Malawi: 'Brain Drain' in Health System Continues Unabated

Most nurses who have left Malawi have immigrated to the United Kingdom (UK), offering that country their services in the past. But now the United States of America (US) is fast becoming another attractive destination after many nurses are having an extension to their working visa being rejected in the UK, even after having worked there for nearly 5 years.

The American Hospital Association has reported that the US last year needed an extra 118,000 nurses, a demand that will rise to 800,000 by 2020. In order to cater for this shortage a little un-noticed provision in the Immigration Bill is expected to be used. This could intensify the drain of nurses from the developing world.


Reaction has been swift and filled with outrage with Physicians for Human Rights (PHR), a US advocacy group saying that this provision could undermine the multi-billion dollar effort by the US to combat AIDS and Malaria by potentially worsening the already existing shortage of health workers in poor countries like Malawi.

"We're pouring water in a bucket with a hole in it, and we (US) drilled the hole," declared Holly Burkhalter from PHR when the proposals were first made.

There is no doubt, the public health sector in Malawi is already badly hit by the "Brain Drain" in the large exodus of medical professional personnel leaving the country for greener pastures in the developed world.

It has been reported that over the past five years 52% of health administrators, 64% nurses and 85% physicians have left the government health system either to join private medical providers, join other NGOs or have left the country to join overseas health systems.

Freda* has just come off her night shift in one of the largest referral hospital in Lilongwe, Kamuzu Central Hospital (KCH). Working on the Female General Ward 2A had been totally exhausting for her, and if it were not for the patients' guardians helping her during the night, some of the patients would have been left unattended for long periods while she paid attention to the patients that required immediate attention.

The ward has 31 beds with an overflow of patients sleeping on the floor and on the verandah with an estimate of 38 patients to care for. Freda has one auxiliary nurse to help her. Sitting on a chair and looking more like she has been running a marathon, Freda says she is fast burning out and after working at the hospital, she barely has the energy to take care of her family.

"I have been working for many years as a nurse and at one time we were many on the ward and we were all working as a team.The burden of caring for patients was shared; we were even able to take time to have a cup of tea."

She says it is difficult to take a break without feeling as though there are more important things she should be doing.

"You feel as if it is time wasted if you stop; and even if guardians are many and disturb you when you have to give special care to a patient, we can not do otherwise since they do help in caring for their relatives because the nurse patient ratio is so bad."

She says when she became a nurse it was never her intention to work in any other organization but one of the major hospitals in the country.

Asked if she would consider leaving the country to join the medical profession overseas, Freda says now she would indeed consider it: "Before, I would have problems but now, even although nursing my own people is my passion, I feel that I am not able to give my best because I have to care for so many patients at one time. How can I give my best?" she asked adding, "besides, I have heard that very good working conditions and higher salaries have benefited many of my colleagues. Maybe it is time to look somewhere else for a job that will benefit me and my family."

Is Freda about to become a "Brain Drain" statistic in Malawi?

Recent media reports on the Senate Immigration Bill with a small but significant provision that will make it possible for an unlimited number of health care workers and their immidiate family to live and work in America makes the US another possible destination for nurses from Malawi. The Senate Bill 2611 already passed by the Senate Judiciary Committee will make it possible for more foreign nurses to live and work in the US.

The provision is intended to assist the US government fill the gap of a shortage of nursing staff needed for their health system.

At present the US has 500 special visas for nurses each year that makes it possible for nurses and their immediate family members to get a green card and live in the US.

The possibility of recruiting foreign nurses to cater for the needs of the US has drawn some negative responses from experts from within the US and Africa who have been following the situation of the "Brain Drain" from the African continent