The Exodus of Health Personnel

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By Henry Kyambalesa

A mock operation by doctors from the University Teaching Hospital

I wish to comment on the statement made in Parliament recently by Health Minister Kapembwa Simbao about the extension of a Medical Retention Scheme to nurses and paramedics—a scheme which currently provides medical doctors with such incentives as further training outside the country, new vehicles and school fees for their children.

This is a progressive idea for a country that has been losing significant numbers of locally trained health personnel through the brain drain.

However, the Medical Retention Scheme may not be adequate to curb the exodus of health personnel. The provision for new vehicles, for example, is really not an incentive to individuals who are keen on securing jobs in developed countries where their services would fetch adequate salaries and allowances which would make it possible for them to buy vehicles on their own. And formal education (from Grade 1 through Grade 12) in such countries is generally free!

The Scheme, however, is likely to give incentive to those who wish to emigrate to other developing countries in search of higher incomes, a better standard of living and/or a less-hostile environment, among a host of other reasons.

It is essential for the authorities to discern the causes of the brain drain in order to devise viable ways and means of curbing the phenomenon. There are currently many factors obtaining in Zambia which have contributed to the exodus of skilled talent. One of such factors relates to poor conditions of service, including inadequate wages, salaries and fringe benefits. The second factor pertains to human rights abuses and violations, including the violation of individuals’ freedom of speech, and the repudiation of freedom of the press.

many technical and professional personnel have decided to “vote with their feet” upon finding that the rewards of their labor in Zambia are generally measured on the basis of political patronage rather than excellence, and that corruption, nepotism, tribalism, and other similar forms of behavior have permeated every level of work life, particularly in the civil service.

Third, many technical and professional personnel have decided to “vote with their feet” upon finding that the rewards of their labor in Zambia are generally measured on the basis of political patronage rather than excellence, and that corruption, nepotism, tribalism, and other similar forms of behavior have permeated every level of work life, particularly in the civil service.

Fourthly, the common tendency among local and national leaders to scout for expatriate scientists, technologists and consultants from industrialized nations has made indigenous experts to feel disregarded, and has made many of them to migrate to countries where their qualifications are appreciated.

Fifth, the high interest rates, income taxes and value-added taxes in the country have, among other factors, adversely affected investment in new enterprises, and have consequently hampered the creation of jobs for streams of graduates from local schools, colleges and universities. And the government cannot absorb many locally trained citizens due to the lack of financial resources. In 2004, for example, about 9,000 trained teachers were roaming the streets as they anxiously awaited their postings to schools. In 2005, around 1,000 out of 7,000 needed teachers were employed through financial assistance rendered by the Netherlands.

Sixth, access to life-saving healthcare in Zambia today is seriously hampered by inadequate, dilapidated and antiquated healthcare facilities, among other things. In November 2005, for example, Ms. Inonge Wina secured “ox-cart ambulances” for the country’s Nalolo constituency during her tenure of office as MP for the constituency in order to curb maternity-related deaths occasioned by delays in the transportation of expecting mothers to healthcare centers. And, of course, we still remember First Lady Thandiwe Banda’s call in November 2009 for developing innovative transportation schemes like “bicycle ambulances” to help women reach health facilities from distant places!

And seventh, unprecedented and widespread poverty and unemployment in the country have made burglars, thieves and robbers more daring, thereby contributing to the emigration of skilled to safer countries. Besides, Zambian migrants who are resident in affluent countries, where there is generally greater safety and security, are fearful of becoming obvious targets of perpetrators of such crimes upon returning to their countries of origin.

Clearly, there is a need for policy initiatives designed to address the brain-drain problem because, without large pools of skilled professionals to facilitate and expedite the process of socio-economic development, Zambia will not likely attain meaningful levels of growth, development and competitiveness. Such initiatives could include the following:

(a) Tax proposals requiring native professionals trained through the public treasury to pay a certain percentage of their incomes earned abroad to the Zambian government;

(b) Generation of restrictive policies aimed at delaying emigration – such as by adding extra years to medical students’ training, requiring doctors and other professionals to stay on for a number of years to ‘pay back’ what they ‘owe’ to society, or to incorporate the delay within the training period, thus ensuring that certification follows rather than precedes a spell of public service;

(c) Taxation of the earnings of emigrants by the Zambian government, although this would depend largely on emigrants’ continued citizenship in their native country, Zambia;

(e) Initiation of international agreements requiring employers in foreign countries who may hire professionals trained through public resources to reimburse the Zambian government for financial and material resources committed to the training of the professionals; and

(f) Provision for attractive retention allowances, research grants for academic staff, car-ownership and home-ownership schemes, and adequate upward salary adjustments.

