This Week's News 27-31 July 2009

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UN Urges Free Flow of Labour on Continent
Business Day, SA

28/07/2009

Johannesburg — UNLESS African states start embracing labour migration by enacting laws that will enable the free flow of skills and talent, the African Union's (AU's) facilitation of regional economic co-operation and integration will remain a pipe dream, a United Nations Economic Commission for Africa (Uneca) expert has said.
Economist Dr Janvier Nkurunziza, was part of the team that researched and compiled the Economic Development in Africa Report 2009. He said the restrictions on labour migration imposed by many African states were slowing down the pace of regional economic development in Africa.
Yet countries such as SA, Nigeria and Côte d'Ivoire had thriving economies built largely on labour migration.
He said countries that experienced labour migration to neighbouring states decried the brain drain, the erosion of family values, and were not comfortable with raising the issue of the abuse of their citizens, such as the xenophobic attacks experienced by Zimbabweans and Mozambicans in SA recently.
On the other hand, those receiving the labour migrants often expressed concern that migrants competed with locals for employment and depressed wages by working for low pay. They also cited security and other social and cultural integration dynamics that affected education and health infrastructure.
Considering the levels of political instability plaguing the continent in the past decades, no amount of restrictive legislation had been able to contain migration motivated by economic, social and political pressures back home.
Nkurunziza told Business Day that research had shown that at least 69% of African migrants remained on the continent. However, the media had often reported "tragic incidents of migrants drowning in boats" on their way to Europe and elsewhere and "wrongly assumed that most migrants are headed for shores beyond the continent".
The United Nations estimated there were 191-million migrants worldwide in 2005, of which 17-million were widely distributed in Africa, representing 1,9% of the African population. The top five countries that received about 40% of the migrants were Côte d'Ivoire (2,4- million), Ghana (1,7-million), SA (1,1- million), Nigeria (1-million) and Tanzania (0,8-million).
Nkurunziza said member states were still battling with negative perceptions of labour migration instead of urgently honouring the Abuja Treaty of 1991, which established the continent's five economic regions and called on countries to adopt employment policies that would allow the free movement of people. This was considered essential for the promotion of regional co-operation and integration.
He said the treaty entailed the strengthening and establishment of labour exchanges in a bid to assist the employment of skilled manpower of one member state in another member state. Such a move would mark an important milestone in the promotion of regional co-operation and integration on the continent.
The AU had been working for months on a comprehensive pan- African migration strategy that would ensure the maximum benefits of migration to countries that will be exporting the skills and talent.
Nkurunziza argued that if well managed, enacting easier labour migration would enhance co-operation in the Nepad (New Partnership for Africa's Development) trade and investment development initiatives of regional economic communities. "Migration brings remittances and facilitates the creation of business and trade networks," he said.
According to World Bank estimates for 2007, African countries received 6,8% (23,1bn) of total global remittances of 337bn. Although north African countries received more remittances than sub-Saharan countries, the size of remittances in smaller states was significant relative to their gross domestic product (GDP), such as in Lesotho (28% of GDP in 2007).
Nkurunziza said countries that received migrants would go a long way to fill the required human resource and skills gap in key sectors of the economy as well as the social system. "Migration in Africa is real, and African leaders themselves know the importance of addressing this issue at the regional level.
"It is imperative to build on the existing initiatives on facilitating labour mobility and migration management already laid out in various regional economic communities and other consultative forums," Nkurunziza said.
The move would boost the qualifications and competencies of African labour and elevate it to international renown. This African pool of talent would likewise serve as attractions for the entry of foreign investments, including outsource services.

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Brain Drain Hurting Country
Daily Nation, Kenya

