Africa must avoid collapsing its health delivery system

Dr Johannes Marisa

A FEW days ago, news agencies were awash with news that Germany is in need of about 500 000 nurses to fill that country’s nursing gaps.

A 2022 report, published by the National Institute for Health, said Germany had been unable to fill up to 520 000 full-time nursing positions.

The World Health Organisation (WHO) and the International Council of Nurses have revealed a global shortage of 5,6 million, with the greatest need for qualified nurses in South East Asia and Africa.

At least 7,3 million nurses and midwives are currently employed in Europe, but the figure is believed to be inadequate to meet current and future needs.

Whenever there is global demand for nurses, the exodus will mostly affect poor countries, with our country being one of the victims.

What I foresee is Africa having a poorer health delivery system after unprecedented migration to the so-called greener pastures.

Germany is eyeing South Africa for recruitment of the nurses, with South Africa only having about 20 000 unemployed nurses.

Migration of nurses can may result in that country losing almost everyone to Germany.

The consequences are dire with collapsed health systems being on top of the list.

Government-to-government negotiations will not yield positive results, but will only be of relevance when monetary benefits are improved at government level.

African governments have always cried foul when there is worker migration, citing financial losses emanating from training costs.

It is estimated that at least US$175 000 is required to train one doctor and about US$70 000 to train a nurse in Zimbabwe, so it is absurd to lose healthcare workers to foreign countries on a silver platter. It is the taxpayer who loses more from the migration.

In 2007, WHO released a framework of action that has six building blocks which include service delivery, health workforce, information systems, medical products, financing and governance.

The framework is instrumental in strengthening the overall health system and as a catalyst for achieving global health targets.

When one of the six pillars is deformed, then there is catastrophe on the overall structure of the health system with serious threats of collapse.

Without a vibrant workforce, there is obvious disaster in the health system characterised by understaffing, demotivation and loss of morale.

Zimbabwe has continuously been losing health workers to greener pastures and it is not a secret that close to 5 000 health workers have left Zimbabwe in the past two years. United Kingdom being the biggest beneficiary of the migration.

Government should adopt strategies that help in worker retention. It is senseless to have state-of-the-art healthcare facilities without adequate staff.

Mahusekwa Hospital was constructed some years ago in Mashonaland East province with high expectations from the community, alas, the institution is now a pale shadow of itself.

A skilled and experienced workforce is critical to every institution in the country and failure to acquire such is detrimental to sound health service delivery.

It is not a secret that the working conditions of our healthcare workers are not pleasing with nurses getting salaries that are not enough to send their children to school, pay for accommodation and to fuel their vehicles, among other necessities.

Why does government take time to address health workers’ grievances, yet health service delivery is under threat?

There has been talk of health workers getting housing loans, vehicle loans, stands, farms et cetera, but implementation is the elephant in the room.

The end result is extensive loss of healthcare workers to foreign countries.

The home countries will surely face collapse in the health sector.

What are we going to do as a nation if half of our skilled health workers leave the country for greener pastures?

Where will we seek expert treatment if the situation remains unabated?

African governments should seek to avert impeding health disasters by putting in place worker retention strategies.

The Western world will not hesitate to fish from our pools of qualified health personnel and we should not blame health imperialism when we fold our hands when we are supposed to be fighting back.

Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.

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