tag:theconversation.com,2011:/africa/topics/brain-drain-34124/articlesBrain drain – The Conversation2023-11-16T19:03:34Ztag:theconversation.com,2011:article/2177902023-11-16T19:03:34Z2023-11-16T19:03:34ZNZ wants more seasonal workers – but Pacific nations no longer want to be the ‘outposts’ that ‘grow’ them<p>The three party leaders currently negotiating to form New Zealand’s next government might have their differences, but they seem to agree on one thing: the Recognised Seasonal Employer (RSE) scheme needs to expand.</p>
<p>New Zealand, like Australia, faces critical labour shortages in some sectors, with real implications for future economic performance. The RSE scheme, which has delivered thousands of crucial workers in viticulture and horticulture since it began in 2007, is the logical solution.</p>
<p>Incoming prime minister Christopher Luxon has <a href="https://www.stuff.co.nz/national/politics/131805911/national-promises-to-double-rse-worker-cap-ban-foreign-investment-in-farmtoforestry-conversions">pledged to double</a> the RSE intake from the current 19,500. ACT’s David Seymour wants the cap on these workers <a href="https://www.act.org.nz/rse-change-too-little-too-late-just-remove-the-cap-completely">lifted completely</a> – emulating the Australian approach. And NZ First is in favour of <a href="https://www.nzfirst.nz/video-winston-peters-on-economy-rse-workers-and-putins-nuclear-threats">recruiting more migrant workers</a> in all fields facing shortages.</p>
<p>But while an increase in RSE workers might benefit New Zealand, the impact on the Pacific nations they come from is becoming hard to ignore. In fact, the schemes risk undermining the very communities and economies they supposedly benefit.</p>
<h2>Intake doubled after COVID</h2>
<p>In the year to June 2023, <a href="https://devpolicy.org/pacific-labour-mobility-over-the-last-year-continued-growth-20230808/">48,000 people</a> left the Pacific to participate in New Zealand’s RSE scheme and Australia’s Pacific Australia Labour Mobility (PALM) scheme. This represented almost a <a href="https://devpolicy.org/pacific-labour-mobility-over-the-last-year-continued-growth-20230808/">doubling of visas</a> issued since 2018-19, the last year of recruitment before COVID-19 interrupted things.</p>
<p>Remittance payments from workers in these schemes undoubtedly assisted Pacific countries during the periods of pandemic-related border closures. But the resulting labour shortages in the source countries saw <a href="https://www.stuff.co.nz/pou-tiaki/132684414/pacific-to-review-seasonal-work-schemes-to-protect-the-economy">calls for a review</a> of participation in the schemes.</p>
<p>As the table below shows, 20% of the male working-age population in Vanuatu and Tonga were recruited in either the Australian or New Zealand seasonal labour schemes in 2022-23. These are people who will be absent from farms, schools, hospitals, mechanical workshops and other sectors in their home countries for six to nine months of the year.</p>
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<p>A <a href="https://vcci.vu/vanuatu-skills-needs-industry-report-2023-now-available/">recent report from Vanuatu</a> found 60% of enterprises – mostly in trades, retail and restaurants – had been affected by staff losses to RSE and PALM schemes. The tourism sector, in particular, has felt the impact strongly since the PALM scheme expanded to recruit workers beyond the primary sector.</p>
<p>Tourism operators report training staff only to see them leave for more lucrative work on seasonal worker schemes. Taumeasina Island resort in Samoa <a href="https://www.stuff.co.nz/pou-tiaki/131112535/pacific-businesses-desperate-for-workers-as-thousands-leave-for-nz-jobs">lost almost 60 workers</a> over the 12 months to February 2023.</p>
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<h2>Not a win-win policy</h2>
<p>The Pacific development policies of both New Zealand and Australia purport to “<a href="https://www.mfat.govt.nz/en/aid-and-development/our-approach-to-aid/our-priorities/">strengthen resilience</a>” and “<a href="https://www.dfat.gov.au/geo/pacific/development-assistance/development-assistance-in-the-pacific">grow economies</a>”, devoting millions of dollars to various initiatives.</p>
<p>Arguably, the extraction of increasingly large numbers of skilled and semi-skilled workers from important social and economic sectors is systematically undermining these same initiatives.</p>
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Read more:
<a href="https://theconversation.com/labors-proposed-pacific-labour-scheme-reforms-might-be-good-soft-diplomacy-but-will-it-address-worker-exploitation-183119">Labor's proposed Pacific labour scheme reforms might be good soft diplomacy but will it address worker exploitation?</a>
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<p>The aid money cannot fully compensate for the loss of people from their families, communities, businesses and economic sectors for such extended periods. The Archbishop of Fiji <a href="https://www.fijitimes.com/opinion-the-dark-side-of-seasonal-work/?fbclid=IwAR3T0aD3f82jTYHsQzkf5Ve8X3fDm9O-A346pR7EOtpwZhOi_vUVoCQgras">recently spoke</a> about the “dark side of seasonal work”, and it’s clearly no longer tenable to say seasonal labour schemes are the win-win they were originally <a href="https://devpolicy.org/pdf/blog/RSE10thPaper_WhatmanBedfordFinal.pdf">intended to be</a>.</p>
<p>The balance has tipped in favour of the bigger, richer countries. Earlier this year the <a href="https://www.oecd.org/development-cooperation-learning/practices/addressing-policy-trade-offs-new-zealand-s-pacific-regional-labour-mobility-scheme-36f4c676/">OECD reported</a> there is “limited upskilling” of these workers. The anticipated transformative effect on the Pacific private sector has not been seen.</p>
<p>The largest Pacific nation RSE contributors have found this loss of labour is undermining <a href="https://devpolicy.org/pacific-workers-in-rse-scheme-numbers-and-their-implications-20230413/">community development</a> as well as the labour market. When workers leave it puts an <a href="https://devpolicy.org/when-a-family-member-works-overseas-20230330/">extra burden</a> on family and communities.</p>
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Read more:
<a href="https://theconversation.com/underpaid-at-home-vulnerable-abroad-how-seasonal-job-schemes-are-draining-pacific-nations-of-vital-workers-194810">Underpaid at home, vulnerable abroad: how seasonal job schemes are draining Pacific nations of vital workers</a>
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<p>Samoan prime minister Fiame Naomi Mata’afa has been <a href="https://www.abc.net.au/news/2023-08-31/fiame-samoa-pacific-labour-scheme-australia/102794256">particularly concerned</a> that Pacific countries are perceived as mere “outposts” which “grow” labourers for Australia and New Zealand.</p>
<p>Her sentiments are echoed in Vanuatu, where labour commissioner Murille Maltenoven has <a href="https://www.rnz.co.nz/international/pacific-news/475900/vanuatu-concerned-about-labour-drain-from-expanded-rse-scheme">spoken of complaints</a> about the “brain drain” affecting the domestic labour market. And Fiji’s prime minister Sitiveni Rabuka argues the local economy <a href="https://pmn.co.nz/read/politics/fiji-prime-minister-sitiveni-rabuka-calls-for-rethink-of-rse-scheme">should be prioritised</a> over seasonal labour schemes.</p>
<h2>Policy and practice must change</h2>
<p>The criticism has led both <a href="https://www.palmscheme.gov.au/resources/budget-2023-24-reforming-palm-scheme">Australia</a> and <a href="https://www.radiopolynesiasamoa.com/local/nz-govt-undertaking-review-of-the-rse-policy-and-design">New Zealand</a> to review and reform their respective seasonal worker policies. Improvements include more investment in pastoral care and skills training, and greater benefits for employees.</p>
<p>It seems unlikely, however, that this will fully address the growing imbalance between who benefits and who bears the cost of these schemes. Furthermore, with Australia <a href="https://www.abc.net.au/news/2023-10-19/labor-expands-pacific-immigration-with-new-visa/102997646">expanding its own residency pathway</a> to match New Zealand’s, even more skilled workers may be enticed to leave their Pacific homelands.</p>
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Read more:
<a href="https://theconversation.com/reaping-what-we-sow-cultural-ignorance-undermines-australias-recruitment-of-pacific-island-workers-197910">Reaping what we sow: cultural ignorance undermines Australia's recruitment of Pacific Island workers</a>
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<p>The Samoan government is tackling the problem head on, <a href="https://www.rnz.co.nz/international/pacific-news/498966/samoa-govt-approves-new-labour-mobility-policy">approving a new labour mobility policy</a> in late September. Among other things, it will prioritise those who have been unemployed for more than six months.</p>
<p>This reflects the <a href="https://www.oecd.org/development-cooperation-learning/practices/addressing-policy-trade-offs-new-zealand-s-pacific-regional-labour-mobility-scheme-36f4c676/">OECD position</a> that unskilled workers must be a priority. Otherwise, the schemes will directly undermine human development in Pacific countries.</p>
<p>Other seasoned observers <a href="https://devpolicy.org/pacific-labour-mobility-over-the-last-year-continued-growth-20230808/">have suggested</a> New Zealand and Australia begin recruiting more workers from Papua New Guinea and Solomon Islands, rather than further deplete Samoa, Tonga and Vanuatu.</p>
<p>The OECD also urges investment in the private sectors of partner countries to create better job options and wages at home for Pacific workers. This is where Australian and New Zealand development aid policies should now be focused.</p><img src="https://counter.theconversation.com/content/217790/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Apisalome Movono receives funding from Royal Society Te Apārangi.</span></em></p><p class="fine-print"><em><span>Regina Scheyvens receives funding from Royal Society Te Apārangi.</span></em></p><p class="fine-print"><em><span>Sophie Auckram does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new government is likely to increase the numbers of workers coming to New Zealand on seasonal work schemes. But the impact on Pacific economies and communities is now too great to be ignored.Apisalome Movono, Senior Lecturer in Development Studies, Massey UniversityRegina Scheyvens, Professor of Development Studies, Massey UniversitySophie Auckram, Research Assistant, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2112912023-08-30T13:38:58Z2023-08-30T13:38:58ZKofi Ansah left Ghana to become a world famous fashion designer - how his return home boosted the industry<p>In the 1950s and 1960s, young Africans were assisted financially by their governments to study in western countries in the hope they would return to contribute to nation <a href="https://doi.org/10.4324/9781315623399">building</a>. Individuals who qualified abroad and returned home formed the educated elites of immediate post-independent <a href="https://doi.org/10.2139/ssrn.1374329">Africa</a>. </p>
<p>Over the years, the demography of such migrants has changed to include professionals who after graduation at home move abroad in search of employment and remain there <a href="https://doi.org/10.1136%2Fbmj.331.7519.780-b">permanently</a>. This loss of human talent and skills – the “brain drain” – is arguably one of Africa’s key developmental <a href="https://suraadiq.com/wp-content/uploads/2021/07/Skills-for-science-systems-in-Africa.pdf">challenges</a>. </p>
<p>The migration of highly skilled professionals such as doctors, nurses, engineers and academics from Africa has serious economic, political and social implications for <a href="https://www.proquest.com/openview/cef9a0e6f56bf9de0d6683c52c60c2c7/1?pq-origsite=gscholar&c%20bl=2026366&diss=y.">development</a>.</p>
<p>But there is another side to the migration of skilled people. That is “<a href="https://doi.org/10.1111/jofi.12198">brain gain</a>” – the return migration of professionals – and “<a href="https://www.brookings.edu/articles/brain-circulation-how-high-skill-immigration-makes-everyone-better-off/">brain circulation</a>” – temporary migration of professionals between countries. This is not well documented, especially in the case of African countries. </p>
<p>This is the gap we sought to fill, using a case study of the late Ghanaian fashion designer, <a href="https://doi.org/10.1080/14767724.2023.2236563">Kofi Ansah</a>. </p>