In this regard, Zambia will need new leaders with a desire to pursue radical, practical and comprehensive change designed to uplift our beloved country from the current socio-economic decay and backwardness. Superficial schemes like the Medical Retention Scheme are not likely to help the country in its quest to stem the exodus of technical and professional personnel. Only the creation of socio-economic conditions that will lead to a higher quality of life for all citizens will, by and large, mitigate the exodus of the country’s skilled personnel.

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27 COMMENTS

  1. Henry, people (medical personnel included) in diaspora leave Zambia for various reasons. For you to get conclusive reasons as to why they are in diaspora a research is required by interviewing or receiving reasons through the net as to why they are in diaspora and what will make them go back.

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  2. you rightly pointed out the various reasons for brain drain such as poor conditions of service, poor governance and poor public safety. none of these are of the poor health workers’ cause. in fact the health worker is the victim. when you suggested remedies i am supprised they are all aimed at making it difficult to migrate or taxing those who migrate in one way or another thus punishing the victim further. are you suggesting that health workers should stay and pepertually face suffering? come on suggest solutions which seek to remove the causes instead of victimising the victim further. we all wish to serve our country and while at it enjoy the fruits of our sweat.

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  3. The British realised a long time ago that they might need experts from the colonies at one point and that is why they made sure you all use English as the official language. It was not because you were so divided as not to agree on a language. That my friends is called foresight and to give you a reason not to trust each other was a very good trick. It is very easy for Doctors, Engineers and Nurses from Zambia, Malawi, Zimbabwe or Ghana to find work in the UK and other English speaking countries but more difficult for a Tanzanian, Eritrian, Libyan or Morocan. That is the first problem and the rest follow e.g the people that could have contributed to making the country better so that these people leaving now would have had a reason to stay after they graduate left earlier.

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  4. In short, we educate the people so that they get employed in the UK and US. They have to speak good English and we emphasise on that. That is a green light for them to work in any English speaking country, but this stems more from self hatred than anything else and the British saw this a long time ago. It has to be For Us By Us cause only from within may we trully shine!!

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  5. An interesting essay. High tax rates are identified as one of the reasons Zambian professionals vote with their feet and yet recommendation (a) (c) and (e) seek to confiscate earnings from Zambians in the diaspora for the account of GRZ. No ways bro! Let the circus finance itself.

    Suggestion (b) infringes on human rights, an issue raised elsewhere in the article. Wrong number.

    Doling out toffee sweets to professionals will not dent emigration. Zambia is battling for highly skilled workers with the rest of the world.

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  6. One day in a meeting one civil servant made a suggestion which fell on deaf ears to a politician. He said if the civil servant was given half rate in acquiring land from councils we would stay and we generally all agreed. Right now we all agree that the first thing that all diaspora do when they begin to earn real salaries is build a house back home. Please make it easier for me to build a home here. Why should two years abroad = to ten years in zambia to build a house. In short give us land easy we will stay.

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  7. very good points as usual, but i personally believe one problem us Zambians have is our lack of patriotism and pride, as zambians. When we visit other countries we admire what they have and wish and hope that one day Zambia can also thrive but Development doesn’t occur by wishing, you complain that it’s hard for a local to invest then find a foreigner to invest with. It’s not the money you send home but your brains that can develop Zambia.

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  8. Lee Nkandu,
    Very good points my fellow blogger..

