The absence of Botswana from the 2023 World Health Organisation’s (WHO) Health Workforce Support and Safeguards list could jeopardise the country’s healthcare system and accelerate the hiring of nurses and other medical professionals by foreign countries.
The newly revised 2023 list classified 55 countries, 37 of which were African, as being particularly vulnerable to a shortage of healthcare professionals necessary to achieve the United Nations’ Sustainable Development Goal objective of universal health coverage (UHC) by 2030.
The list is released at a time when Botswana’s fragile healthcare system is already stretched thin due to the country’s high nursing staffing vacancy rate, which is estimated at more than 30%.
“In particular, these countries have: 1) a density of doctors, nurses and midwives below the global median (i.e., 49 per 10 000 population); and 2) a universal health coverage service coverage index below a certain threshold,” states WHO, adding that the 55 countries face the most pressing health workforce challenges related to universal health coverage.
In the 2020 list, a total of 33 African countries were identified as having pressing universal health coverage health workforce needs. This has now grown to 37 countries on the list for this year, ten of which are Southern African Development Community (SADC) member states: Zambia, Lesotho, Malawi, Madagascar, Malawi, Zimbabwe, Comoros, Democratic Republic of the Congo, Angola, and Tanzania.
The United Kingdom (UK) embarked on an intensive recruitment drive to plug a shortage of almost 40,000 nurses in the National Health Service (NHS). Hundreds of Botswana nurses are currently applying for jobs abroad as they continue to seek better-paying jobs in affluent countries. In 2022, an Essex Partnership University NHS Trust recruitment team visited Botswana, where they said they interviewed scores of individuals who wish to work in the UK. In the first phase of the recruitment campaign, 66 nurses were hired, with more planned in the future.
The Botswana Nurses Union (BONU), which signed an agreement with NHS to open doors for Botswana nurses to work in the UK, is also engaged in a drive to support its members in finding employment abroad. Despite Botswana not being included on the WHO Workforce Support and Safeguard List, a World Bank assessment of the nurse labour markets in 14 ECSA (Eastern, Central and Southern African Region) countries discovered that documented vacancy rates varied from 30 to 55% across the region.
The WHO global code of practice mandates that nations placed on the Health Workforce Support and Safeguards list receive priority for health system-related support and safeguards that prevent active international recruitment of health professionals. Governments which intend to hire medical staff from countries with fragile health systems are encouraged to be made aware of the effects such activities will have on the health systems of the nations from which they source qualified medical personnel.
The WHO global code of practice also states that: “An adequate and accessible health workforce is fundamental to an integrated and effective health system and for the provision of health services”.