<p>Ansah’s impact on Ghanaian fashion was immense because of the timing and context of his return in 1992. He had built a successful career for 20 years in the UK and the future looked <a href="https://doi.org/10.1080/14767724.2023.2236563">promising</a>. On the other hand, the country he returned to was undergoing profound political and economic transformation. Ghana was transitioning from military rule to a civilian <a href="https://doi.org/10.2979/aft.2010.57.1.24">government</a>. Political tension was high, linked to an economic downturn following <a href="https://scholarworks.uvm.edu/cgi/viewcontent.cgi?article=1310&context=hcoltheses">structural adjustment programmes</a> adopted in the 1980s. But Ansah chose to relocate his budding career to Ghana. </p>
<p>His case demonstrates how the knowledge and expertise migrants gather through international career mobility can be converted into assets at an individual, national and international level. Returning migrants can transform traditional industries into modern, globalised ones.</p>
<h2>Transforming Ghana’s fashion industry</h2>
<p>We are researchers in sociology, African studies and geography who have been studying how internal and external migration and spatial context influence cultural and creative practice in Ghana. For the Kofi Ansah case study we interviewed 31 Ghanaian fashion designers whose career journeys had been directly and indirectly influenced by him. These interviews are supplemented by information from social media dedicated to Ansah and his works. </p>
<p>Kofi Ansah, who <a href="https://www.peacefmonline.com/pages/showbiz/fashion/201405/198235.php">died in 2014</a>, was from a creative family. His elder sister, <a href="https://face2faceafrica.com/article/felicia-abban-ghanas-first-female-photographer-in-whose-lens-was-nkrumahs-mirror">Felicia Abban</a>, was the official photographer of Kwame Nkrumah, Ghana’s first president. His elder brother, <a href="https://www.imdb.com/name/nm0030503/">Kwaw Ansah</a>, is an acclaimed film writer, director and producer. </p>
<p>After completing his secondary education, Kofi enrolled in the Chelsea School of Art in the United Kingdom to study fashion design. He made his first fashion headline after he designed a beaded dress for Princess Anne. Subsequently, he worked for several successful British fashion brands, including Gerald Austin and Guy Laroche, before establishing his own studio in central London in 1980. </p>
<p>Despite his early success on the UK fashion scene, Ansah returned to Ghana in 1992 to get fresh inspiration and “try to show people that we can use our fabrics for other things … We just have to work on it and make it commercial,” he explained during an <a href="https://www.instagram.com/p/B_FXwpwJMgV/?igshid=MzRlODBiNWFlZA==">interview</a>. </p>
<p>The way cloth was produced locally, using <a href="https://www.adireafricantextiles.com/textiles-resources-sub-saharan-africa/an-introduction-to-sub-saharan-african-textiles/loom-types-in-sub-saharan-africa/">strip loom</a> technology, limited the volume of production. And the conventional styling of clothes limited their patronage. These were some of the features Ansah sought to change.</p>
<p>Ansah transformed Ghana’s fashion industry in four areas: </p>
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<li><p><strong>Fabrics and design</strong>: His modern designs used African traditional cloth, such as kente and <a href="https://craftatlas.co/crafts/bogolan">bogolanfini</a>. Linked to these style changes was his collaboration with Woodin and the Ghana Textiles Production, two textile producing companies, to introduce the sale of fabric in single yards instead of the standard six yards. This made the cloth more accessible and functional. It led to the production of casual clothes, such as skirts, blouses, shirts, shorts and trousers, for men and women. He then introduced ready-to-wear clothing at Woodin.</p></li>
<li><p><strong>Accessories</strong>: Ansah was also passionate about promoting fashion accessories made with local materials. These included wood, raffia and his personal favourite, calabash. His runway designs always included stunning accessories. The use of prominent accessories has now become an integral element of African fashion shows.</p></li>
<li><p><strong>Production</strong>: Ansah was instrumental in the introduction of the <a href="https://www.ghanaweb.com/GhanaHomePage/NewsArchive/National-Friday-Wear-Programme-launched-69720">Friday African wear policy</a> in Ghana. This was aimed at promoting the wearing of local bespoke garments in workplaces on Fridays. Ansah used his friendship with then minister for trade and industry, Alan Kyeremanten, to push his idea to democratise and regularise the use of wax print. Ansah also influenced fashion production by employing international marketing strategies like fashion shows and exhibitions. He thus opened Ghanaian fashion to international audiences by using globally accepted techniques.</p></li>
<li><p><strong>Human capital</strong>: More importantly, Ansah’s vision to grow a lasting and successful industry propelled him to mentor many of Ghana’s finest contemporary designers. He partnered with international agencies to launch mentorship programmes for young designers. </p></li>
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<p>One such programme was the <a href="https://www.ghanaweb.com/GhanaHomePage/entertainment/Roberto-Cavalli-and-Vogue-Italia-Editor-In-Chief-visit-Ghana-and-Nigeria-227092">Web Young Designers Hub</a>, financed by the French Embassy and coordinated by Ansah and <a href="https://www.businessoffashion.com/community/people/franca-sozzani">Franca Sozzani</a>, former editor of Vogue Italia. Another project spearheaded by Ansah was the <a href="https://ethicalfashioninitiative.org/">Ethical Fashion Initiative</a>, a partnership between the United Nations and the Presidential Special Initiative programme. These programmes and the exposure that came with them positioned contemporary designers to engage in “brain circulation.”</p>
<p>By participating in projects, young designers had the opportunity to travel to other countries and learn about aspects of fashion such as fabric production and event organisation. Such travel was geared towards acquiring knowledge that would have an impact on Ghana’s fashion industry. </p>
<p>These engagements helped young fashion designers build networks with designers across the globe. </p>
<h2>Ansah’s impact</h2>
<p>The Ghanaian fashion industry is making its mark <a href="https://library.oapen.org/bitstream/handle/20.500.12657/51163/1/9781003148340_oachapter1.pdf">globally</a>. <a href="https://instagram.com/steviefrenchie?igshid=MzRlODBiNWFlZA==">Steve French</a> and other young designers are recognised for their creative works and talents. Garments made by Ghanaian designers like <a href="https://www.duabaserwastudios.com/">Duaba Serwaa</a> and <a href="https://christiebrownonline.com/en-gh">Christie Brown</a> are worn by stars such as Lupita Nyongo and Beyonce respectively. Young Ghanaians, too, proudly wear African clothes for all occasions. The current status of Ghana’s fashion industry is largely due to the efforts of Kofi Ansah.</p><img src="https://counter.theconversation.com/content/211291/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adwoa Owusuaa Bobie received funding from the Danish Foreign Ministry (DANIDA) for this research. </span></em></p><p class="fine-print"><em><span>Akosua Keseboa Darkwah received funding from the Ministry of Foreign Affairs of Denmark grant number 18-05-CBS, Advancing Creative Industries for Development in Ghana for this study. </span></em></p><p class="fine-print"><em><span>Katherine V. Gough received funding from the Ministry of Foreign Affairs of Denmark grant number 18-05-CBS, Advancing Creative Industries for Development in Ghana, for this study.</span></em></p>International career mobility can give people valuable knowledge and expertise to be used in their home country.Adwoa Owusuaa Bobie, Research Fellow, Center for Cultural and African Studies, Kwame Nkrumah University of Science and Technology (KNUST)Akosua Keseboa Darkwah, Associate Professor of Sociology, University of GhanaKatherine V. Gough, Professor of Human Geography, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1759142022-02-03T19:08:08Z2022-02-03T19:08:08ZCritically understaffed and with Omicron looming, why isn’t NZ employing more of its foreign-trained doctors?<figure><img src="https://images.theconversation.com/files/444181/original/file-20220203-27-p7fsi5.jpg?ixlib=rb-1.1.0&rect=38%2C0%2C6451%2C4330&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>New Zealand’s critical <a href="https://www.rnz.co.nz/news/political/460780/new-zealand-competing-with-other-countries-to-recruit-icu-nurses-national">shortage of specialist nurses</a> made headlines again this week, but it’s not the country’s only pressing medical need.</p>
<p>The Association of Salaried Medical Specialists (<a href="https://www.asms.org.nz/">ASMS</a>) has estimated <a href="https://www.asms.org.nz/news/2022/01/25/we-need-to-declare-a-health-workforce-emergency/">almost 3,000 more</a> GPs and specialist doctors, and 12,000 more nurses, are needed to match Australia’s per-capita staffing levels.</p>
<p>The predicted impact of Omicron adds to the urgency, but since the beginning of the COVID-19 pandemic there have been regular <a href="https://www.nzdoctor.co.nz/article/we-are-drowning-gp-workforce-survey">reports</a> of a medical workforce <a href="https://www.rnzcgp.org.nz/GPPulse/RNZCGP/News/College_news/2020/New-Zealands-GPs-are%20a-workforce-in-crisis.aspx">in crisis</a>, with <a href="https://www.nzherald.co.nz/nz/auckland-hospitals-overloaded-patients-waiting-in-corridors-as-demand-skyrockets/NIU26VB3XCSZFHHGASKSXOXP2A/">longer waiting times</a> and patients being <a href="https://www.stuff.co.nz/national/health/124477572/doctor-shortage-forcing-gp-clinics-to-turn-away-new-patients">turned away</a>. </p>
<p>Border closures and immigration restrictions have only made the doctor shortage worse. We need to ask, therefore, why many foreign-trained doctors currently living in New Zealand are still not allowed to work.</p>
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<h2>Brain drain and brain gain</h2>
<p>Doctors have <a href="http://neuron.mefst.hr/docs/CMJ/issues/2001/42/5/11593497.pdf">always moved around</a>. It’s been an important aspect of the medical profession for centuries, as a way of learning new skills and knowledge. According to a 2019 Medical Council <a href="https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/6be731ea72/Workforce-Survey-Report-2019.pdf">workforce survey</a>, around 40% of New Zealand-trained physicians from the 2005 cohort were living overseas after ten years.</p>
<p>To compensate for this “<a href="https://www.bmj.com/content/324/7336/499">brain drain</a>”, which leads to roughly <a href="https://www.asms.org.nz/wp-content/uploads/2017/02/IMG-Research-Brief_167359.5.pdf">one in six</a> New Zealand-trained doctors working overseas, doctors from other countries are encouraged to immigrate. New Zealand’s health system depends on this migrant “brain gain”.</p>
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Read more:
<a href="https://theconversation.com/omicron-is-overwhelming-australias-hospital-system-3-emergency-measures-aim-to-ease-the-burden-175233">Omicron is overwhelming Australia's hospital system. 3 emergency measures aim to ease the burden</a>
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<p>Before the pandemic, almost <a href="https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/6be731ea72/Workforce-Survey-Report-2019.pdf">43% of New Zealand doctors</a> were from overseas. But many have joined a general <a href="https://www.stuff.co.nz/business/125796584/skilled-migrants-are-leaving-in-droves-frustrated-by-lengthy-residency-delays">exodus of skilled workers</a>, with some blaming <a href="https://www.rnz.co.nz/news/national/441433/departing-gp-warns-govt-failing-to-retain-overseas-medical-staff">delays over residency</a>.</p>
<p>To make matters worse, not all of those who stay are able to <a href="https://www.nzherald.co.nz/nz/covid-19-delta-outbreak-immigrant-doctors-denied-work-at-understaffed-hospitals/OKRC764YCBPNOUSOPRUIJ7FOVM/">work as doctors</a> in their adopted country.</p>
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<h2>Long pathways to practising</h2>
<p>The reason lies in the way New Zealand licenses foreign doctors depending on where they trained. Those with training and experience in “comparable health systems” <a href="https://www.mcnz.org.nz/registration/getting-registered/">can generally practise</a> as soon as they receive a job offer. </p>
<p>That comparability is <a href="https://www.mcnz.org.nz/registration/getting-registered/registration-policy/comparable-health-system-criteria/">measured by indicators</a> such as life expectancy and doctors-per-capita in other countries. It’s hardly surprising that only wealthier countries are on the list.</p>
