In the Mavalane district in Mozambique, patients with HIV have been forced to wait up to two months to start treatment—not because of a dearth of drugs but because of a lack of doctors and nurse clinicians to administer them. During the wait, many of the patients have died, reports Doctors Without Borders.

Long a simmering crisis, the lack of health workers in sub-Saharan Africa has reached a boiling point as the continent now bears 25 percent of the world’s disease burden but has only 3 percent of the world’s health workers. Mozambique, one of the sub-Saharan Africa countries hardest hit by the shortage, has a physician-to-population ratio of just 0.03 for every 1,000, compared with 2.56 in the United States—or 85 times more physicians per population. Many factors account for this alarming disparity, including an insufficient number of medical schools and training programs in the region.

But in the last few months, international health policy experts have redoubled efforts to offset one of the more troubling causes of the problem: the active recruitment of health workers by wealthier countries. In a recent year, for instance, Ghana trained 70 new doctors but saw another 64 go overseas, says Peggy Clark, managing director of New York City-based humanitarian organization Realizing Rights. 

Among the efforts, Clark’s group is working with the World Health Organization and others to develop a code of practice by next year that would help low- and high-income countries work together to better manage the flow of workers through bilateral agreements. On the table are measures to encourage wealthier countries to help strengthen medical training programs in poorer countries, as well as boosting the training of workers in rich nations. While health workers have the right to emigrate in search of a better life, “we need to look at incentives to get health workers to stay [in their home countries] and to decrease the push factors,” says Clark, who co-authored a piece on the issue with former President of Ireland Mary Robinson in the February 23 edition of The Lancet.

In the same Lancet issue, AIDS expert Dr. Edward J. Mills suggests a tougher approach, arguing that enforceable regulation is needed to stop for-profit recruiting companies from “enticing” workers away from countries already in desperate need of medical professionals. This recruitment by nations including Australia, Canada, Saudi Arabia, the United Kingdom, the United Arab Emirates, and the U.S. violates existing international laws and treaties, as it creates social alarm in resource-poor countries, among other ill effects, argues Mills of the British Columbia Centre for Excellence in HIV/AIDS. “If we fundamentally believe people have a right to healthcare, we have to stop the systematic recruitment by” wealthy countries, he says.

Particularly noxious, says Mills, are high-pressure tactics used by certain Western recruitment agencies, such as holding workshops on opportunities abroad in which health workers are forced to decide to stay or go before leaving the session. Other agencies, including Australia’s Allied Health and O’Grady Peyton International in the U.S. and U.K., have established offices in South Africa to facilitate recruitment, Mill says. O’Grady Peyton spokesman Phil Miller says the company has since closed its South Africa office and is phasing out recruitment from Africa “to focus on countries that have an excess capacity of nurses or which may be less affected by the international migration of labor.”

In addition to discouraging recruiting, Mills says developed countries should compensate less-developed nations for their lost health workers. Citing a 2004 study, Mills in the article notes Ghana alone has lost about £35 million ($69 million) of its health professional training investment to the U.K. Meantime, the U.K. saved some £65 million in training costs between 1998 and 2002 by recruiting doctors from Ghana. “Some doctors in these countries are seeing 300 patients a day compared with 24 a day for a doctor in Canada,” says Mills. “They have been exposed to violence. When a recruiting company says you can make 10 times your salary somewhere else, you can understand why they consider it.”

With Mills and others saying healthcare worker migration is rising, the task of reducing the big gaps in working conditions between source and destination countries won’t be easy. But the health of sub-Saharan Africa, and the world, may depend on it.