27/07/2009

Nairobi — Prime Minister Raila Odinga has called on professionals trained locally to commit a fraction of their careers to serving the country after training before they go abroad for greener pastures if they must.
The PM said the government is not opposed to Kenyans seeking greener pastures abroad saying the immigrants contribute to the economy through remittances but there should be a balance.
"We need some amount of service from our citizens to our country after we have trained them. We need to strike a balance that ensure our services do not suffer and that we pay back to our country after it has trained us before we can fly abroad for greener pastures. That is not asking for too much," the PM said.
The PM decried the losses the country is incurring through migration of intellectuals and professionals to greener pastures abroad.
He attributed the brain drain to lack of high caliber research institutions that would enable intellectuals keep abreast with the latest developments in their fields.
He said the government has spelt out measures to respond to this in its Vision 2030, but called for a strong involvement of the private sector.
Mr Odinga was speaking when he met The Aga Khan, the spiritual leader of Ismaili Muslims, who called at his office on Monday.
The Prime Minister said that the government is keen to make Kenya the regional hub for medical services.
"The government spends a lot of money to train just one doctor. Yet those doctors leave almost immediately for greener pastures abroad, leaving us exposed. It is a trend we must reverse," the PM said.
"A good number of the intellectuals leaving the country are not driven by desire for money. Many are disappointed by the lack of research facilities that could enable them further their knowledge, be at par with their counterparts abroad and gain intellectual satisfaction from their work," he added.
He said the government is addressing the problem by sourcing funds for the Ministry of Higher Education, Research and Technology.
The PM said that because of absence of adequate research facilities, Kenya currently spends a lot of money taking patients abroad, where in some cases they are treated by Kenyans who fled to greener pastures.
The Aga Khan said he is keen to help Kenya attain higher standards in provision of healthcare and training of health workers.
He said his network is keen to put up an institution for training of more doctors and nurses at graduate and post graduate level, and to provide research facilities to keep the professionals around.
The Aga Khan said that currently, Kenya and India are the highest suppliers of doctors and nurses to the developed world, a situation he said is unfortunate.
"We must provide sufficient reasons to make the doctors see the need to remain here. We need institutions with best practices. We suffer brain drain because we have no institutions that thrive on best practices.

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State Eases Conditions to Hire Medics
The Citizen, Tanzania

27/07/2009

The government has eased conditions for hiring public health workers to curb staff shortage.
The deputy minister for Health and Social Welfare, Dr Aisha Kigoda told the Parliament in Dodoma yesterday that the nation was currently short of public health workers by a staggering 62 per cent.
The plan would see graduates from medical training colleges hired directly and rushed to places where they were needed the most without being interviewed, Dr Kigoda said .
The Government has also expanded training for medical personnel and carried out improvements and expansion of the colleges to cope with the increased needs, she said.
She said the government hired 11,709 skilled health care workers between January, 2006 and March, 2009 and increased enrolment to medical schools from 1,013 students in 2005/06 to 3,831 students in 2008/09.
Dr Kigoda also said the government will review the existing curriculum in order to reduce the time taken to train para-medics from three to two years without compromising quality.
Responding to questions asked by MPs, Ambassador Abdi Mshangama, Sijapata Mkayamba and John Malecela, Dr Kigoda assured them that the measures would fast track availability of skilled manpower within a short time.
He urged municipal councils to incorporate into their annual budgets funds for hiring medical personnel according to levels of demand.

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Uganda: U.S.$218 Million to Improve Health And Education
The East African, Kenya

27/07/2009

Bernard Busuulwa
Nairobi — Uganda will receive Euros 175 million ($218 million; about Ush511 billion) budgetary support from the European Commission for the next six years.
This will help the country achieve Millennium Development Goals, particularly on education and health.
The aid will be provided under the MDG contract -- a new European Commission (EC) budget support instrument to benefit small developing countries that have had remarkable progress in fighting poverty and maintaining economic stability.
The EC says Uganda has reduced the number of poor people from more than half of the population in 1992 to less than a third in 2006, making it eligible for the MDG contract. Only eight other countries in the developing world have done so.
The facility provides for policy dialogue and verification of aid conditions and payments between donors and recipient countries under the joint budget support framework.
Policy dialogue will focus on reforms in public financial management, macro economic policy and poverty reduction.
The support hopes to improve the quality of education and health services in Uganda through reduction of teacher absenteeism and increased supply of drugs to medical centres.
It covers the period 2008/09 to 2013/14 and hopes to alleviate weaknesses in Uganda's efforts to attaining MDGs while minimising operational costs.
"The money will be spent under local procedures. The European Union (EU) wants to reduce transaction costs by limiting eligibility procedures,' said Ambassador Vicent de Visscher, Head of EU's delegation in Uganda.
The EC has disbursed the first portion of the fund -- 30 million euros (Ush87 billion) in line with its pledge of predictable donor funding.
Poor working conditions, mainly reflected in low salaries and lack of teaching materials, have undermined the quality of education offered in many government-owned schools.
This is despite the government's efforts to increase access to education under the Universal Primary Education and Universal Secondary Education programmes.
Primary school enrolment in Uganda is currently estimated at 7.5 million pupils while the net enrolment ratio is 93.3 per cent.
Secondary school enrolment, on the other hand, is estimated at 452,137 students, of whom 255,324 are male. Government schools account for 70 per cent of the enrolment.
The health sector has experienced consistent increases in budget allocation recently, but it is plagued with many hurdles, among them limited supply of drugs to health centres, low staffing levels and lack of sufficient accommodation for medical staff.
This has affected the quality of services offered.
The sector received Ush628 billion ($318.8 million) in 2008/09, compared with Ush428 billion ($217.3 million) in 2007/08. There has been a further increase in the current financial year.
To redress these problem, the government has intensified efforts to equip health centres with theatre facilities, ultra sound scanners and generators.
But concerns about accountability in utilising donor money still persist.
"Uganda's structures of accountability are good, but there is need for follow-up on recommendations made. For instance, the Auditor General's recommendations should be implemented," said Jeroen Verhegl, Dutch Ambassador to Uganda.

