Franklyn Lisk CSGR, University of Warwick

1. The Potential of African Diaspora Professional Organizations in Europe for Bridging Human Resources for Health ‘Needs Gap’ in Sub-Saharan Africa Countries Franklyn Lisk CSGR, University of Warwick

2. Diaspora and Development: Transnational Movement of People and Resources • Increasing interest in diasporas’ role in development in Sub-Saharan Africa (SSA) • Direct and personal involvement of diaspora members in development initiatives in homeland / country of origin • Positive connections between diasporas and development • Networks of cultural, economic, social and political relations • A better and cost-effective option for delivery of development assistance?

3. Diaspora and Development: Areas of Engagement • Basic Social Services (health, education, water and sanitation) • Commercial activities (trade and export promotion) • Infrastructure (residential and community buildings, access roads

4. Diaspora and Development: Types of Engagement • Transfer of financial ( remittances) and material resources • Transfer of knowledge, experience and contribution to capacity development • Raising awareness about global, regional and national development issues and practices • Influencing public policy through advocacy and personal contacts in homeland government • Collaborative research • Facilitating foreign direct investment • Collaborating with donor and development agencies in host country and with multilateral organisations

5. Diaspora and Human Resources for Health (HRH): The Origin and Nature of the Problem • Migration of health professionals from SSA countries to Europe, North America and Australia – African ‘Brain Drain’ and colossal loss of investment in expensively-trained human capital; developed countries ‘free-riding’ on the education and training efforts of source countries. • Massive health worker shortages (physicians, nurses and medical technicians) in the many SSA countries such as Gambia, Sierra Leone, Liberia, Ethiopia, Mauritius, Zambia, Zimbabwe, Malawi, Uganda, Nigeria, Burundi, Equatorial Guinea, Kenya, Mozambique, Senegal, Ghana, Cameroon, Togo and Sao Tome • Sub-standard and poorly-staffed health infrastructure and ineffective services/systems, which reinforce persistence of poverty and under-development and hold back achievement of the Millennium Development Goals.

6. Diaspora and HRH: The Magnitude of the Problem of Health Worker Shortage • Approximately 65,000 African-born doctors and 70,000 African-born professional nurses were working abroad in a developed country in 2000, representing about one-fifth of African-born physicians and one-tenth of African-born nurses in the world [Center for Global Development study by Michael Clemens and Gunilla Pettersson] • E.g.75% of people born in Mozambique who now work as doctors do not live in Mozambique

7. Migration of African Health Professionals: Another view – A ‘Brain Gain’ through Diaspora Activity ? • Clemens and some others have argued that on average the emigration of African health professionals to developed countries has not been entirely harmful to the source countries, contending that some African countries, such as Ghana, Senegal and Mauritius, with the highest health professional emigration rates tend to have the best health systems in the region • Apparently, there are possible beneficial professional and technical assistance contacts and promotion of knowledge exchange through diasporas

8. Options to bridge HRH Needs Gap • Retention Option: Ensuring that highly-skilled professionals do not leave home country in the first place – both non-voluntary (bonded to serve homeland for a period of time after training) and incentive methods [WHO’s Treat, Train and Retain; WHO proposed Code of Practice on the international recruitment of health professionals; WHO-sponsored Global Health Workforce Alliance; WHO-OECD Dialogue on migration of health workforce, ILO’s Health Worker Migration and a Fair Globalization programme] • Return Option: Luring professionals abroad back to their countries of origin [IOM’s Return of Qualified African Nationals programme; UNDP’s Transfer of Knowledge Through Expatriate Nationals (TOKTEN)] • DiasporaOption: Making use of the contributions of nationals abroad without requiring them to relocate back to their home countries

9. The Diaspora Option Illustrative examples of African Professional Diaspora Organizations in Europe engaged in Human Resources for Health and Health Sector Development • Afro-European Medical and Research Network (AERN): A Swiss-based non-government and non-profit Pan-African diaspora organization, suppoted by the Swiss Development Cooperation,with activities designed to help improve the quality of life of people in resource-poor settings in SSA through provision of the services of volunteer medical professionals, mobile clinics, equipment, knowledge exchange and training. • Sierra Leone Diaspora Network: A London-based charity and diaspora organization, supported by DFID, with the aim of mobilizing Sierra Leone health professionals in the Diaspora towards the improvement of health facilities and delivery of healthcare in Sierra Leone through volunteering, policy dialogue with the government and Knowledge exchange. • Environment and Health In Communities in Africa (ENHICA): An international diaspora organization of Nigerian origin, based in both Europe and North America, specializing in mobilizing intellectual and material resources to support health sector projects in Africa.

10. Critical Issues and Challenges in the Diaspora Option • How to maximize the contributions of diasporas • How to ensure accountability and maintain credibility, including monitoring and evaluation • Collaboration with homeland government and local authorities without being ‘politicized’ • Cooperation with host government development assistance machinery, to recognize and support the diaspora option as a cost-effective complement or alternative to conventional means of donor assistance • Institutionalization of arrangements for contributing to sustainable development