Paul Hunt: 'This perverse healthcare subsidy flows from poor to rich countries'

From a presentation by the United Nations Special Rapporteur on the right to health care, given to the General Assembly, in New York

The skills drain phenomenon in health care is experienced differently in different countries. Some 30-50 per cent of health graduates leave South Africa for the US or UK each year. In 1999, Ghana lost more nurses than it trained. During the 1990s, two-thirds of Jamaica's nurses left the country permanently.

Migration of this sort is like a haemorrhage on a health system, making it more difficult for developing countries of origin to deliver the right to health to those within their jurisdiction. It imposes substantial economic and social costs on developing countries, while saving developed countries significant training costs. The economic name for this process is a "subsidy". The subsidy is perverse because it flows from poor to rich countries.

The skills drain may have some positive effects, including for developing countries. In some cases, for example, migrants' remittances make a major contribution to the economies of countries of origin. But even when this occurs, it does not mean that the remitted funds are invested in those countries' health systems

It is disingenuous for developed countries to provide overseas development assistance, debt relief and so on for developing countries, while simultaneously hiring health professionals who have been trained at the expense of, and are desperately needed in, developing countries of origin. What is the point of giving with one hand and taking with the other?

In today's world, there is a shocking inequality in levels of health care and protection. In rich countries, life expectancy approaches 80 years; in some of the poorest it is below 40 years. In Sweden, the death rate of children under five years is 0.3 per cent; in Sierra Leone it is 28 per cent. A woman in sub-Saharan Africa faces a 1 in 16 risk of dying during pregnancy or childbirth, as compared to a 1 in almost 3,000 risk in the developed world.

The skills drain deepens this global health inequality. Policies that are intended to tackle the skills drain must address, in a systematic and co-ordinated way, global health inequality.