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Govt in Drive to Lure Back Health Professionals
The Standard, Zimbabwe

11/07/2009

Nkululeko Sibanda
Bulawayo — Government intends to lure back senior health professionals who migrated to Botswana, South Africa, Lesotho, and Swaziland in a bid to beef up staffing levels at overstretched health institutions.
Dr Henry Madzorera, the Minister of Health and Child Welfare announced the plan last week as he bemoaned the fact that the inclusive government was still struggling to attract returning health professionals six months after the formation of the unity government.
Madzorera said although a significant number of nurses and other low-level staff had returned during the past few months, the situation remained critical.
He said 50% of the posts for highly qualified staff still remained vacant.
"We have specifically registered nurses and other general hand staff and the greatest challenge at the moment is that of doctors and other highly-qualified personnel," he said.
"We have a serious task ahead of us. That is why we are now planning to go to our neighbours and convince those Zimbabweans working there to come back home and work in the country's health sector," he added.
Madzorera said his ministry would build houses and provide health personnel with easy access to clean water, electricity, and proper ablution facilities in an effort to retain qualified staff.
"We also want to address the issue of dilapidated infrastructure at our hospitals. We have come across situations where some buildings are collapsing while others need a facelift.
"We are currently engaging donors to solicit for funding of these developments that will seek to bring back the proper service provision at our hospitals."
The ministry would also prioritise the provision of blankets and other essentials at hospitals.
"We are trying by all means to put back Zimbabwe in its rightful place in the health sector as compared to other countries.
"If we are able to get the money from the donors, we believe as a government, nothing will stop us from achieving this feat," Madzorera said.
Health professionals receive allowances from donors on top of the US$100 a month that government has been paying civil servants since February.

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Doctors' Strike Thanks to Health Department Incompetence
Health-e, SA

30/07/2009

Anso Thom

OPINION
The crisis that led to doctors downing their stethoscopes recently was not created in the last two months. This calamity was created over at least 18 months after almost a decade of neglect by former health Minister Manto Tshabalala Msimang.