<p>Doctors who can’t claim comparability must first complete a medical knowledge exam from either Australia, the UK, US or Canada, pass an English test and then pass the New Zealand Registration Examination (<a href="https://www.mcnz.org.nz/registration/getting-registered/registration-exam-nzrex/">NZREX</a>). </p>
<p>This process can cost more than NZ$10,000 and takes years – especially since COVID-19 has meant half of the exam offerings were cancelled in 2020 and 2021, adding to wait times.</p>
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Read more:
<a href="https://theconversation.com/new-zealands-border-quarantine-has-intercepted-thousands-of-covid-cases-but-is-it-time-to-retire-the-flawed-system-176144">New Zealand's border quarantine has intercepted thousands of COVID cases, but is it time to retire the flawed system?</a>
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<h2>A hurdle too far</h2>
<p>Once a doctor has passed the exams and met the required standard, they must still complete two years of supervised work before being licensed. </p>
<p>This is where the catch comes: <a href="https://www.mcnz.org.nz/registration/maintain-or-renew-registration/pgy1pgy2-and-nzrex-training-requirements/">first-year supervised positions</a> are limited, prioritised for New Zealand medical graduates and rarely offered to foreign-trained doctors. </p>
<p>Most doctors from comparable health systems, on the other hand, don’t need to take the NZREX or complete two years of supervised work. By not competing with New Zealand medical graduates to be licensed, they don’t experience the same bottlenecks.</p>
<p>Of the foreign doctors who passed the NZREX <a href="https://www.mcnz.org.nz/assets/NZREX/b6d370fe8b/NZREX-Clinical-Pass-Rates-and-Subsequent-Registration.pdf">between 2016 and 2021</a>, just over half now have provisional registration and can work. This leaves 94 who have passed the exam in the past five years but are still not licensed to practise medicine. </p>
<p>For those who passed the exam earlier, the results are valid for only five years. If they haven’t been able to secure a supervised position in that time, they are back to square one. </p>
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<h2>A wasted workforce</h2>
<p>The government has an ongoing <a href="https://www.careers.govt.nz/jobs-database/health-and-community/health/physician/">recruitment campaign</a> to lure overseas doctors. The Medical Council is also looking for ways to <a href="https://www.mcnz.org.nz/about-us/news-and-updates/consultation-on-the-comparable-health-system-registration-pathway/">simplify the pathway</a> for doctors from comparable health systems. </p>
<p>Despite the obvious need, qualified immigrant doctors have reportedly been <a href="https://www.nzherald.co.nz/nz/covid-19-delta-outbreak-immigrant-doctors-denied-work-at-understaffed-hospitals/OKRC764YCBPNOUSOPRUIJ7FOVM/">denied work opportunities</a> at understaffed hospitals during the pandemic.</p>
<p>It is difficult not to see an apparent assumption that a doctor’s competency as a physician is associated with the country they are from. This is not an unusual phenomenon – migrant physicians from non-Western backgrounds often <a href="https://link.springer.com/article/10.1007/s11127-014-0152-8">experience barriers</a> to registration and licensing in their destination countries.</p>
<p>But in New Zealand the disadvantage some foreign doctors face also extends to the licensing pathways. To be registered, those from non-Western countries must demonstrate clinical skills, including showing Māori cultural competency, while those from “comparable health systems” don’t. </p>
<p>One might ask, if cultural competency is important in the context of New Zealand’s <a href="https://waitangitribunal.govt.nz/news/report-on-stage-one-of-health-services-and-outcomes-released/">inequitable health outcomes</a>, why shouldn’t all foreign doctors be required to demonstrate this before being licensed? </p>
<p>With so many foreign-trained doctors in New Zealand unable to work, even after passing their licensing exams, we argue the problem is less about brain drains or brain gains. Rather, it reflects a “brain waste” for both the doctors themselves and for Aotearoa New Zealand, as Omicron threatens to stretch a system already in crisis.</p><img src="https://counter.theconversation.com/content/175914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharon McLennan received funding from the Royal Society of New Zealand's Marsden Fund.</span></em></p><p class="fine-print"><em><span>Johanna Thomas-Maude does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The pathway for foreign doctors to practise in New Zealand is neither easy nor very fair, meaning an over-stretched health system is missing out on valuable expertise.Johanna Thomas-Maude, PhD Candidate, Massey UniversitySharon McLennan, Senior Lecturer in Development Studies, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1695522021-11-02T14:40:57Z2021-11-02T14:40:57ZAfrica needs to speed up research excellence: here’s how<figure><img src="https://images.theconversation.com/files/426216/original/file-20211013-13-1smu13i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Africa accounts for 12.5% of the world’s population, but produces less than 1% of global research output.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Prospective students and their parents have been examining the recently published <a href="https://www.topuniversities.com/university-rankings/world-university-rankings/2022">2022 World</a> University Rankings. </p>
<p>The ranking pattern has now become familiar. </p>
<p>European, American and Asian universities jostle for the top positions while a sprinkling of African universities start appearing after the first 200. Some don’t even enter the rankings. This is despite universities in Africa making the <a href="https://www.universityworldnews.com/post.php?story=20210907084121756">most progress in the rankings since 2018</a>. The rankings are derived using various measures. These include funding and endowment, research excellence or influence, specialisation expertise, student admissions and options, and historical reputation. </p>
<p>Africa accounts for 12.5% of the world’s population. But it produces less than <a href="https://www.elsevier.com/connect/africa-generates-less-than-1-of-the-worlds-research-data-analytics-can-change-that">1% of global research output</a>. Sub-Saharan Africa has the lowest research capacity and <a href="https://thedocs.worldbank.org/en/doc/764421611934520379-0090022021/original/OneAfricaTEandCovidupdated.pdf">output in the world</a>. At this rate the region’s universities are unlikely ever to break into the top 10 – or even 50.</p>
<p>The continent has no shortage of intelligent, hardworking and innovative people. These rankings indicate that Africa is not tapping its full potential. How can the continent’s research potential be enabled to make its full contribution to domestic and global challenges?</p>
<p>We cannot manage or improve what we do not measure. So, I propose the creation of a Research Excellence Barometer for Africa (REBA). As a Zimbabwean I feel this is particularly apt – <em>reba</em> is the Shona verb “to grow tall”.</p>
<p>The barometer would operate at country level. It would identify areas of research excellence and areas of weakness.</p>
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Read more:
<a href="https://theconversation.com/covid-19-shows-why-africas-reliance-on-outsiders-for-health-services-is-a-problem-163441">COVID-19 shows why Africa's reliance on outsiders for health services is a problem</a>
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<p>Tools like this can be transformative. For example, a few years ago I contributed to an assessment of national health research systems in Africa using a <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0492-8">research barometer</a>. The work was prompted by the recognition that health systems lacked resources and research capacity to deliver on the UN’s Sustainable Development Goals. </p>
<p>Between 2014 and 2018, 47 WHO Africa Region member states used the barometer to <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0492-8">monitor, identify and address critical gaps</a> in national health research systems. This has delivered significant progress over just four years. For example, there was significant progress in the governance of research for health; developing and sustaining research resources; and producing and using research. </p>
<p>Something similar, but more ambitious, can help transform Africa’s entire scientific research ecosystem.</p>
<h2>Research ecosystems</h2>
<p>Currently, among Africa’s <a href="https://www.leadersofafrica.org/analysis/youth-unemployment-dilemma-in-africa-recent-data/">10-12 million</a> annual graduates, those wishing to continue their research face huge challenges. Poorly equipped and funded institutions translate into low salaries. Limited domestic investment results in poor research funding and stifles innovation. Weak research support systems mean researchers carry huge administrative burdens. Some research governance and regulatory systems are cumbersome. It’s hard to have a career in research in such an environment.</p>
<p>Three undesirable outcomes are the result: </p>
<ul>
<li><p>limited, “less expensive” research, not necessarily addressing relevant local challenges </p></li>
<li><p>inequitable, externally funded collaborations where the African researcher is the data or sample collector for researchers in western institutions </p></li>
<li><p>movement of people to better paying, equipped and funded western institutions.</p></li>
</ul>
<p>Of the <a href="https://www.oecd.org/coronavirus/policy-responses/contribution-of-migrant-doctors-and-nurses-totackling-covid-19-crisis-in-oecd-countries-2f7bace2/">10 countries</a> in the world that lose more than half of their medical graduates to work abroad, six are in sub-Saharan Africa. This means Africa loses health workers as well as potential clinical researchers. </p>
<p>My proposed barometer would identify African countries where the research ecosystem is poor, and brain drain is a significant problem and highlight policies and circumstances contributing to these. The barometer would also identify best practice in countries that score well in these, for sharing across the continent.</p>
<p>The large number of existing ranking systems is evidence of their value. For example, the <a href="https://afrobarometer.org/about">Afrobarometer</a> measures public attitudes on democracy, governance, the economy and society; and the <a href="https://www.brookings.edu/interactives/africa-learning-barometer/">Africa Learning Barometer</a> analyses the state of education and learning. </p>
<p>It is therefore a surprise and an oversight that there’s no such tool for the national ease and capacity of conducting research. Ultimately, the barometer I propose is not about competition. It’s about creating signposts on the road to functional national research ecosystems, celebrating excellence and addressing weakness along the way.</p>
<p>The barometer would include all science disciplines. It would measure among others, the state of national research governance, including all research foundations and academies, research policies - including procurement and importation, ethical review and sample sharing processes/policies. It would also look at number and type of research institutes and their infrastructure. Other important factors to measure are systems for research uptake and implementation; local research financing; and salaries, benefits and job satisfaction among scientists. </p>
<h2>Going forward</h2>
<p>Setting up the barometer requires time and investment, but its impact on the African research ecosystem will far outweigh the cost.</p>
<p>Implementation could follow the WHO Africa National Health Research Systems Barometer model where input data is collected from ministries of health via WHO country offices. The data collection pipeline can use links between tertiary education, science, innovation and technology ministries, the African Union, Regional Economic Community or UNESCO country representatives.</p>
<p>This all requires buy-in and a commitment from African stakeholders and national governments. </p>
<p>A well-constructed and fully adopted Research Excellence Barometer for Africa would guide the continent to support the right research, by the right people, in the right places, and for the right reasons. It would contribute to retaining talent and expertise and ensure that Africans benefited from their own research efforts.</p><img src="https://counter.theconversation.com/content/169552/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francisca Mutapi receives funding from the UK National Institute for Health Research and the Royal Society (UK).
