Migration of health professionals.

J B Eastwood and colleagues1Eastwood JB Conroy RE Naicker S West PA Tutt RC Plange-Rhule J Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK.Lancet. 2005; 365: 1893-1900Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar are to be commended for a constructive and timely account of the loss of health professionals from Africa to the UK. They make many excellent recommendations, particularly those emphasising improved training and work incentives in Africa and enhanced collaborative links between Africa and the UK. Their recommendation to restrict the access of African health professionals to the UK is, however, likely to be more controversial than they suppose.Working in the UK Medical Research Council's Gambian unit, we sit poised between Britain and Africa and feel the rub of both sides of this issue. We believe that giving Africans reasons to stay is the primary solution to the brain-drain problem.A story is told of an Australian outback sheep farmer who when asked by a surprised visitor why he had no fences replied, “Out here we don't need fences, we just dig wells”. Given an environment where health professionals can live reasonably, develop professionally, and use their capabilities effectively, most will stay in the region. Further restrictions on the freedom of Africans, however well meaning, are likely to be viewed with suspicion in Africa as further examples of marginalisation and exploitation.Eastwood and colleagues' call for joint action to improve health-service incentives in the continent, provide quality training, and enhance collaborative ties is timely. To these we would add measures to ensure basic facilities for effective medical practice, such as essential laboratory and radiology services, and adequate drug supplies. The opportunity to practice effectively would do much to raise morale and retain practitioners.The UK government has signalled its intention to take a lead in engaging with Africa. We would like to encourage the government to maintain a positive approach that focuses on reducing the “push” from Africa rather than the “pull” to the UK. From where we sit, wells are working better than fences.We declare that we have no conflict of interest. J B Eastwood and colleagues1Eastwood JB Conroy RE Naicker S West PA Tutt RC Plange-Rhule J Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK.Lancet. 2005; 365: 1893-1900Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar are to be commended for a constructive and timely account of the loss of health professionals from Africa to the UK. They make many excellent recommendations, particularly those emphasising improved training and work incentives in Africa and enhanced collaborative links between Africa and the UK. Their recommendation to restrict the access of African health professionals to the UK is, however, likely to be more controversial than they suppose. Working in the UK Medical Research Council's Gambian unit, we sit poised between Britain and Africa and feel the rub of both sides of this issue. We believe that giving Africans reasons to stay is the primary solution to the brain-drain problem. A story is told of an Australian outback sheep farmer who when asked by a surprised visitor why he had no fences replied, “Out here we don't need fences, we just dig wells”. Given an environment where health professionals can live reasonably, develop professionally, and use their capabilities effectively, most will stay in the region. Further restrictions on the freedom of Africans, however well meaning, are likely to be viewed with suspicion in Africa as further examples of marginalisation and exploitation. Eastwood and colleagues' call for joint action to improve health-service incentives in the continent, provide quality training, and enhance collaborative ties is timely. To these we would add measures to ensure basic facilities for effective medical practice, such as essential laboratory and radiology services, and adequate drug supplies. The opportunity to practice effectively would do much to raise morale and retain practitioners. The UK government has signalled its intention to take a lead in engaging with Africa. We would like to encourage the government to maintain a positive approach that focuses on reducing the “push” from Africa rather than the “pull” to the UK. From where we sit, wells are working better than fences. We declare that we have no conflict of interest.