    Of all the points from Henry Kyambalesa, poverty hits the nerve best, dilapidated infrastructures, poor focusing on major developmental issues etc..
    I would live and love to die in Zambia if the point in (f) was implemented. But as it is .. ni washala- washala and you only live once bane:-h:-h:-h~o)~o):)>-**==

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  9. Henry is speaking from research point of view and we don’t know what kind of research it was( double blinded or randomised or X-section). The best information can only be obtained from the professionals themselves now living in diaspora. Brain-drain is not only pathogmonic to Zambia but to other countries like USA, UK too. Hence, the term brain-drain has since changed to brain circulation. You cannot hold an educated person at gun point and say you need to live here and these are your conditions of service.
    Education makes one marketable and he/she will travel the world to see where his services are appreciated. All Zambia needs to do is to increase the production of professionals compared to the rate of professional hemorrhage. Then sustain a net balance of professionals.

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  10. This is a great summary on an important subject. Kyambalesa must have excerpted and adapted it from his lengthy article on the subject which Cho placed on his website (Zambian Economist) a couple of years ago. “In this regard, Zambia will need new leaders with a desire to pursue radical, practical and comprehensive change designed to uplift our beloved country from the current socio-economic decay and backwardness.” Well, people like Roger Chongwe and Godfrey Miyanda who seem to fit this category are not pushing themselves into the political arena.

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  11. Lee Nkandu your presumption that people are employed based on their english and origin is wrong. It is as if you are saying people from tanzania libya or morocco can’t get jobs because they cannot speak proper english. I don’t know where you get such a miguided notion, people are employed based on their skills and what they have to offer. I know of more moroccan and tanzanian professionals than Zambian professionals in the UK. The moroccan and tanzanian community in the UK have so many millionaires and companies in comparison with so called proper speaking zambians. Speaking english in a country where 99% speak english won’t get you special treatment, you will ending up kusuka mpoto if you are playing

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  12. You struggle to get your education and then someone wants you to struggle to feed yourself with a ka small salary all in the name of patriotism…..dream on!

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  13. I think Lee is right. Yo, Lee! I am with you man!
    We can’t accept Lozi/Tonga/Ngoni/Bemba for a national language but we easily find English to be very romantic and fitting. Forty-five years and we still don’t see anything wrong with it. Dials turn anti-logic in our heads, tulu!

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  14. I am with you the Legacy. Why on earth should I stick to poverty when God has opened doors somewhere else. They do not appreciate us in our own land so we go where they appreciate us and pay us well. Kwatha!

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  15. Impressive stuff and I would like t call your attention to Just to look at development news, the Daily Mail reported “[Outgoing US Ambassador to Zambia] Mr Booth, who has been in Zambia for 17 months, said the country should promote value addition investment… said the country should attract investment with mutual benefit to Zambians and investors… however, said Zambians should assess whether only foreign investment can develop the country.

    Value Addition must be our talk as a Nation more and more. This is progressive data that we should be able to discuss as opposed to the useless insults we read from our newspapers almost every day.

    Have a blessed day.
    _
    Matt 6: 33 But seek ye first the kingdom of God and His righteousness and all these things shall be added…

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  16. health workers retention scheme. we here this phrase time and time again from the mouths of our politicians but yet, the exodus of this cadre of citizens continues.
    questions that need to be answered, maybe your research expertize can help shed light of these Henry
    1. is this just political rethoric and this incentive does not exist
    2. or if it does, is it as rosy as it sounds
    3. what percentage of the health workers are actually benefiting from the said scheme

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  17. Globalisation applies to skilled workers as well. Government spends significant amounts of money training people only to let them go. HR practices need to be improved, you can’t treat ‘knowledge workers’ like labourers, guys have choices and will vote with their feet. wake up! What stops African Govts ‘poaching’ westerners on say one/two year voluntary assignments? Its not money we offer but meeting desires they have to ‘make a difference’ in poorer nations. Most people practice medicine because they care, govt must get this, only in Africa they use it to exploit their doctors. Govt can exploit this desire in westernenrs by providing facilities to attact such people. Do conferences in the west, see how many volunteers you’ll get. Israel has Kibutz, what do we have

