Tele health can help bridge brian drain in the health sector

By Brenda Zulu
Less than 10% of doctors trained in Zambia since its independence in 1964 are still in the country: the other 90% have migrated, mainly to Europe and the United States indicates press reports.

Lack of financial resources for the health sector and policies of some developed countries have caused a mushrooming of doctors and nurses in the west, hence exacerbating the problem of brain drain. It is evident that the US and UK receive the highest number of medical practitioners from Africa, who often migrate for search of greener pastures, oblivious of the dent they leave in their own countries.

The health sector in Zambia is one of the highest hit in terms of brain drain followed by the education sector. The health sector continues to loose it’s most tresured human resource to developed countries.

What should be the role of government in the health sector as regards the issue of brain drain. Not only do people in the health sector spend a lot of time to be moulded into what they are now they also should think about their patriotism to offer their delegate services in their own African Countries. Who is to blame for this brain drain?

When have we felt the need for better health in Zambia? Is it when we have had people die in big numbers because of lack of being attended to by a doctor or is it when we see wealthy Zambians flying to London and South Africa to be attended to by the same doctors who left because of shoudy wages. The situation is a replica of what is also happening in other African countries.

“How can the people in government care about the health situation of the local people when they can afford to go out for treatment to hosiptals abroad and overseas? If indeed they care about the situation in the health sector they should have cared a long time ago as the problem of brain drain has been ongoing,” asked Mercy Mukabila a student of Business Studies.

The causes of the brain drain are among the push factors where we have low and eroding salaries, social unrest and political conflict, including wars, unsatisfactory living conditions, such as lack of housing and transport. Also contributing factors are the lack of research facilities and funding, discrimination in academic appointments and promotions especially when it come to the education sector.

The pull factors, mostly perceived as being offered in the West, are the reverse: higher wages, political stability, intellectual freedom and better career opportunities, among others.

“As African countries we have have been subsidising foreign governments by sending our people to work outside. Our governments have failed to prioritise the plight of health workers who, consequently have gone to seek greener pasture in the developed countries,” observed Thandiwe Daka a widow and mother of four children.

She noticed that health workers in Zambia have not been fully motivated and that this has also affected their attitude towards work. “Some nurses are hostile torwards women especially in reporductive health where the numbers of women who die are quite high in Zambia,” said Thandiwe.

Many rural hospitals are headed by Clinical Officers and have been without doctors for a long time. For this reason Zambia is poised to develop a tele-health initiative in Africa that would ensure that the health system and health care is inter-connected via computers to cater for the ailing populous. Tele-health is simply the use of information technology to deliver health services and information from one location to another. The concept of tele-medicine is a multimedia system using voice, video and data to deliver medical services remotely.

But the new technology overcomes the limitations of the telephone and fax to ensure that patients are diagnosed from remote locations. Tele-medicine has its pros and cons though it meets government needs for bringing health care as close to the family as possible, the need for medical workers will also diminish. It has the potential to bridge the gaps created by Africa’s brain drain as health professionals seek greener pastures in developed nations.

Challenges in integrating Information Communication Technologies (ICTs) in the health sector outlined in the National ICT Policy include the need to improve ICT infrastructure to support basic communication systems and specialised applications such as tele-medicines.

Inadequate ICT awareness and skills among health professionals to effectively utilise the ICT tools and services, inadequate support services for installed ICT equipment especially in rural areas and incorporating and priotising ICT in the core business of health care delivery are all challenges to e-health delivery.

The National ICT Policy states that the potential of ICT in contributing to the effective performance of the health sector is very high especially in remote diagnosis and treatment.

It sees timely collection, management and dissemination of critical information has significant bearing on the performance of the sector in general and to this extent, the health sector has embarked on reforms that include development of health management information systems at various levels.

Equally important is the Telemedicine programme being initiated as a deliberate effort to maximise the services provided by the few but highly experienced medical personnel whose services can only be extended through technologies such as Telemedicine. Therefore, connectivity of medical institutions to services such as telecommunication and Internet is an important milestone in the use of ICTs in the health sector.

Telemedicine also can be used to provide both basic and continuous skills transfer to health professionals. This would help mitigate isolation of health professionals in rural areas. The dissemination of medical information through ICTs will facilitate informed decision- making particularly in hard to reach areas.

To improve access to quality healthcare as close to the family as possible through the deployment and exploitation of ICTs and other modern technologies, the Government of Zambia is committed to invest in ICT based healthcare systems to increase the opportunity for Zambians to have access to adequate and appropriate modern health services irrespective of time, distance and location.

The Government shall also facilitate the development and implementation of a national telemedicine programme to efficiently and effectively utilise scare human resources and to further improve human capacity in the healthcare delivery system.

The Government shall also partner with private sector and civil society in the development and utilisation of ICTs in the health sector and develop a legal regulatory and ethical framework for effective use of the Health information and implement security measures to safe guard the privacy of patient information inherent in health care records. The Government will also mainstream ICTs in the management and treatment of HIV/AIDS and other pandemics.
In 2001, African leaders meeting in Abuja committed themselves to dedicating 15% of their countries' annual bugdets on the health sector. This emcompasses training of more health workers to counteract the current shortages of medics in Africa. Unfortunetly, six years down the line, the committment remains under the ceiling.
The World Health Organisation (WHO) report for 2006 states that although there is universal health worker shortage, it underlines that Africa is the only continent where the total number of health worker shortages(817,992) exceeds the existing number of health care workers(590,198). Consequently Africa has more health workers working outside Africa than any other continent.

Meanwhile, a Lusaka Citizen noticed that, while all this brain drain is still happening, Zambians continues to die from many diseases that can be prevented, managed and treated. How can our government account for the deaths of thousands of its people when health is not a core priority? Asked Thom Mayowe.

Figures from WHO indicate that an estimated 40 million Africans have died from health related conditions. A failure to reverse the health worker shortages within the next 4 to 6 years means that all of Africa's 2010 Universal Access targets for prevention, treatment and care for HIV/Aids, tuberculosis and malaria will not be met. Could we then say that brain drain is also caused by lack of developed countries to train their workers?