Employees at the Ministry of Health in Malawi say two factors have caused the sharp rise in MMR – HIV, which infects 14 per cent of the population, and brain drain, the exodus of healthcare workers, particularly nurses, to western countries. The exodus has ramifications for other areas in healthcare, in child mortality, HIV and general healthcare. One hospital in Mangochi district has a catchment population of almost 800,000. It has a staff of one doctor, 40 nurses and 13 clinical officers (medics who work as de facto doctors).
Doctors at Malawi's Ministry of Health acknowledge the right of medics to seek work in the west, but they speak angrily about the West's facilitation of this. They condemn private health companies who operate in the west for recruiting nurses in swathes, and they speak equally critically of the governments who grant work permits to African medics, whether private and public.
Ireland is not without blame. Almost 800 African nurses work in Ireland. About 550 of these were trained in African countries. A study on the emigration of African medics says that for every nurse that emigrates, the country loses about €220k in returns for investment in training. For doctors, €330k is lost.
The Philippines is also affected by brain drain. About 85 per cent (164,000) nurses trained in the Philippines work outside the country; 100,000 left in the last decade. This includes 4,000 doctors who retrained as nurses in order to emigrate. The attraction is greater pay. But while foreign remittances account for about 13 per cent of the Philippines' GDP, hospitals are closing down because of a lack of doctors and nurses. The HSE employs 4,087 Filipino nurses who trained in the Philippines.