She is a 2021 TED Fellow and a 2021 Aspen New Voices Fellow </span></em></p>The creation of a Research Excellence Barometer for Africa would contribute to retaining talent and expertise and ensure that Africans benefited from their own research efforts.Francisca Mutapi, Professor in Global Health Infection and Immunity. and co-Director of the Global Health Academy, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1641222021-07-22T12:19:36Z2021-07-22T12:19:36ZBrain drain is a hidden tax on the countries left behind<figure><img src="https://images.theconversation.com/files/412641/original/file-20210722-15-khjhbi.jpg?ixlib=rb-1.1.0&rect=0%2C3%2C2556%2C1686&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many doctors and healthcare staff feel the need to practice in richer countries that offer a more stable politics, better education and opportunities for their families.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Pediatric_doctors_at_Donka_hospital_reviewing_mealses_cases.jpg">Julien Harneis</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Dr John Baptist Mukasa, or JB Neuro, as his colleagues called him, “was always at the beck and call of everyone who needed neurosurgical care”, <a href="https://www.monitor.co.ug/uganda/news/national/covid-19-medics-who-have-died-in-line-of-duty--3457244">according to</a> his colleague Dr Sabrina Kitaka. Mukasa’s <a href="https://www.newvision.co.ug/articledetails/107415">death from COVID</a> on June 29, in the middle of <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=%7EUGA">Uganda’s most lethal wave so far</a>, robbed the country’s medical fellowship of a friend and a mentor.</p>
<p>It also cut the total number of neurosurgeons in Uganda <a href="https://www.newvision.co.ug/articledetails/107415">by 25%</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1409883071038566401"}"></div></p>
<p>Only <a href="https://www.newvision.co.ug/articledetails/107415">three</a> neurosurgeons remain in Uganda, a country of 44 million people (although some estimates put the workforce as high as <a href="https://wfns.org/menu/61/global-neurosurgical-workforce-map">ten</a>). By comparison, Canada, with a population of 35 million, has over 150 neurosurgeons. New York City’s Columbia Presbyterian Hospital, where I did my residency, has <a href="https://www.columbianeurosurgery.org/doctors/">17 neurosurgeons in one department alone</a> – several times larger than the entire neurosurgical workforce of Uganda.</p>
<p>There are many reasons for this disparity, including a lack of training facilities and hospitals capable of supporting complex surgical care. And then there’s the <a href="https://theconversation.com/finlands-brain-drain-what-happens-to-small-countries-when-the-talent-leaves-79952">brain drain</a> – the <a href="https://theconversation.com/why-nigerias-doctors-are-leaving-and-how-the-problem-can-be-fixed-117860">migration of trained professionals</a> out of a country to other, often wealthier, locations. </p>
<h2>Brain drain is taxation</h2>
<p>There are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1275994/">many reasons doctors leave</a>. A higher salary, access to education, stable political conditions, improved standards of living, increased perceived quality of life, and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961826-1/fulltext">greater personal safety</a> all draw doctors away from their homes and often to countries that previously colonised theirs.</p>
<p>It’s a multi-billion–dollar industry. Recently, my colleagues and I published an estimate of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042584/">the economic effect of the migration of doctors</a> (we didn’t have enough information to look at the migration of nurses or other health professionals). We found that countries lose somewhere between US$3.5 billion and US$38 billion a year as a result of the excess deaths that brain drain causes. The countries exporting the greatest number of doctors incur the largest costs: India, Nigeria, Pakistan and South Africa.</p>
<p>In other words, not only do the countries to which doctors migrate benefit from an influx of trained, experienced professionals, they also inflict what is essentially a tax on the economies of source countries — all for the privilege of attracting away their clinical staff.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map showing main routes of migration by doctors from poorer to richer countries." src="https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=284&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=284&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=284&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=357&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=357&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412133/original/file-20210720-27-2ylm4u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=357&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Migration of doctors from source (orange) countries to destination (green) countries.</span>
<span class="attribution"><a class="source" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042584/">Saluja, Rudolfson, Massenburg, Meara, Shrime/BMJ Global Health</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<h2>Brain drain and COVID</h2>
<p>In 2010, the World Health Organization agreed the <a href="https://www.who.int/hrh/migration/code/WHO_global_code_of_practice_EN.pdf">Global Code of Practice on the International Recruitment of Health Personnel</a>. This agreement encouraged source countries to hold onto their healthcare workforce by improving education, living standards and working conditions (it didn’t address how this could be achieved in the face of limited resources). The agreement also required destination countries to <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0198-0">stop recruiting from countries with a shortage of healthcare workers</a>.</p>
<p>But that never happened. In fact, at the beginning of the COVID pandemic, active recruitment of doctors from these source countries stepped up as the scale of the crisis became clear.</p>
<p>COVID initially hit richer countries in Europe and the US hard, pummelling Italy, Spain and New York City, leaving countries in Africa relatively unscathed. It seemed pretty miraculous, prompting commentators to <a href="https://www.bbc.com/news/world-africa-54418613">offer reasons</a> for Africa’s <a href="https://www.medicalnewstoday.com/articles/what-explains-africas-successful-response-to-the-covid-19-pandemic">relative success</a>. </p>
<p>Calls rose for medical professionals from resource-constrained regions to help shoulder the burden of the pandemic in these wealthier countries — flying in the face of the WHO code of practice. These calls went beyond simple recruitment. Some offered additional incentives to entice doctors to stay: for example, the UK <a href="https://www.theguardian.com/world/2020/mar/25/covid-19-call-for-fast-track-registration-of-refugee-doctors-in-uk">fast tracked registration of doctors trained outside the country</a>. </p>
<p>Now that the pandemic has swung back to ravage Africa, India and other parts of the world, this is a favour that the more wealthy nations have not returned. </p>
<p>Since I began writing this piece, Uganda also lost a 36-year-old ENT surgeon, <a href="https://www.facebook.com/KakensaMed/posts/205205844828872">Dr Ian Bwete Apuuli</a>. During the pandemic, he performed tracheotomies on COVID patients, allowing them the chance to breathe without ventilation. But tracheotomies generate aerosols, and aerosols carry infection. Apuuli succumbed to the disease, leaving Uganda with only one surgeon trained to remove tumours from the head and neck.</p>
<p>The brain drain of healthcare workers from countries that can scarcely afford to lose them is not an emotionless, economic discussion. When we actively entice doctors not just to come and help, but to and come and stay, the effect is more than temporary. It is more than monetary. It undermines the entire health systems of the countries these doctors leave behind.</p><img src="https://counter.theconversation.com/content/164122/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Shrime receives funding from the Iris O'Brien Foundation and is on the board of Pharos Global Health Advisors. </span></em></p>India, Nigeria, Pakistan and South Africa lose thousands of trained doctors each year, lured away to work in richer countries – at great cost to their nation’s healthcare systems.Mark Shrime, Chair of Global Surgery, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1430302020-08-04T15:23:17Z2020-08-04T15:23:17ZAfrica’s research ecosystem needs a culture of mentoring<figure><img src="https://images.theconversation.com/files/350845/original/file-20200803-16-1lxp0dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mentoring can help build the confidence of young researchers in Sub-Saharan Africa </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/african-centre-of-excellence-for-genomics-of-infectious-news-photo/1227450975?adppopup=true">Pius Utomi Ekpe/AFP via Getty Images </a></span></figcaption></figure><p>Sub-Saharan Africa faces a range of development challenges, including <a href="https://blogs.worldbank.org/africacan/7-facts-about-population-in-sub-saharan-africa">high population growth</a>, <a href="https://isdsnet.com/ijds-v3n12-3.pdf">poverty</a>, <a href="https://www.frontiersin.org/articles/10.3389/fsufs.2019.00104/full">food insecurity</a>, and <a href="https://www.who.int/bulletin/africanhealth/en/">poor health</a>. There is <a href="https://www.britishcouncil.org/sites/default/files/h233_07_synthesis_report_final_web.pdf">a clear need</a> for qualified and skilled researchers to tackle these issues. But there is also a scarcity. For instance, Sub-Saharan Africa <a href="https://dl.uswr.ac.ir/bitstream/Hannan/79487/1/2018%20Lancet%20Volume%20392%20Issue%2010153%20September%20%2825%29.pdf">contributes less than 1%</a> to global research output despite accounting for <a href="https://dl.uswr.ac.ir/bitstream/Hannan/79487/1/2018%20Lancet%20Volume%20392%20Issue%2010153%20September%20%2825%29.pdf">13.5% of the global population</a>.</p>
<p>This asymmetry calls for a <a href="https://dl.uswr.ac.ir/bitstream/Hannan/79487/1/2018%20Lancet%20Volume%20392%20Issue%2010153%20September%20%2825%29.pdf">response</a> that builds research capacity and trains skilled researchers for the continent. Mentoring is a key ingredient of this approach. </p>
<p>Mentoring can help build the confidence of young scholars by improving research outputs, thereby <a href="https://www.sciencedirect.com/science/article/pii/S1877042813032837">reducing</a> the likelihood of brain drain from the region. But higher education programmes don’t always provide regular mentoring opportunities. And where there are opportunities, there may be other <a href="https://europepmc.org/article/med/27170084">barriers</a> to building research capacity. These include scarcity of mentors, ambiguity in mentor-mentee relationships, limited mentoring knowledge and skills, <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0962-8">lack of formal structure</a> and the nonsupporting cultural atmosphere of African institutions of learning.</p>
<p>Mentoring can confer many <a href="https://journals.lww.com/academicmedicine/Fulltext/2013/07000/Mentoring_Programs_for_Physicians_in_Academic.37.aspx">benefits</a> to the careers of junior faculty. But there are challenges in finding mentors or sustaining relationships with them. This has already been highlighted by other <a href="https://www.researchgate.net/publication/316650133_Challenges_facing_young_African_scientists_in_their_research_careers_A_qualitative_exploratory_study">researchers</a> in the region. It could have serious implications for the development of research in the region. For instance, researchers who do not have mentors may not be motivated to continue their academic programmes or may try to <a href="https://www.sciencedirect.com/science/article/pii/S1877042813032837">leave the region</a>.</p>
<p>Understanding this need, we conducted <a href="https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1776365">research</a> among doctoral fellows in the <a href="http://cartafrica.org/">Consortium for Advanced Research Training in Africa</a> (CARTA) programme. The aim was to examine the mentoring experiences of fellows within the programme and highlight how mentoring can be further improved.</p>
<p>Our study established that there is a need to improve institutional capacity for the development of mentoring systems in higher education and research systems in Africa. This matters because mentoring in the region can sustain the gains being made to retain African researchers for development.</p>
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Read more:
<a href="https://theconversation.com/africas-research-capacity-is-growing-thats-good-news-for-pandemic-response-efforts-142293">Africa's research capacity is growing. That's good news for pandemic response efforts</a>
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<h2>Building local research capacity</h2>
<p>The CARTA programme aims to build local research capacity in population and public health by creating a network of locally trained but globally recognised scholars through a <a href="https://www.tandfonline.com/doi/full/10.3402/gha.v3i0.5693">PhD training fellowship </a>. Fellows are usually staff of nine academic and four research institutions representative of Africa. We contacted fellows in the CARTA network through the <a href="https://www.project-redcap.org/">RedCap</a> platform and asked them questions about their perceptions of mentoring and what could be done to improve this aspect of the programme. </p>
<p>At the time of data collection, CARTA had only seven cohorts and each cohort had between 24 and 27 members from diverse academic disciplines and backgrounds. More than half of the respondents worked in health sciences while 35% were in social sciences. Our results showed that only 47% of the fellows had mentors and 20% had mentees. One of the reasons stated for this was the difficulty in finding a mentor.</p>
<p>We also found that fellows perceived mentorship to be a responsibility. They saw it as an opportunity to live up to their duty to scholarship, their mentors and to society. </p>
<p>Several fellows had not received any request for them to act as mentors. We deduced that young scholars within the network may be reluctant to seek guidance useful for their professional development. Poor understanding of the need for and importance of mentoring to academic career growth may also be responsible. It is important that mentees learn the art of networking and gain skills that will help them to confidently seek out mentors within and outside their network. </p>
<p>Peer mentoring, in which CARTA fellows mentor each other, was a striking feature of our findings. Young researchers from different parts of the continent and involved in diverse research topics across varied disciplines help and learn from one another. Peer mentoring should be encouraged as these relationships are likely to increase collaboration among scholars on the continent.</p>
