Brain Drain, Not IMF Policies Main Obstacle to Sustainable Health Care in Poor Countries

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January 26, 2011 By Jimmy Kainja

Oxford University-led study has established that poor countries that borrow money from the International Monetary Fund (IMF) spends only one percent of aid money on health and medical care while countries without IMF loans were said to use 45 percent of aid money on medical and health care. The purpose of the study was to explain why many countries are unlikely to meet Millennium Development Goals (MDGs) for health despite increased aid on health sector.

The authors have attributed the situation to the fact that countries that mostly seek IMF support are the ones facing economic problems. Such economic constraint means that countries seeking IMF assistance also have other areas, beside the health sector, needing urgent economic attention.


“Nonetheless, even in such circumstances, it is reasonable to expect aid from donors to have at least some positive impact on health funding, especially given that health needs are often greatest at such times… A change in loan policies is needed to lift the existing restrictions on finance ministers so they are no longer prevented from spending health aid on the people that urgently need medical help.”

This is correct, and diversion of aid money has been, and it is fair to say it will always be there. It’s easier for governments to get aid on premise of improving health sector, especially at a when international community is hell-bent on making sure that poor countries meet MDGs by 2015. ‘A change in loan policies’, is ideal if not a necessary move. Apart from meeting the MDGs in hope of attracting more aid money, most leaders of the global south have no real incentive to improve expensive health sector. Presidents, former presidents, ministers, MPs and their inner circle always seek medical health outside their own countries. If not then can afford to pay for expensive private clinics with their boarders.

This leaves governments with less incentive to improve medical care. Take Malawi, for example. With nearly 14 million people, the country has a doctor to patient ratio of 2: 100,000; it has only 43 doctors and 3, 456 nurses. Yet its former president, Bakili Muluzi has spent a big chunk of his retirement in London and South African hospitals. All this is paid for by Malawi taxpayers who can hardly afford medical care for themselves and their families. The lack of political-will is by no means the only reason why poor countries are unlikely to meet MDGs for health.

The study’s emphasis on the need to reform IMF loan policies neglects a very important area: brain drain. There is a high migration rate of already inadequate heath workers trained in and by the poor countries to the rich countries, particularly from Africa and Asia. Statistics indicates that 23% of doctors trained in sub-Saharan Africa are working in economically developed countries. “Canada and the United States, with only 10% of the global burden of diseases, have 37% of the world’s health workers.” Africa and Asia have fewer than ‘2.3 nurses, doctors and midwives for every 1,000 people.

The situation is unlikely to be reversed anytime soon given the shortage of health workers in rich countries. Rich countries are too attractive for most health workers from the poor countries due to its comparatively higher wages and better life prospects for the health workers and their families. There are more Malawian doctors in the UK than there are in Malawi. At a time of economic uncertainty, many rich nations have resorted to protectionism and stiffened their immigration policies but health worker have been exception.

IMF loans however effective or ineffective they may will not and would address the problem of health care in the poor countries. “A lack of skilled personnel has health systems in developing countries ‘on the brink of collapse.’” In order to improve health care systems, poor countries must use meager resources they have to train health workers, only to lose them to rich nations upon qualifying. How are the poor countries expected to improve without qualified personnel? The problem is much more than ineffective IMF loan policies; it is also about injustices: rich nations exploiting poor countries.

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