Apart from the whir of the fan, not a single noise disturbs this third-year course devoted to diabetes. Pen and notebook in hand, on their small individual desks, around fifty students listen religiously to the trainer despite the scorching weather enveloping Dakar that day. These future nurses are among the 800 students at the Institut santé service (ISS), a private school located in a multi-story house in the Senegalese capital, which also trains midwives, biologists and laboratory technicians. Once they have obtained their bachelor's degree, many will go to specialize or directly work far from Senegal.
“Over the last three years, we've had a lot of students leave,” says Badiane Kowry Sow, the general director, from her office a flight of stairs down. “There is a very large exodus, especially of nurses,” she adds, emphasizing that, for the latter, the duration of training is the same as in developed countries, i.e. three years (when it takes five years studies to be a midwife). As soon as they graduate, its students – Senegalese but also many nationals from neighboring countries – are therefore immediately “recruitable” abroad.
In sub-Saharan Africa, the departure of caregivers, particularly nurses, is a known phenomenon. To the United Kingdom and North America, for English speakers (Nigerians, Ghanaians, Zimbabweans in particular); to France and Canada, for French speakers (Senegalese, Beninese among others).
Better and more specializations
And this despite the fact that the rate of caregivers per capita is already very low in Africa. The situation is certainly not uniform (much better in southern Africa, worse in Central Africa) but very far from, for example, European ratios. To stay with the same examples, the density of nurses and midwives in 2020 was 2.9 per 10,000 inhabitants in Benin and 3.5 in Senegal, far from the 122 recorded in France, according to the World Organization of Health (WHO). This inequality is also found among doctors (31.7 per 10,000 inhabitants in the United Kingdom compared to 3.9 in Nigeria, again according to the WHO).
The exodus is fueled by several factors. For caregivers, there is the call for better salaries (nurses and midwives at the ISS can expect 200,000 to 300,000 CFA francs when they leave, or around 300 to 450 euros), but also specializations, better and more numerous, or even working conditions.
“If I had the choice, I would choose the West,” explains Boukar Léonard Robndoh, a Chadian doctor practicing in Senegal, who says he spends 80% of his time “managing aspects that have nothing to do with medicine ”, like finding an ambulance. Go back to Chad? Even less so, he said, referring to “the days without electricity” and “the sociopolitical climate.” States, even if they bear the social but also financial cost of this phenomenon, are struggling to offer enough positions.
Covid has worsened the trend, considerably increasing demand from developed countries. The WHO notes that no less than 115,000 caregivers died from the virus between January 2020 and May 2021 worldwide, and many more left the sector after burnout or depression. The latter have therefore become a highly sought-after workforce, for which rich countries have relaxed their migration policies. At the end of January, as part of the “immigration” law, France, for example, created a new residence permit dedicated to medical professions. According to the local press, Zimbabwean immigration to the United Kingdom, mainly caregivers, increased by 1,500% between 2019 and 2022.
" Opportunities "
The WHO, led by the Ethiopian Tedros Adhanom Ghebreyesus, was alarmed by this situation by establishing a red list of 55 countries, mainly African, in a situation of critical deficit. It alerts, without much success, rich countries about the impact of their recruitment in the listed regions, and promises to help the latter improve their health system. A challenge faced with a lack of resources.
Faced with the flow, some States are still trying to find a solution. Either through supply, as in Senegal, where efforts have been made over the last two years to open specialized master's degrees, which will perhaps make it possible to "curb" certain attempts, notes the director of the ISS, Ms. Sow. Either through constraint, by adopting more severe regulations. At the start of 2024, Nigeria, which according to its association of nurses and midwives lost 75,000 of its assets in five years, announced among other measures a two-year moratorium between the diploma and a possible departure abroad - provoking anger in the sector.
But it would be wrong to consider that all African states view this phenomenon negatively. Kenya, for example, has signed bilateral agreements with the United Kingdom to send nurses there. One way for the authorities to respond to their inability to “absorb” the approximately 7,500 people who graduate each year, estimates Lina Mwita, trainer in this discipline at the university of the medical NGO Amref, in Nairobi.
Of course, hospitals lack nurses, but due to the limited creation of new positions, many are also unemployed. “They are not just going to stay there because they are Kenyan and patriotic, they are looking for opportunities to advance their careers,” underlines the professor, who refutes the expression “brain drain” in this context.
In Dakar, while the studious course on diabetes continues, the dissertation defense of two students ends on another floor, under the proud gaze of their families in their Sunday best. In a long midnight blue dress and hat, Mamadou Lamine Tamba is presented, with her friend, with the congratulations of the jury. This young Senegalese is surprised to be asked about his desire to go abroad. “You have to discover, you have to travel,” he gets a little annoyed. I want to see how nurses work in Europe, in the United States, everywhere. You travel well, right? Why not us ? »
