African governments are subsidising health systems in the UK, the US and other developed countries because many of their nurses are migrating for better pay and working conditions. According to a long report in the New York Times, almost two-thirds of the nursing jobs in Malawi’s public health system are vacant. More registered nurses have left to work overseas in the past four years than the 336 who remain in the public hospitals to care for the country’s 11.6 million people.

According to a recent report by Physicians for Human Rights, about 75% of the countries in sub-Saharan Africa fall short of the World Health Organisation’s standard of 20 doctors per 100,000 people. Zambia’s public sector has retained only 50 of the 600 doctors who were trained its medical school between 1978 and 1999. Seventeen countries do not even have half of the WHO minimum standard for nurses, 100 per 100,000 people. Conditions for nurses in many countries are appalling. Thousands are leaving the profession or have died of AIDS. In Malawi, a quarter of public health workers, including nurses, will probably be dead, mostly from AIDS and TB, by 2009, according to a study of worker death rates.

Unsurprisingly, African nurses are flocking to Britain, where the government is under pressure to improve health care. Since 1998, 12,115 African nurses have registered to work in Britain. Many of these begin by working in nursing homes and then move into the National Health Service. An expatriate British doctor working for the Malawi Health Ministry, Anthony Harries, says that it is immoral for Britain to allow Malawi nurses to migrate so easily. "Come on," he says. "Train your own unemployed people."

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