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  18. The author identifies the problems well. He however loses himself when it comes to solutions.
    He has to realise that foreign states will only acquiess to treaties that are in their interest, & the west generally respects individual human rights. So if I pay tax in that country, there is no way that I’ll be paying tax in another. This is short sightedness of politicians. Value to a country comes in form of remittances we make back home – whom we remit to is our business. politicians shud keep their dirty fingers out of it! I’m medical, i worked for a good 5yrs after my MD, was treated like crap, late pay, long hours, minimal opportunities – thus paid back to the country those 5 yrs. When Leaders MISUSE the SPECIALIST EVACUATION created for when we had no local experts, to go to SA for…

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  19. …treatment for DYSENTRY & other simple ailments, does one honestly think this instills confidence in the medical professionals?? I commend Mubanga Kashoki, who REFUSED to be Evacuated, BUT OPTED for EQUIPMENT to be bought for his BRAIN OPERATION – that wasn’t just a stunt, it shows
    1] TRUST & CONFIDENCE 2] That EQUIPMENT IS NOW AVAILABLE FOR EVERY ZAMBIAN!!! – it speaks VOLUMES of the man, that in his hour of suffering, he still had a heart & forethought for his beloved mother land – has any politician stepped up to the plate, except for KK, who had established a presidential annexe at UTH.

    There are many counties in todays world whose income is solely dependent on their workforce abroad, they [email protected] victimise their citizens, they ENCOURAGE them & register them for a small token fee…

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  20. …to stay on such registers. These Govts have schemes in place encouraging HOMEWARD INVESTMENTS!! What we shud learn once & for all, is that, FORCING PEOPLE DOESN’T WORK!!
    PERSUATION is what works. Take BONUSES which brought the world economy to its knees, This was Money persuasion/incentive for bankers to promote & drive schemes that were unsustainable, & didn’t they do the job so well!! Even today inspite of all the talk, NO ONE HAS BANNED THE BONUSES!
    To improve zambia, attract home grown investment in whatever form, this will generate jobs, even if I employed 2 of my relatives in a small business, I would pay tax & my employees would pay tax too, that’s whats called widening the tax base!! This is how govt would earn it’s income, NOT BY STEALING MY HARD EARNED DOSH OUT HERE!!!!

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  21. Kyambalesa, for all the yrs you spent abroad, one would expect a better analyses when coming to the solutions.

    What is required is as follows:
    A] Stop hounding citizens, remove 5yr resident clause allowing one to stand for president!!
    B] Designate a dept in the Trade ministry dedicated to helping citizens abroad to invest – cutting out useless red-tape
    C] Be adventurous & innovative, introduce a tax rebate for companies set-up via this scheme, e.g for first 2 yr if it employs 20, etc etc
    D] Incentives, such as reserved land in the new tax free zones for investorsin the scheme
    E] A board of representatives to run the scheme with the ministry.

    Remember, Rome was not built in a day, small incentives over time, will slowly win confidence of the diaspora to look back at home &…

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  22. …..fuel the desire to come back home, as home will always be home, whether stripped of our citizenship or not!

    Together we can build a better place we call home!!!

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  23. it is very depressing to work in Zambia with the salaries our government offers,it has led to many civil servants being plunderers.

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  24. Its because people like Henry and their thinking that people run away from zambia. you want to TAX people working abroad? So more money is poured into an already inefficient government, hard earned money? NO WAY my brother! youve got such large b a l l s . And increase training years? How old are you henry? did you finish secondary school? Why not make it like burma or some other dictatorship where by we just shoot the doctors if they try to run away, the rest will fear and stay and everyone will beneffit right? thats your brand of thinking you s t u p i d i d i o t .

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  25. oh yeah, a bit on retention scheme, its more a scam, the cars are SECOND hand and OLD, and the docs get them on LOANS that they have to pay out of their SMALL SALARIES. further training abroad DOES NOT EXIST, its sporadic and frought with corruption and nepotism. Guys studying abroad anywhere have to SPONSER THEMSELVES.
    Secondly its REALLY HARD to get out of zambia even if your a proffessional (in any field), one has to try VERY hard, so these guys are SUPER FRUSTRATED who manage to run away.
    Thirdly zambia wont develop without a RADICAL CHANGE in approaching this whole problem. Like ndapapa ine said, GO RESEAERCH the problem, you wanna really know WHAT IT TAKES to SOLVE???? Usobela mwana…

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