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IMPACT OF NURSE MIGRATION ON SOUTHERN AFRICA

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IMPACT OF NURSE MIGRATION ON SOUTHERN AFRICA Christine Zondagh GROUP INDUSTRIAL RELATIONS MANAGER NETCARE Catastrophic effect The loss of health nurses from SSA ... – PowerPoint PPT presentation

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Title: IMPACT OF NURSE MIGRATION ON SOUTHERN AFRICA


1
IMPACT OF NURSE MIGRATION ON SOUTHERN AFRICA
Christine Zondagh GROUP INDUSTRIAL RELATIONS
MANAGER NETCARE
2
Human Resources for health
"The most critical issue facing health care
systems is the shortage of people who make them
work" WHO 2003110
3
Catastrophic effect
  • The loss of health nurses from SSA is having a
    catastrophic effect on these countries.
  • Movement of nurses towards more wealthy regions
    is nothing new - the current situation is more
    problematic than in the past HIV/AIDS crisis in
    developing countries is rapidly depleting current
    workforces and increasing the overall workload,
    and the recent sharp rise in the sheer number of
    people leaving has led to a staffing crisis.
  • Africa reported a nurse vacancy rate of 30 in
    2002.

4
Sub-Sahara Africa
  • WHO estimates SSA has 25 of the worlds
    diseases burden but only 1.3 of the trained
    health workforce and 1 of world financial
    resources even with loans and grants from
    abroad.
  • Recent estimate is that SSA countries have a
    shortfall of more than 600 000 nurses needed to
    meet the MDGs of improving the health and
    wellbeing of the population Buchanan and Calman,
    200419
  • Total nurse to population in SSA - reported to
    be 135 nurses per 100 000 population worst in
    world.
  • .

5
Migration Impact -Africa
  • Africa lost 1/3 of health professionals- costing
    4 billion to replace about 23 000 African
    health professionals migrate to developed
    countries every year.
  • Malawi losing more nurses through migration than
    it can train. A main hospital in Malawi has half
    its nursing posts vacant, and only two nurses
    were available to staff a maternity ward with 40
    births a day Anderson, 2004.
  • Almost 50 of Zimbabwe RNs 80 of doctors left
    the country.

6
Impact Southern Africa
  • Ghana reported 10 000 nurses taking care of
    population of about 19 million.
  • Zambia 100 and Uganda 6 nurse / 100 000
    population Buchanan and Calman, 200419.
  • In contrast - UK reported one nurse / 110
    population.

7
Impact Southern Africa
  • Misdistribution between public and private and
    rural and urban areas major concern.
  • Tanzania Average nurse/population ratio is
    160/100,000 but 6/100,000 in rural districts.

8
South Africa
  • South Africa also reported a serious nurse
    shortage and brain drain.
  • Nearly 250 000 skilled health personnel people
    left the country for Australia, Canada, New
    Zealand, UK and the US between 1989 and 1997.
  • More than 25 000 nurses requested the SA Nursing
    Council to verify their qualifications between
    1994 and 2004.

9
South Africa
  • Reported 42 000 vacant nursing positions in the
    public service Padarath et al, 2003 307
  • We only have around 2 500 ICU trained and 2 800
    theatre trained RNs in the country estimated
    that up to 50 of them might have migrated or
    inactive.
  • There is a critical shortage of nurse tutors and
    educators, which will constrain any attempts to
    increase the numbers of nurses being educated.

10
Impact Southern Africa
  • RN ratio in SA declined from 120 /100 000
    population in 2000 to 109 in 2005.
  • In contrast - the U.S. - has almost 1000 RNs for
    every 100 000 Americans.
  • Nurses in SSA are expected to accept unreasonable
    workloads, to work outside their scope of
    practice and are increasingly been put at risk of
    professional negligence due shortage of nurses.

11
Impact of HIV
  • SSA is home to more than 60 of all people living
    with HIV and AIDS although this region contains
    little more than 10 of the world's population.
  • Almost 53 of all deaths in Government employees
    in Africa due to HIV/AIDS. Tawfik Kinoti 2001.
  • Student nurse HIV related deaths
  • Malawi is 40
  • Zambia is 38.