<p>Some fellows who are mentees complained about the delay in getting feedback from mentors. Some of the reasons they identified were time, internet connectivity and geographical time difference. </p>
<p>In the view of the young researchers in our study, a successful mentor-mentee relationship can improve the level of progress in mentees’ research publications and career options. </p>
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Read more:
<a href="https://theconversation.com/international-research-collaborations-how-can-we-shift-the-power-towards-africa-142421">International research collaborations: how can we shift the power towards Africa?</a>
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<h2>Transforming mentoring programmes</h2>
<p>Our results are important as they are quite representative of a broad group of researchers from different countries in sub-Saharan Africa. Mentoring does not seem to be part of the institutional culture or framework in several African institutions. </p>
<p>A well-designed research capacity building programme like CARTA can provide young researchers with mentoring opportunities. Ultimately, combining formal and informal mentoring approaches appears to be the way forward.</p>
<p>The culture of training and capacity building in Africa’s institutions of higher learning must transform to widen the access of young researchers to mentoring opportunities.</p><img src="https://counter.theconversation.com/content/143030/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mentoring can help build the confidence of young scholars in Sub-Saharan Africa, reducing the likelihood of brain drain.Oluwaseyi Dolapo Somefun, Postdoctoral fellow, University of the Western CapeKudus Adebayo, Research Fellow, Institute of African Studies, University of Ibadan, NigeriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1225552019-09-02T12:07:36Z2019-09-02T12:07:36ZScholarly success of African universities: common contributing factors<figure><img src="https://images.theconversation.com/files/290071/original/file-20190829-106494-1s0jusm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It’s not all doom and gloom for African universities – some are getting it right.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As the start of the northern hemisphere academic year <a href="https://monitor.icef.com/2016/12/new-study-highlights-shifting-patterns-african-student-mobility/">hundreds of thousands</a> of students across Africa head to the airport. The reason for this “student exodus” is that those who can afford it head abroad for their tertiary education. </p>
<p>Why do they go? A survey done last year <a href="https://monitor.icef.com/2018/09/african-student-perspectives-study-abroad/">found</a> that 71% of African students studying outside Africa thought a degree earned abroad represented a higher-level qualification than a degree at home. </p>
<p>The <a href="https://www.wittenborg.eu/where-does-modern-african-student-go-when-he-or-she-chooses-study-abroad.htm">exodus</a> can be attributed to numerous reasons. These include inadequate funding of tertiary education resulting in dilapidated campuses and obsolete study programmes that are not adapted to developments in science and technology. Other factors include an absence of research policy and insufficient resources. All these result in a perception of low quality African universities.</p>
<p>That more than 70% of the students interviewed had a jaundiced view of an African degree seems a bit unjust. Nevertheless, the truth is that <a href="https://www.worldometers.info/world-population/africa-population/">17%</a> of the world’s population lives on the African continent. Yet Africa has <a href="https://www.timeshighereducation.com/student/best-universities/best-universities-africa">less than 1%</a> of the world’s top 250 universities. </p>
<p>But it’s not all doom and gloom. There are African universities, despite the financial constraints, that are getting it right.</p>
<p>I did an analysis of universities on the continent to establish which were strongest in terms of research output. I used published research to identify the strongest and sourced scholarly outputs statistics from the academic database <a href="https://www.scival.com/">SciVal</a>. </p>
<p>I used a number of measures for the analysis. These included the number of scholarly outputs (academic publications), the growth of authors contributing to these outputs, the number of international co-authors and the proportion of scholarly outputs in the top 10% of academic journals. I looked at the period between 2014 to 2019.</p>
<p>The number of outputs represents the research productivity of academics within an institution. For their part, articles published in the top 10% of academic journals serve to quantify the quality and impact of the scholarly outputs. The level of international co-authors indicates the level of international research collaboration and global prestige of each institution.</p>
<p>What emerged from the analysis is the similarity in the strategic approaches the best and aspiring African universities employ to achieve an increase in both scholarly output and quality. All universities covered in the article deemed international partnerships as essential to research productivity.</p>
<h2>The best performers</h2>
<p>Two of the top universities in Africa for published research – also known as scholarly output – are the University of Cape Town and the University of the Witwatersrand. Both are in South Africa. They are ranked in the <a href="https://www.timeshighereducation.com/student/best-universities/best-universities-africa">top 250</a> globally.</p>
<p>Both universities have between 30%-35% of all their scholarly output published in the top 10% of global academic journals. This is important for universities’ prestige as well as their finances. </p>
<p>Also notable was the high number of international co-authors in their outputs. At the University of Cape Town it was 60%. At the University of the Witwatersrand it was 54%. </p>
<p>An institution with a rapid increase in scholarly outputs is Egypt’s Zewail City of Science and Technology. Established in 2012, just over 43% of its scholarly outputs were published in the top 10% of global academic journals. In addition, 51% of all its outputs were co-authored with international institutions.</p>
<p>There are positive signs in Nigeria too. The University of Ibadan was the top West African university for scholarly outputs. The university has 15% of all its outputs published in the top 10% of academic journals. And 38% of its publications were co-authored with institutions in other countries.</p>
<p>Another institution with an increasing scholarly output rate is Covenant University, Nigeria. It’s also a relatively young institution – it was opened in 2002. Just over 8% of all its outputs were published in the top 10% of academic journals.</p>
<p>The fact that 31% of its publications were co-authored with institutions in other countries demonstrated a collaborative approach to research. </p>
<p>So how have these African universities bucked the trend, and made their voices heard outside Africa?</p>
<h2>Six key factors</h2>
<p>In researching the issue, I identified six lessons that can be learnt from these successful African universities: </p>
<p><strong>Research excellence:</strong> The University of Witwatersrand has driven a 37% increase in its <a href="https://www.wits.ac.za/media/wits-university/news-and-events/images/documents/2018/2016-2017%20Research%20Report.pdf">scholarly outputs</a> over the last five years, with an emphasis on quality. The university has also adopted a strategic focus on increasing the number of post-graduate students. It aims to have post-graduates as <a href="https://www.wits.ac.za/news/latest-news/general-news/2019/2019-07/huawei-awards-bursaries-to-wits-postgraduate-students.html">45%</a> of its student population by 2022. This, in turn, has helped drive the surge in scholarly output. The university also has a clear focus on priority <a href="https://www.wits.ac.za/research/areas-of-excellence/">research areas</a> where it can make a significant impact. An example is clinical research to manage AIDS.</p>
<p><strong>Research support infrastructure:</strong> Research productivity is crucial for academic promotions within the universities. The University of Cape Town in particular has invested heavily in a pro-research infrastructure. This comes with extensive research administrative support and guidance. In Nigeria, the University of Ibadan recently established <a href="https://www.thenhef.org/news-events/partner-university-spotlight-university-of-ibadan/">a new leadership role</a> to focus on research and innovation.</p>
<p><strong>A balance between the teaching and research workloads, possibly by restricting student intake:</strong> The University of Ibadan, for example, has adopted an approach of rigorously maintaining a student-staff ratio that ensures academic workloads allow time for research. The university has maintained an annual undergraduate intake of approximately <a href="https://www.ngschoolz.net/ui-admission-statistics/">4,000</a> students. This has been despite growing pressure to increase the numbers.</p>
<p><strong>Attracting the best professors and researchers:</strong> The University of the Witwatersrand has made a concerted effort to recruit professors with high citations – <a href="https://www.wits.ac.za/news/latest-news/general-news/2018/2018-04/wits-celebrates-its-rated-researchers.html">“A”-rated professors</a>. </p>
<p><strong>Setting levels of academic expectation:</strong> Covenant University in Nigeria has adopted a research, citations, innovation and teaching agenda that drives academic activities at all levels. There’s significant <a href="https://covenantuniversity.edu.ng/Research2#.XWaRLugzaM8">support</a> for staff through workshops in grant writing and publication. </p>
<p>Zewail City of Science and Technology was founded by Nobel laurate in Chemistry, Professor Ahmed Zewail. It has four Nobel laurates as members of its <a href="https://zewailcity.edu.eg/main/content.php?lang=en&alias=supreme_advisory_board_(sab_)_">Supreme Advisory Board</a>. It’s therefore no surprise that it has a significant number of its scholarly outputs in the top 10% of global academic journals.</p>
<p><strong>Forging international partnerships:</strong> The University of Ibadan, and the University of Nigeria, Nsukka, also emphasise the importance of international references for professorial promotion. The University of Nigeria, Nsukka has taken the decision to actively seek collaborative international partners to mitigate the lack of research infrastructure. </p>
<p><em>As part of his research, the author also conducted interviews with: Dr Marilet Sienaert, Executive Director Research, University of Cape Town, South Africa; Professor Zeblon Vilakazi, Deputy Vice-Chancellor for Research and Postgraduate affairs, University of the Witwatersrand, South Africa; Professor Olanike Adeyemo, Deputy Vice-Chancellor for Research, Innovation and Strategic Partnerships, University of Ibadan, Nigeria; Professor Salah Obayya, Zewail City of Science and Technology, Egypt; Professor Emeka Iweala, Director, Covenant University Centre for Research, Innovation and Discovery, Covenant University, Nigeria; Professor James Ogbonna, Deputy Vice-Chancellor Academic, University of Nigeria, Nsukka, Nigeria.</em></p><img src="https://counter.theconversation.com/content/122555/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Mba does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With limited resources and inadequate infrastructure, African universities appear to be under tremendous strain. But some are beating the odds and getting it right.David Mba, Pro Vice-Chancellor and Dean of Computing, Engineering and Media, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1178602019-07-01T14:03:41Z2019-07-01T14:03:41ZWhy Nigeria’s doctors are leaving, and how the problem can be fixed<figure><img src="https://images.theconversation.com/files/280919/original/file-20190624-97794-3x3mhw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors preparing to perform an operation.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Brain drain is a major challenge facing the <a href="https://www.ajol.info/index.php/rejhs/article/view/165775">Nigerian health system</a>, leading to a dramatic reduction in the number of doctors in the country. According to the Organisation for Economic Co-operation and Development, Nigeria is <a href="https://www.oecd-ilibrary.org/social-issues-migration-health/international-migration-outlook-2015_migr_outlook-2015-en">one of the three leading African sources</a> of foreign-born physicians. </p>
<p>Doctors leave for a variety of reasons depending on where they are in their careers. For example, many leave immediately after graduation. They usually leave for one or two reasons. Firstly, to pursue international residency training. Most in this category usually don’t return to the country. They prefer to work where their newly acquired skills can be put to better use. The second reason is if they fail to find a job or space for residency training. Most in this category also never return home to practice.</p>
<p>There are usually another two sets of leavers: those who leave five to 10 years after graduation – usually for better pay. Finally, there are those who leave after specialist training, which can be up to 10 to 15 years after graduation. Specialists – the most qualified and competent doctors – leave because of better prospects in other countries.</p>
<p>The <a href="https://escholarship.org/uc/item/5q36r5xq">exodus</a> has led to a <a href="https://print.ispub.com/api/0/ispub-article/6444">drop</a> in the quality of health care service due to the absence of skilled personnel. </p>
<p>Nigeria hasn’t been able to get on top of the problem because nothing has been tried. The government doesn’t seem to be concerned. Nigeria was the only African country listed among the <a href="https://pdfs.semanticscholar.org/2f74/1754ee67696ba66341f922cc2c5764b6c288.pdf">20 top exporters</a> of physicians in 2004, with a loss of 5 499 doctors up from 1 519 in 1991. </p>
<p>Health indicators may continue to decline in the absence of aggressive interventions to stop this. More doctors leaving the country will eventually lead to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427605/">shortage of Nigerian medical doctors</a>. This, in turn, will add to the stress and dissatisfaction among those remaining. The poor will not be able to access care while the rich will travel out of the country for medical care. </p>
<p>African politicians – <a href="https://theconversation.com/african-politicians-seeking-medical-help-abroad-is-shameful-and-harms-health-care-82771">including Nigerians</a> – who have the responsibility of improving the country’s health system usually travel abroad for their medical needs. The usual destinations are Europe, North America and Asia. And ordinary citizens spend over <a href="https://www.imtj.com/news/nigeria-spends-1-billion-outbound-medical-tourism/">USD$1 billion</a> annually on what’s become known as medical tourism.</p>
