran, a professor at the University of Ottawa Institute of Population Health, said he understands the argument but disagrees with the position that such recruitment is an international crime. "I don't have any difficulty saying that it would be lovely and I would prefer to live in a world where it were criminal," Attaran said, adding, "But their argument is that already customary international law tells us that this recruitment should stop ... That is an incorrect understanding of what customary international law is" (Globe & Mail, 2/22).

Mills and colleagues said developed countries that benefit from recruits should "make amends" by offering to train, build and staff new health schools, and provide ways for health workers to remain in their home countries (Reuters, 2/21).

Online The article is available online.

PRI's "The World" on Friday included a discussion with Mills about the article (Werman, "The World," PRI, 2/22). Audio of the segment is available online.

Back to other news for February 2008

Reprinted with permission from You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at The Kaiser Daily HIV/AIDS Report is published for, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2008 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.
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