12
Impact of HIV South Africa
  • SA accounts for 13 of all people living with HIV
    in the world and has the highest number of people
    living with HIV - 5.6 million are HIV-positive.
  • Estimated that about 600 people die of
    HIV-related illnesses each day.
  • Average of 15,7 of nurses were HIV positive.
    Shisana et al 2003

13
Impact of migration on health services in SSA
  • Rural areas- often only one nurse/clinic. Doctor
    only once week / month. When sick /leave no
    services.
  • SA - recent report of disciplinary hearing -
    found that cleaner were giving injections at
    clinic to immunimize children.
  • Kenya many other countries up to 90 patients
    in 30 bed wards.
  • Patient ratios in general wards in three
    hospitals in Malawi were reported to be one nurse
    to 120 patients Aitken and Kemp 200312
  • Patients wait for days to see health workers
    -even die while waiting to see health
    professional.

14
SA Private Hospital Survey
  • Survey on impact of the global nursing shortage
    on quality patient care and nurses quality of
    worklife among Registered Nurses in the Private
    Hospital Sector (Zondagh, 2004) found the
    following
  • 16 of the respondents indicated that they plan
    to work overseas within the next two years and
    another 25 indicated that there is a possibility
    that they might plan to work overseas within the
    next two years.

15
SA Private Hospital Survey
  • 84 of the respondents have indicated that they
    have experienced an increase in their workload.
  • 70 of the respondents indicated that they would
    not recommend the nursing profession to their
    children or someone else

16
UK
  • The UK is an important receiving country from a
    Southern African perspective.
  • 2003 -UK health permits were approved for 5880
    nurses and doctors from South Africa, 2825 from
    Zimbabwe, 1510 from Nigeria and 850 from Ghana.
  • 8 999 SA born Health Professionals reported to
    work in UK OECD 2003

17
Migration to UK
  • SA entered into bilateral agreement with Britain
    on the recruitment of health professionals.
  • The arrangement is to allow health professionals
    from South Africa and Britain to work in these 2
    countries for a specified period and then return.

18
SA- Strategies to Retain
  • Since 2001, SA made commitment not to recruit
    from SADC unless under terms of specific
    agreement with country of origin.
  • Policy not to recruit professionals from fellow
    developing Africa countries assisted in stemming
    internal African brain drain to SA SA National
    Dept Health April 2006

19
SA -Retention allowances
  • Community service of one year most of health
    professionals. Nurses will ?start in 2007.
  • Rural Allowance (8 -22)paid to health
    professionals working in rural area.
  • Scarce Skills allowance - 10 - 15

20
South Africa
  • Min Health launched Human Resources for health
    plan on 7th April 2006.
  • Plan will assist Dept Health to ensure the right
    human resource mix in health to fulfill health
    care delivery objectives.
  • Set of targets for production of health
    professionals which should be trained

21
South Africa HRH Plan
  • RNs 3000 p.a by 2011 current national
    production is 1896 p.a
  • Staff Nurses 8000 p.a by 2008 current 5000 p.a
  • ENA 10 000 p.a by 2008 current 6 600 p.a.
  • Change Scope of Practice of nurses

22
Other strategies
  • Malawi, for example, has begun to implement a
    six-year emergency human resource program.
  • Zambia and other countries are implementing
    successful measures to improve rural deployment.
  • Kenyas project to develop a computerized nurse
    workforce database recognized as a good
    practice.
  • Ghana and other countries are beginning to
    benefit from increasing health workers salaries
    and allowances.

23
What should be done.
  • All countries around the world should increase
    training of nurses.
  • Developed countries should train own nurses and
    should not be so dependant on migrant workers
    from developing countries.
  • All countries should comply with ethical
    recruitment practices.

24
Need to improve conditions
  • As long as work conditions do not improve -
    industry will fail to retain qualified health
    professionals.
  • Producing more graduates will do little good - if
    these health professionals become disillusioned
    and drop out after a few years of facing the
    reality of working in the healthcare environment.
  • Need to improve the Image of Nursing Profession

25
Conclusion
  • Each person has the fundamental right to migrate
    and seek work and opportunity elsewhere if they
    so desire.
  • Whatever strategies are developed to address the
    worsening situation in the health sector as a
    result of health personnel migration, this must
    be taken into account.

26
Thank you
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