The Huraprim project focuses on primary health care in Africa. It strives to shed new light on the reasons why the human resources required to run these services are hard to recruit and retain and aims to identify strategies that could help to turn the situation around.
Due to end in May 2015, the HURAPRIM project — implemented jointly by partner organisations in Austria, Belgium, Botswana, Mali, Sudan, South Africa, Uganda and the United Kingdom — has analysed the motivations of health workers who have decided to migrate and the impact of these departures on public health. It has also taken steps to raise awareness of the importance of primary health care services, highlighted promising strategies to boost human resources in frontline services and issued recommendations for policy-makers.
Treating the brain drain
While many health care workers leave to work in other continents, says project coordinator Jan De Maeseneer of Ghent University, there is also a brain drain phenomenon within Africa. Human resources are moving from rural areas to the cities, from primary care to specialty care, from the public service to private services, and from general health care to programmes focusing on specific diseases such as HIV/AIDS, he explains.
“There are economic and political elements that determine the fact that people migrate: difficult work conditions, low salaries, and very high workloads,” De Maeseneer notes. Economic conditions are of course an important factor, he explains, but many people emigrate for other reasons — to specialise in a particular field, for example, to escape political instability or insecurity, or to join family members who are already living abroad.
These are understandable personal decisions, often taken in very difficult circumstances, says De Maeseneer. Strategies to counter the phenomenon need to focus on structural solutions that boost health workers’ options at home.
Addressing the problem is not simply a matter of money, De Maeseneer explains, although of course adequate financial resources are needed. Training health workers in their own country would, for example, already solve part of the problem. While a number of African countries have excellent facilities in place to train prospective health workers, others do not — and persons who have already left for their studies often decide to remain abroad.
Specific strategies to support family practice in underserved areas would be another option. Medical graduates willing to work in remote rural locations could receive additional training and support over the internet, for example, enabling them to build up the required skills and autonomy.
A health care emergency
Huraprim looked into the causes of brain drain, but it also examined the consequences — for example by means of “virtual autopsies” of children deceased under the age of five. The researchers interviewed the families and health workers involved in a number of cases and concluded that most of these tragedies could have been prevented. Where primary health care is unavailable or underskilled, lives are lost.
Armed with this information, Huraprim was able to document this fact in its interaction with policy-makers. “In the places where we did this kind of intervention, deaths decreased in the following years,” De Maeseneer reports.
Huraprim is preparing a list of recommendations for policy-makers both in Africa and abroad. Indeed, countries recruiting health workers from less affluent countries also bear part of the responsibility, says De Maeseneer.
This observation shapes one of Huraprim’s key messages. “The international community should agree that if you integrate a doctor or a nurse that was trained in a developing country in your health system in the West, you should reimburse the full cost of training that person to the country of origin,” De Maeseneer explains.
The amount of this refund should correspond to the much higher cost of training such a person in the recruiting country, he adds. This approach would enable countries of origin to train several people for every person that has left. “This is the least we should do if we take advantage of the training people received elsewhere,” De Maeseneer concludes.