AIDS, not overseas recruitment, stripping Zambian hospitals

AIDS is removing twice as many health professionals from the workforce from Zambia as overseas recruitment, according to a US-funded study published today in The Lancet, yet health care workers are not being prioritised for antiretroviral treatment. If the death rate of Zambian nurses could be cut by 60%, says the author, “Zambian health institutions would benefit more than they would from a total ban on recruitment to the UK.”

Many African countries are experiencing a severe shortage of health care workers. The shortage has been blamed on recruitment into the health care systems of wealthier countries, particularly the United Kingdom. Health service administrators have also reported a southward drift of health care professionals in southern Africa, with doctors from Botswana drawn to South Africa, and vacant posts in Botswana filled by recruits from less wealthy countries to the north.

However, research carried out by Frank Feeley of the Center for International Health and Development at Boston University suggests that the shortage has more to do with high death rates over the past ten years.

Feeley and colleagues documented an annual death rate of 3.5% for nurses and 2.8% in Lusaka, the Zambian capital, and the Kasama district.

“Over a decade, these death rates would account for the nurse vacancy rate of 37%. Death claimed more nurses and clinical officers (68%) than resignation or retirement, [and] the median age at death was 38 years, suggesting that AIDS is responsible for most of the deaths.”

Taking figures from 2000, the number of deaths among nurses and midwives is nearly twice as high as the number of nurses who applied for registration in the UK in 2003-4.

But in Zambia, health care workers must join the queue at public clinics, taking time off work and so stretching an over-burdened health acre service even further. Health care workers are also wary of using services at their place of work or even of testing for HIV because of stigma. A recent focus group study in Tanzania showed that health care workers frequently learnt their HIV status by testing themselves secretly with rapid antibody test kits in the workplace.

The editorial recommends that governments should consider the following steps to reduce premature deaths in the health service:

• Education and outreach to health care workers that highlights the benefits of antiretroviral therapy
• Confidential testing, with no fear that results will reach co-workers or managers
• Antiretroviral treatment outside the employing institution, outside working hours, either free or provided through civil service insurance scheme
• Special provision for treatment in remote locations; “absence of effective HIV treatment is another reason for civil servants to avoid remote rural postings,” the authors say.

“Stopping the brain drain requires an unprecedented level of cooperation,” they conclude. “Keeping HIV-positive professionals alive and at work in their home countries is a simple task, and one that we know how to do.”