Global Health Watch 1 in one file

Health care systems | B3
500
400
300
200
100
Zimbabwe
Nigeria
Ghana
Zambia
Kenya
Botswana
Malawi
0
1998/99 1999/2000 2000/01 2001/02
Figure B3.5 Nurse registration in the UK from selected low-income
countries 1998/9–2001/2 (Source: Buchan et al. 2003)
changes are cumulative and self-reinforcing. Policies which work against their
grain are not likely to succeed (Mensah et al. 2005).
South Africa has gone further and introduced a ban on registration of doctors
from other African and Commonwealth countries, as an act of solidarity
with its poorer neighbours. While this has reduced the entry of doctors from
countries like Malawi, Ghana, Zambia and Tanzania, the overall effect on the
outflow of doctors from those countries is unclear – doctors may simply have
migrated elsewhere. Such measures also raise issues about professionals’ right
to freedom of movement.
Government service It is widely accepted in developed and developing countries
alike that governments that invest in the training of health personnel are
entitled to receive a return on that investment. Bonding measures that enforce
public service have often worked well, especially in helping to increase the
numbers of health professionals serving in deprived areas. Commentators
have noted that bonding policies have played a role in the health gain of some
‘high-performing’ developing countries such as Thailand and Malaysia.
Bonding works in contexts where it is perceived as fair and legitimate. However,
evidence suggests that in a number of staff-short, low-income countries
facing large health worker migration, coercive measures work poorly (Mensah
et al. 2005). Salary differentials are often so great – and working conditions so
bad – that there is little incentive to honour the bond. Coercive measures may
also backfire by creating incentives to leave – and not to return (Mensah et al.
2005, Bueno de Mesquita and Gordon 2005).
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