The role of Director General, Thami Mseleku, and particularly his Deputy Director General for Human Resources, Percy Mahlati, need to be investigated in connection with the poor handling, confusion and delays in implementing the present occupational specific dispensation (OSD) for doctors, dentists, pharmacists and emergency medical personnel
Unfortunately the current OSD has turned into a scramble for salary hikes and the intentions of the 2007 agreement with labour have been all but lost. There is such a stand-off between the parties that there is little sanity or rational thinking remaining
The Public Service Coordinating Bargaining Council's Resolution 1 of 2007 states clearly that the objectives of the OSD were to provide a basis for the annual salary adjustments for employees for 2007/8 and 2008/9. In addition, its aim was to introduce revised salary structures for identified occupations that cater for career-pathing, pay progression, grade progression, seniority and increased competencies and performance with a view to attracting and retaining professionals and other specialists, as well as to review the non-pensionable allowances payable in the public sector.
Experts agree that the intentions of the OSD are brilliant. But it is very complex and the implementation of the OSD for nurses after the 2007 strike was so badly managed that the nurses' OSD is now the subject of at least three labour court cases and is far from settled.
It also cost the State vastly more than was projected when the package was designed. Questions are being asked whether the form in which OSD has been moulded is affordable and sustainable. The complexity lies in the fact that, unless it is very tightly defined, the OSD is open to varying interpretations and disputes.
The disaster which has revealed itself in the present strike has been coming for a long time. Mseleku and Mahlati were content to allow the same chaos that was prevalent during the nurses' OSD implementation to taint the execution of OSD for doctors and other professionals.
All indications are that the nurses' OSD was implemented blindly with no proper information available to make sure we could handle the full impact of the new structure, very little or no leadership was given to provinces on how to implement the OSD and provinces were given no guidelines on how to deal with unusual cases.
The Department of Public Service and Administration (DPSA) now needs to make good on their promise to investigate what went wrong with the implementation of OSD for nurses and hold accountable those officials from the health department, DPSA itself and Treasury if need be.
The same investigation must now be extended to the doctor debacle. The investigation needs to explain why there has been a 12-month delay in implementing the OSD for doctors and who needs to be held accountable. It also needs to look at how the implementation of OSD for nurses was allowed to happen without anybody at the National Health Department (specifically Mahlati and Mseleku) fulfilling a proper and meaningful oversight role.
Indications are that former Health Minister Manto Tshabalala-Msimang failed to properly take a lead on improving human resources for health in South Africa and she did not provide the requisite oversight on implementing the nurse OSD. In short the OSD for nurses, doctors, dentists, pharmacists and emergency medical personnel has been such a mess that heads need to roll.
The OSD for nurses was implemented with little proper information, modelling or detailed financial projections. It allowed for too much interpretation which is counter to the intention of creating a national standard career path for each profession. Different sets of data were used by different officials which meant that it was impossible to cost the nurses' OSD properly or to exercise some control or oversight over the implementation in nine provinces.
Provinces, anxious and distressed about being left in limbo while haemorrhaging staff, implemented the nurse OSD in varying degrees of effectiveness and consistency. However it has cost a great deal more than what was projected and budgeted for and while the national health department is trying to blame Treasury or other departments it must take responsibility for what transpired.
In order to prevent a recurrence of the first OSD financial disaster, one of the first things Tshabalala-Msimang's interim successor, Barbara Hogan, did when she took office was to order that proper oversight be put in place for the implementation of OSD for doctors. Data on each individual doctor was collated to generate projections of the financial implications centrally. Missing information had to be found or explained to ensure that there were no surprises when the final offer was made to labour.
However, all this happened when the horse had already bolted and health workers were fed up, tired of being told to wait only to be presented in the end with a package which they felt did not meet their expectations.
Health Minister Aaron Motsoaledi has had a baptism of fire. He has had to grapple with the complexities of a looming yet controversial national health insurance plan, and took office with a doctor strike looming. Not only has there been a delay in the implementation of OSD, but working conditions, which have deteriorated rapidly under the watch of Tshabalala-Msimang and Mseleku have raised the ire of the remaining public health professionals.
Motsoaledi has gone the extra mile to try and secure a fair wage package for doctors. He has insisted that the OSD should not perpetuate inequities of the past but should simultaneously remedy the massive inequities that exist not only between the provinces, but also within provinces.
During the costing of individual OSD implications, it was evident that there are many cases of doctors doing the same job, but working at different hospitals even within the same province, being paid vastly different salaries. So, while some doctors may feel that the proposed salaries are disappointing and do not amount to the claimed increases of around 60%, in some cases, for those doctors who have been comparatively under-remunerated, a 60 % increase is indeed a reality.
Furthermore, recognising that interns and community service doctors are the backbone of the public health system, Motsoaledi has opted to focus on addressing these junior staffs' paltry salaries.
The other focus in the first year of the OSD implementation is on Registrars or specialists undergoing their formal training and on the Principal and Chief Specialists (many of whom are university professors) who train them and who need to be retained.
One can understand that the medical officers might feel hard done by, but many are arguing that their salary package of R330 000 to R530 000 (before overtime) is fair.
Doctors have also argued that Motsoaledi lied when he announced the new salary packages as they claimed that he had merely collapsed allowance such as scarce skills allowance, medical aid, pension and overtime into the revised salary packages. It is correct that these allowances are now included in the overall total packages on offer, but this is in line with the terms negotiated as part of the 2007 OSD agreement.
The frustration among health workers is understandable. For many years they have been dealing with an antagonistic employer (health department) which has often targeted doctors who have tried to raise their grievances about poor working conditions.
For too long, health workers have dealt with the fall-out due to a lack of leadership from the national health department.
Motsoaledi is making all the right noises and he was very frank in his budget speech about some of the factors contributing to the problems in the health system, such as:
•Lack of managerial skills within health institutions;

•Failure to cut on identified deficiencies;

•Delayed response to quality improvement requirements;

•Unsatisfactory maintenance and repair services;

•Poor technological management;

•Poor supply chain management;

•Inability of individuals to take responsibility for their actions;

•Poor disciplinary procedures and corruption;

Significant problems in clinical areas related to training and poor attitude of staff; Inadequate staffing levels in all areas
He adds that some of these issues will be dealt with urgently and has committed himself to facing the challenges head on. While we know that it is easy to make promises, it would be only fair to give Motsoaledi an opportunity to prove himself.
He faces a daunting task, not only to deal with the ever increasing burden of disease, but also to try and repair a public health system that has collapsed on many levels coupled with the fact that many of his senior officials lack the ability to build trust across health professions. Perhaps, urgent restructuring of the health department is needed so that senior management is made up of experts in health and management, not just political appointments.

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