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<strong>
Read more:
<a href="https://theconversation.com/african-politicians-seeking-medical-help-abroad-is-shameful-and-harms-health-care-82771">African politicians seeking medical help abroad is shameful, and harms health care</a>
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<h2>Reasons for leaving</h2>
<p>Poor pay is a major factor for leaving, particularly for mid-career doctors who have families to support. </p>
<p>Apart from pay packages that are <a href="https://www.ncbi.nlm.nih.gov/pubmed/15375449">low</a>, actual payment of salaries is often irregular. In some states, government workers’ salaries aren’t <a href="https://guardian.ng/news/23-states-owing-workers-says-labour/">paid on time</a> every <a href="https://qz.com/africa/663626/nigeria-has-a-culture-of-not-paying-workers-and-its-not-about-to-change-anytime-soon/">month</a>. Delayed salaries were <a href="https://allafrica.com/stories/201806200428.html">reported</a> in Plateau State and <a href="https://punchng.com/n500m-monthly-loan-repayments-responsible-for-irregular-salary-in-kogi-govt/">Kogi State</a> among others. This is true for doctors too. </p>
<p>Another major driver is poor working conditions. This includes having to work extra hours due to inadequate staff, lack of diagnostic facilities or to supplement monthly income. </p>
<p>These problems spring from the Nigerian government’s low funding. In this year’s budget only <a href="https://www.budgetoffice.gov.ng/index.php/2018-budget">3.9% </a> was allocated to health. This is much lower than the estimated <a href="https://www.unicef.org/esaro/UNICEF_South_Africa_--_2017_--_Health_Budget_Brief.pdf">13.5%</a> of South Africa’s national expenditure dedicated to health. </p>
<p>In 2001 African Union countries met and pledged to set a target of allocating at least <a href="https://www.who.int/healthsystems/publications/abuja_declaration/en/">15%</a> of their annual budget to improve the health sector and urged donor countries to scale up support. <a href="https://www.who.int/healthsystems/publications/abuja_report_aug_2011.pdf?ua=1">Ten years</a> after that commitment was made only Mauritius, Seychelles and Eritrea had met the target. </p>
<p>The lack of funding has led to poor remuneration, the underfunding of hospitals which in turn means that medical facilities are inadequate and infrastructure is obsolete.</p>
<p>Other reasons for leaving relate more generally to a lack of infrastructure in the country which makes it difficult to ensure a good standard of living in a favourable environment that promises good future prospects for children. This includes the lack of social amenities such as a good health care system, quality education, roads, electricity and piped water.</p>
<h2>What needs to be done</h2>
<p>To reverse the brain drain, the Nigerian government should create a conducive environment that will ensure <a href="https://www.stearsng.com/article/why-are-medical-doctors-leaving-nigeria">employment opportunities</a> and reduce poverty. It must provide the needed infrastructure such as good roads and transport systems, affordable and functional education, water supply, security, stable energy in addition to good health care system.</p>
<p>On their own, these won’t be enough to prevent the brain drain among medical doctors – and other professionals. It would need to be supplemented by other strategies. These should include providing financial and other incentives to stay. Institutional capacity-building that promotes career development should be fostered, along with mentorship opportunities as well as efforts to improve <a href="https://escholarship.org/uc/item/5q36r5xq">working conditions</a>. </p>
<p>A central human resource planning body should be instituted. This would ensure a continuous increase in the number of health care workers through careful coordination and prediction of number of <a href="http://seahipaj.org/journals-ci/mar-2016/IJIHCR/full/IJIHCR-M-2-2016.pdf">medical graduates</a>. </p>
<p>Enforcement of Bill of Patients’ Rights in Nigeria as well as National Health Insurance are <a href="https://www.thisdaylive.com/index.php/2019/03/28/experts-charge-fg-doctors-to-halt-brain-drain/">due for consideration</a>. Without policies that will lead to available and accessible health care for all the bill may not have its desired impact.</p><img src="https://counter.theconversation.com/content/117860/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olayinka Stephen Ilesanmi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To reverse brain drain, the government should create a conducive environment for investment that will ensure employment opportunitiesOlayinka Stephen Ilesanmi, Lecturer, Department of Community Medicine, University of IbadanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/974042018-08-21T13:44:31Z2018-08-21T13:44:31ZWhat’s stopping young African scientists from achieving their potential<figure><img src="https://images.theconversation.com/files/231643/original/file-20180813-2894-mxi5d9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young African scientists face persistent barriers which cause them to leave academia.</span> <span class="attribution"><span class="source">Shutterstock/WAYHOME studio</span></span></figcaption></figure><p>Young African scientists face <a href="https://theconversation.com/how-africa-is-tackling-next-generation-fears-in-academia-49057">persistent barriers</a> which cause them to leave their own countries, and even academia. This means the continent’s work force loses highly trained people who are crucial for scientific and technological advancement, and for economic development.</p>
<p>It’s estimated that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637331/">20,000 highly</a> educated professionals leave the continent annually, with <a href="http://www.universityworldnews.com/article.php?story=20081214092057738">up to 30%</a> of Africa’s scientists among them. </p>
<p>A number of factors contribute to this trend. The extreme factors include war and political instability. But the more common “pushes” are a desire for higher pay, better opportunities, and the search for a conducive research environment – one where infrastructure and management help drive careers and research potential.</p>
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<img alt="" src="https://images.theconversation.com/files/232444/original/file-20180817-165946-lfdsz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/232444/original/file-20180817-165946-lfdsz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=302&fit=crop&dpr=1 600w, https://images.theconversation.com/files/232444/original/file-20180817-165946-lfdsz5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=302&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/232444/original/file-20180817-165946-lfdsz5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=302&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/232444/original/file-20180817-165946-lfdsz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=379&fit=crop&dpr=1 754w, https://images.theconversation.com/files/232444/original/file-20180817-165946-lfdsz5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=379&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/232444/original/file-20180817-165946-lfdsz5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=379&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Movement of survey respondents within and out of Africa over the last 10 years.</span>
<span class="attribution"><span class="source">Generated by Hsin-Chou Yang and Chia-Wei. Not publicly available</span></span>
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<p>To identify all the barriers and develop strategies to address them, the <a href="https://globalyoungacademy.net/">Global Young Academy</a> – an organisation of 200 talented young scientists and over 200 alumni from 83 countries – established the Global State of Young Scientists (<a href="https://globalyoungacademy.net/activities/the-global-state-of-young-scientists/">GloSYS</a>) Africa project. Working with <a href="https://globalyoungacademy.net/global-state-of-young-scientists-project-researchers-meet-in-morocco/">local research partners</a> and international higher education experts, the project aims to identify the challenges and motivations that shape young scientists’ career trajectories. </p>
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<a href="https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=208&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=208&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=208&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=261&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=261&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222521/original/file-20180611-191965-1d2jpyw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=261&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Global Young Academy members ran a GloSYS workshop at the Next Einstein Forum Global Gathering in Kigali.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/nexteinsteinforum/albums/72157693278337691">NextEinsteinForum/flickr</a></span>
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<p>Our initial findings point to a lack of mentoring, resources and funding as key issues young scientists face across the continent. Using this data, we will be able to identify critical areas in which young scientists need support and develop innovative strategies to alleviate these challenges.</p>
<p>The project comes at an important time as, over the past few years, African countries have initiated programmes to <a href="http://www.universityworldnews.com/article.php?story=20090529112249793">increase</a> the number of PhD graduates. But if governments don’t simultaneously develop support structures for graduates, and increase access to critical teaching and research infrastructure, these young scientists are set up to fail. </p>
<h2>The study</h2>
<p>The Global State of Young Scientists Africa project, uses an <a href="https://glosys.typeform.com/to/Cup20s">online survey</a> (which is currently open to respondents) and in-depth interviews to gather as much detail as possible. It looks at young scientists’ motivations, career ambitions and the barriers they experience in fulfilling their career aspirations.</p>
<p>It targets researchers and scholars who have earned a Masters or PhD within the last 10 years, irrespective of their current employment status and sector. It’s also open to current PhD students in Africa and African scientists and scholars currently living in the diaspora. </p>
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<p>Having this wide range of participants means the data will reflect a broad range of experiences. From early-career researchers with a history of moving within and out of Africa, to those who have never left their home countries. From department heads, to researchers who have trouble finding work despite their high qualifications. The team is also particularly interested in hearing from early career researchers outside of academia, as this helps us understand their reasons for not pursuing a career in research.</p>
<p>From our preliminary survey results – drawn from more than 700 young scientists’ responses – we have found that, even with diverse backgrounds, early-career researchers have a great deal in common. A lack of mentoring, infrastructure, resources (staff and material) and funding for research and resources are key reasons for not pursuing a career in academia. There is also a strong desire for more training in grant writing and professional skills.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/231583/original/file-20180812-2909-wl2a21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Career challenges young scientists from Africa are experiencing.</span>
</figcaption>
</figure>
<p>Using this information, the GYA plans to develop programmes to address the challenges, as we’ve previously done. </p>
<p>This is the third survey done under the Global State of Young Scientists umbrella. The first was a global <a href="https://globalyoungacademy.net/publications/the-global-state-of-young-scientists/">study</a> of young scientists from 14 countries across five continents. The second was a regional study which focused on <a href="https://globalyoungacademy.net/publications/the-global-state-of-young-scientists-in-asean/">four Southeast Asian countries</a>. </p>
<p>A major challenge identified from those two studies was the desire for training in leadership skills. As these young scientists began to grow their own research groups they needed the tools to deal with the challenges of integrating research, teaching, and fundraising. In response, Global Young Academy members developed and implemented science leadership programmes in <a href="http://www.futureafrica.science/index.php/leadership-programmes/aslp">Africa</a> and <a href="http://www.nationmultimedia.com/business/First-Science-Leadership-Programme-for-Asean-30290867.html">Asia</a>, in collaboration with creative facilitators <a href="http://knowinnovation.com/">KnowInnovation</a> and <a href="http://www.futureafrica.science/">Future Africa</a>. </p>
<p>Obtaining these new skills created an incentive for the young scientists to pursue their career in academia. The fellows found, for instance, the science leadership programmes to be one to the most significant workshops of their careers. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MgoqpaCac4I?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Anecdotes from fellows of the Africa Science Leadership Program.</span></figcaption>
</figure>
<h2>From barriers to action</h2>
<p>The African leg of the survey continues. Once common challenges have been identified, the team will then work with policymakers in Africa as well as with international funding bodies to develop evidence-based initiatives to address them.</p>
<p>It’s hoped that the Global State of Young Scientists Africa project will highlight further areas of need, so that the Academy can develop new innovative programmes in collaboration with science and education policymakers to improve young African scientists’ prospects.</p>
<p><em>Early career researchers from and in Africa can become involved by taking the <a href="https://glosys.typeform.com/to/Cup20s">GloSYS Africa survey</a>. The survey will remain open until mid September 2018 with results to be published at the beginning of 2019.</em></p>
<p><strong><em>Marie Luise Neumann, GloSYS project researcher for the Global Young Academy assisted in the writing of this article</em>. <em>Mobility data analysis was conducted by Dr Hsin-Chou Yang and his research team at the Institute of Statistical Science Academia Sinica, Taiwan</em></strong></p><img src="https://counter.theconversation.com/content/97404/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The GloSYS study receives funding from the German Federal Ministry of Education and Research (BMBF) and the Wellcome Trust.
Anna Coussens receives funding from the Walter and Eliza Hall Institute of Medical Research, South African MRC, US National Institute of Heath. She is affiliated with the Global Young Academy and is a Laboratory Head at the Walter and Eliza Hall Institute of Medical Research.
</span></em></p><p class="fine-print"><em><span>Abidemi James Akindele, Badre Abdeslam, Fridah Kanana, and Mona Khoury-Kassabri do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Global State of Young Scientists Africa project investigates the challenges that shape the career trajectories of young African scientists.Anna Coussens, Honorary Associate Professor in Medical Microbiology, University of Cape TownAbidemi James Akindele, Lecturer, University of LagosBadre Abdeslam, Professor, Social Sciences, Université Mohammed V de RabatFridah Kanana, Senior lecturer, Kenyatta UniversityMona Khoury-Kassabri, Postdoctoral fellow, Hebrew University of JerusalemLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/865522017-10-31T13:16:19Z2017-10-31T13:16:19ZSouth Africa can’t afford to see its universities pitch over the precipice<figure><img src="https://images.theconversation.com/files/192447/original/file-20171030-18700-cdgn8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africa boasts world class universities. It must not allow their quality to drop.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>For the past two years the actions of <a href="http://chet.org.za/data/sahe-open-data">government</a> and protesting <a href="http://www.sahistory.org.za/article/student-protests-democratic-south-africa">students</a> have slowly started squeezing South Africa’s universities into a shadow of their former selves.</p>
<p>In his book “<a href="http://nb.bookslive.co.za/blog/2017/05/23/as-by-fire-an-urgent-and-necessary-book-on-the-south-african-student-protests-crisis/">As by Fire</a>” prominent educationalist Jonathan Jansen argues that South Africa is witnessing the end of its universities. He explains that this doesn’t mean the doors will close. Registration will not stop. The day to day business of universities will continue. But, he warns, the excellence evidenced by the rankings of South African universities will slowly dip into oblivion.</p>
<p>South Africa is the only country in Africa with ten universities that regularly feature on at <a href="https://www.topuniversities.com/university-rankings/world-university-rankings/2018">least one</a> world <a href="https://www.timeshighereducation.com/world-university-rankings/2017/world-ranking#!/page/0/length/25/sort_by/rank/sort_order/asc/cols/stats">ranking list</a>. These ten are institutions that South Africans can be hugely proud of and whose achievements could serve as models for expanding excellence to other institutions.</p>
<p>The <a href="http://www.uct.ac.za/usr/news/downloads/2016/UniversitiesFundingSouthAfrica_FactSheet.pdf">decline in government funding</a> to South African universities has meant that institutions have had to look elsewhere to cover costs. This has inevitably included <a href="http://www.uct.ac.za/usr/news/downloads/2016/UniversitiesFundingSouthAfrica_FactSheet.pdf">increasing student tuition</a>. In turn, this contributed to student protests in 2015 and 2016. In some instances those protests shut down institutions – suspending their normal functioning for days or weeks at a time. </p>
<p>Shut downs have knock-on effects, some of them long lasting. If universities have to close their doors terms are delayed. Students don’t graduate and don’t pay fees. Universities cannot balance their budgets and infrastructure is not maintained. Staff salaries can’t be paid and academics have to work two or three jobs to survive. </p>
<p>The impact is also felt when it comes to funding. Funding agencies have deadlines and if research outputs are not met grants get cancelled. If grants are cancelled there is less money for equipment. Post graduate student bursaries are cancelled. Post graduate students drop out and go elsewhere and even if new research grants are awarded the students are no longer available to do the research. Then the research outputs cannot be met - again. </p>
<p>Universities elsewhere – in <a href="https://theconversation.com/when-politics-and-academia-collide-quality-suffers-just-ask-nigeria-67313">Nigeria</a>, <a href="https://theconversation.com/kenyas-universities-are-in-the-grip-of-a-quality-crisis-54664">Kenya</a> and, as Jansen <a href="http://www.universityworldnews.com/article.php?story=2017082408304974">himself writes</a>, Zimbabwe and Uganda – stand as a stark warning. South Africa must act to halt the decline and save its universities’ well deserved global reputation of excellence.</p>
<h2>Sustaining universities</h2>
<p>Who cares about universities’ world rankings? Isn’t this just an elitist system in which South Africa cannot afford to compete given its <a href="http://www.statssa.gov.za/?p=9989">declining economy</a>? </p>
<p>No, it’s not. Excellence in academia is a self perpetuating cycle. Break this cycle and universities dive into a spiral of decline. </p>
<p>Excellent students complete their degrees in the minimum time. They drive excellence in an institution’s research programmes. They then become top quality post graduate students who in turn become top class academics and a university’s research machine benefits. These graduates have the ability and the interest needed to engage with a university’s research activities. Because they excel academically, they are often keen to get to grips with more advanced research.</p>
<p>What I’ve found is that getting students involved early on in research often inspires them to study further, equipping them to be future lecturers and professors. Many research programmes – including <a href="https://www.fabinet.up.ac.za/index.php/research-groups/dst-nrf-centre-of-excellence-in-tree-health-biotechnology">my own</a> and that of the faculty in which I work – offer opportunities for undergraduate students to work in their laboratories. In this way students can participate in an institutions’ research activities. </p>
<p>In turn, increased research output <a href="http://www.dhet.gov.za/Policy%20and%20Development%20Support/Research%20Outputs%20policy%20gazette%202015.pdf">benefits universities financially</a>. </p>
<p>Keeping a steady flow of research output will ensure that South Africa can continue to boast some of the world’s top ranked research programmes. The universities of Pretoria, the Witwatersrand and Cape Town are considered <a href="http://www.heraldlive.co.za/news/2017/04/10/three-sa-universities-score-top-marks-world-subject-rankings/">world leaders</a> in mycology, ornithology, anthropology and area studies. The research programmes that earned them these rankings depend on access to top quality postgraduate students. These bright young minds drive world class research – and they come from all over the world.</p>
<p>My own programme has attracted students from Australia, China, Iran, Kenya, Korea, Nigeria, Vietnam and Zimbabwe who are now studying with me. I have in the past also had the privilege of supervising students from Cameroon, Colombia, Chile, Ethiopia, Germany, Lesotho, Namibia, Oman, Switzerland, Uruguay, Venezuela and Zambia. This internationally rich group of students benefits my research and is hugely stimulating to the South Africa students in the programme. </p>
<h2>Preventing brain drain</h2>
<p>The common thread here is engaging students and providing them with the facilities and environment that will keep them in South Africa. Brain drain is <a href="https://businesstech.co.za/news/general/120211/this-map-shows-where-all-south-africas-skilled-workers-are-going/">a reality</a>. The country <a href="https://mg.co.za/article/2016-06-10-00-scarce-skills">needs more</a> doctors to staff its hospitals and engineers to build its power stations. Losing skilled professionals is <a href="https://businesstech.co.za/news/wealth/193764/how-the-rush-to-leave-south-africa-is-starting-to-hurt-business/">bad for the economy</a>.</p>
<p>In addition, university students the world over have changed the direction of business, governments and politics because they are a country’s intellectual leaders. When the strongest of these students choose not to study at universities in their homeland the country is robbed of its next generation of leaders.</p>
<p>Universities must maintain their excellence – or watch their best and brightest minds <a href="https://www.washingtonpost.com/r/2010-2019/WashingtonPost/2016/07/13/Editorial-Opinion/Graphics/KF_Report.pdf">choosing to study</a> and perhaps settle elsewhere.</p>
<p>The role of universities is to educate. They need to produce research and attract brilliant young thinkers who will, ultimately, contribute to a stronger economy and society. South Africa’s universities have long fulfilled these roles. The country cannot afford to see its tertiary education sector pitch over the precipice.</p><img src="https://counter.theconversation.com/content/86552/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brenda Wingfield is a Professor in Genetics at the University of Pretoria
She holds the DST-NRF SARChI chair in Fungal Genomics
She is one of the vice presidents of the Academy of Science of South Africa (ASSAf) </span></em></p>South Africa must act to halt the decline and save its universities’ well deserved global reputation of excellence.Brenda Wingfield, Vice President of the Academy of Science of South Africa and DST-NRF SARChI chair in Fungal Genomics, Professor of Genetics, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/789672017-06-27T14:57:44Z2017-06-27T14:57:44ZChina tops US and UK as destination for anglophone African students<figure><img src="https://images.theconversation.com/files/175161/original/file-20170622-11971-1w6bqoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More and more African students head to China each year to study.</span> <span class="attribution"><span class="source">REUTERS/Bobby Yip </span></span></figcaption></figure><p>The surge in the number of African students in China is remarkable. In less than 15 years the African student body has grown 26-fold – from just under <a href="http://old.moe.gov.cn//publicfiles/business/htmlfiles/moe/moe_850/201001/xxgk_77826.html">2,000</a> in 2003 to almost <a href="http://www.moe.gov.cn/jyb_xwfb/gzdt_gzdt/s5987/201604/t20160414_238263.html">50,000</a> in 2015. </p>
<p>According to the <a href="http://data.uis.unesco.org/">UNESCO Institute for Statistics</a>, the US and UK host around 40,000 African students a year. China surpassed this number in 2014, making it the second most popular destination for African students studying abroad, after France which hosts just over 95,000 students. </p>
<p>For years, these numbers have remained untranslated in the online archives of the Chinese Ministry of Education. But a <a href="https://breezegeography.wordpress.com/2017/06/23/stats-on-international-students-studying-in-china/">recent initiative</a> by Michigan State University researchers to translate them introduces the reports to a wider audience.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=567&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=567&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=567&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=713&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=713&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175324/original/file-20170623-21202-15uwna8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=713&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">China has overtaken the UK and US.</span>
</figcaption>
</figure>
<p>Not only have these reports revealed the growth in China-Africa ties. They also make it possible to compare China’s international education trends in a global context. </p>
<h2>China’s targeted focus</h2>
<p>Chinese universities are filled with international students from around the world, including Asia, the Americas, Europe and Oceania. The proportion of Asian international students still dwarfs the number of Africans, who make up 13% of the student body. But this number, which is up from 2% in 2003, is growing every year, and much faster than other regions. Proportionally more African students are coming to China each year than students from anywhere else in the world.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175325/original/file-20170623-22683-hrxogr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The proportion of African students at Chinese universities is steadily growing.</span>
</figcaption>
</figure>
<p>This dramatic increase in students from Africa can be explained in part by the Chinese government’s targeted focus on African human resource and education development. Starting in 2000, China’s <a href="http://www.focac.org/eng/">Forum on China-Africa Cooperation</a> summits have promised financial and political support for African education at home and abroad in China.</p>
<p>Since 2006, China has set scholarship targets to aid African students coming to China for study. For example, at the most recent 2015 summit, China pledged to provide <a href="http://www.focac.org/eng/ltda/dwjbzjjhys_1/hywj/t1327961.htm">30,000 scholarships</a> to African students by 2018. </p>
<p>Although China stopped publishing regional scholarship data in 2008, our data analysis using the 2003-2008 data to generate scholarship estimates suggests that this target is on the way to being met. China seems to be upholding the pledges made towards African education. </p>
<h2>Mutual Benefit - in education and business</h2>
<p>For the Chinese government, <a href="https://www.theguardian.com/world/2013/jul/31/china-africa-students-scholarship-programme">providing education</a> to Africans is an extension of <a href="http://www.jstor.org/stable/10.7722/j.ctt2tt1tp">China’s soft power</a> – cultivating the <a href="https://www.theguardian.com/global-development/2013/apr/29/africa-future-leaders-china-aid-programme">next generation</a> of African scholars and elites. The experience that these students get in China can translate into a willingness to work with China and view China’s internal or external policies favourably in the future. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/175191/original/file-20170622-12015-e600oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/175191/original/file-20170622-12015-e600oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175191/original/file-20170622-12015-e600oh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175191/original/file-20170622-12015-e600oh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175191/original/file-20170622-12015-e600oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175191/original/file-20170622-12015-e600oh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175191/original/file-20170622-12015-e600oh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Providing education to Africans is an extension of China’s soft power on the continent REUTERS/How Hwee Young/Pool.</span>
</figcaption>
</figure>
<p>But what do African students gain in return? <a href="http://china-africa.ssrc.org/">China-Africa scholars</a> have <a href="http://www.tandfonline.com/doi/abs/10.1080/14767724.2012.750492">found</a> that students head to China for many reasons. Some simply go to pursue an education that is affordable, even without a scholarship, while others go for the chance to develop business connections or learn the language of a country presumed to be a rising power. </p>
<p>Based on <a href="https://www.researchgate.net/publication/266296514_African_Students_in_China">several</a> <a href="http://scholar.sun.ac.za/handle/10019.1/70764">surveys</a>, most students tend to be enrolled in Chinese-language courses or engineering degrees. The preference for engineering may be due to the fact that many engineering programs offered by Chinese universities for international students are <a href="https://www.researchgate.net/publication/266296514_African_Students_in_China">taught in English</a>. </p>
<p>The quality of education has received mixed reviews. Some studies have shown that African students are <a href="https://muse.jhu.edu/article/614089/summary">generally</a> <a href="https://journals.co.za/content/ifepsyc/12/2/EJC38604">satisfied</a> with their Chinese education, as long as they can overcome the <a href="http://onlinelibrary.wiley.com/doi/10.1002/smi.978/full">language barriers</a>. <a href="http://www.tandfonline.com/doi/abs/10.1080/14767724.2012.750492">Others</a> found that even if students were not impressed with their education, they appreciated the <a href="http://www.sais-cari.org/data-china-africa-trade/">trade</a> and <a href="https://www.brookings.edu/wp-content/uploads/2016/07/Chinas-Engagement-with-Africa-David-Dollar-July-2016.pdf">business</a> opportunities that a Chinese education made available to them back home. </p>
<h2>The next generation</h2>
<p>It’s difficult to know exactly which African countries are sending the most students to China. These details are not kept by the Chinese Ministry of Education. But the statistics from <a href="http://is.tsinghua.edu.cn/publish/is/9281/2014/20141223111837219723176/20141223111837219723176_.html">Tsinghua University</a> provide an insight. In the 2015-2016 academic year, the majority of the university’s 111 African students came from Zimbabwe, Ethiopia, Tanzania, Morocco, Eritrea, and Cameroon – slightly favouring East Africa. </p>
<p>African students in France <a href="http://www.universityworldnews.com/article.php?story=20130705203103913">overwhelmingly come from</a> francophone West Africa. If Tsinghua’s profile holds true for the larger African student body in China, it means China is an increasingly important player in the education of countries outside of West Africa. </p>
<p>Due to Chinese visa rules, most international students cannot stay in China after their education is complete. This prevents <a href="https://theconversation.com/stemming-reverse-brain-drain-what-would-make-foreign-students-stay-in-the-us-39148">brain-drain</a> and means that China is educating a generation of African students who – unlike their counterparts in France, the US or UK – are <a href="http://www.jstor.org/stable/10.7722/j.ctt2tt1tp">more likely</a> <a href="https://www.researchgate.net/publication/266296514_African_Students_in_China">to return home</a> and bring their new education and skills with them. </p>
<p>It’s still too early to tell how these new dynamics might be shaping geopolitics on the continent.</p>
<p><em>Note: The original, untranslated Chinese Ministry of Education reports are available as follows: <a href="http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/moe_850/201001/xxgk_77826.html">2003</a>, <a href="http://www.moe.gov.cn/srcsite/A20/moe_850/200502/t20050206_77817.html">2004</a>, <a href="http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/moe_850/201001/xxgk_77808.html">2005</a>, <a href="http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/moe_850/201001/xxgk_77799.html">2006</a>, <a href="http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/s3124/201002/82570.html">2007</a>, <a href="http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/s3124/201002/82571.html">2008</a>, <a href="http://www.gov.cn/gzdt/2010-03/22/content_1562026.htm">2009</a>, 2010, <a href="http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/s5987/201202/131117.html">2011</a>, <a href="http://www.moe.gov.cn/jyb_xwfb/gzdt_gzdt/s5987/201303/t20130307_148379.html">2012</a>, 2013, <a href="http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/s5987/201503/184959.html">2014</a>, and <a href="http://www.moe.gov.cn/jyb_xwfb/gzdt_gzdt/s5987/201604/t20160414_238263.html">2015</a>. The Ministry archives were missing reports for 2010 and 2013. Student numbers for these years were calculated using the percent-growth reported in 2011 and 2014 reports, respectively.</em></p><img src="https://counter.theconversation.com/content/78967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Breeze receives funding from the National Science Foundation as part of a Graduate Research Fellowship. </span></em></p><p class="fine-print"><em><span>Nathan Moore does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Newly translated Chinese Ministry of Education records shine light on China’s shifting place in the global higher education landscape.Victoria Breeze, PhD Candidate in Geography, Environment, and Spatial Sciences, Michigan State UniversityNathan Moore, Associate Professor of Geography, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/782772017-05-24T19:35:30Z2017-05-24T19:35:30ZThe WHO’s new African leader could be a shot in the arm for poorer countries<figure><img src="https://images.theconversation.com/files/170793/original/file-20170524-31373-qq2v03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tedros Ghebreyesus, the newly elected Director-General of the World Health Organisation.</span> <span class="attribution"><span class="source">Reuters/Denis Balibouse</span></span></figcaption></figure><p><em>Dr Tedros Ghebreyesus is the first African to be elected as the <a href="http://www.who.int/mediacentre/news/releases/2017/director-general-elect/en/">Director-General</a> of the World Health Organisation (WHO) in its 70 year history. The WHO is the United Nations body that directs its member states on international health issues. David Sanders explains to The Conversation Africa some of the main challenges Ghebreyesus will face in his five-year term.</em> </p>
<p><strong>What is the significance of this appointment?</strong></p>
<p>This is the first time the entire 194-strong WHO assembly voted for the position. Votes were cast by secret ballot. Previously the organisation’s Executive Board selected the DG. The massive margin for Tedros – 133 votes vs 50 for the UK candidate David Nabarro – suggests that the entire Global South voted for him. The size of the landslide had not been expected. </p>
<p>The vote almost certainly represents a vote against <a href="http://www.ghwatch.org/sites/www.ghwatch.org/files/D1_0.pdf">big power domination and machinations</a> in the WHO which often appears to ignore the main challenges and aspirations of low and middle income countries.</p>
<p><strong>What does he bring to the table?</strong></p>
<p>As Ethiopia’s former Minister of Health Ghebreyesus spearheaded major reforms to their health system. This included a massive expansion of primary health care infrastructure and a dramatic increase in health human resources at all levels. He oversaw a rapid increase in the training of doctors, shifted the responsibility for key interventions such as caesarean sections to mid-level workers, and the introduction of community-level workers (Health Extension Agents). </p>
<p>All contributed to <a href="https://www.researchgate.net/publication/307509510_Reduction_in_child_mortality_in_Ethiopia_analysis_of_data_from_demographic_and_health_surveys">impressive improvements in health</a> outcomes – especially in child health. </p>
<p>This track record is certainly behind his election. But he’ll have his work cut out for him. The WHO is experiencing its greatest crisis since its founding in 1948. It’s biggest challenges are finance-related.</p>
<p>The organisation is facing a financial crisis with a <a href="http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_6-en.pdf">US$ 456 million deficit</a> this year. This is bound to mean that there will have to be a major cuts to some programmes. Some might even have to be closed. Retrenchments are also on the cards.</p>
<p>For the past few decades the organisation has increasingly relied on donor funds because member states – particularly richer ones – have been reducing their <a href="http://www.reuters.com/investigates/special-report/health-who-future/">contributions</a>. A full 80% of the organisation’s funding is now from sources other than member states. Donors such as the Bill and Melinda Gates Foundation are making <a href="http://www.reuters.com/investigates/special-report/health-who-future/">major contributions</a>. </p>
<p>This means that the priorities of donors tend to dominate, thus making it difficult for the WHO to carry out the policies identified by its member states. In addition, intergovernmental bodies such as the World Bank have <a href="http://ijme.in/wp-content/uploads/2016/11/1653-5.pdf">weakened the WHO’s role</a>.</p>
<p>And some key programmes have had their budgets significantly reduced. One example is the programme to control non-communicable diseases. They are now the top cause of <a href="http://www.who.int/gho/ncd/mortality_morbidity/en/">morbidity and mortality</a> globally, and in low and middle-income countries. </p>
<p>Some vital programmes central to the WHO’s mandate remain underfunded. Sometimes this is due to the fact that they conflict with the interests of rich countries and big donors, particularly those with links to industry. For example, governments have consistently opposed putting in place food regulations to <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001253">address the rise in consumption of unhealthy food</a>. This is presumably because they would affect big corporations that are <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)62089-3.pdf">prominent investors</a> in those countries. </p>
<p>The result has been that the WHO’s leadership role in global health has been undermined. </p>
<p>Another big challenge is strengthening health systems. The Ebola epidemic in West Africa in 2014 showed up <a href="https://theconversation.com/ebola-and-zika-epidemics-are-driven-by-pathologies-of-society-not-just-a-virus-54191">weaknesses in the WHO</a> as well as in the health systems of low and middle income countries. </p>
<p>Finally, health systems, particularly in Africa and Asia, face drastic resource shortages. Huge investments are required in human resources, the most expensive and important component. Africa in particular has an extreme shortage of health workers. Their numbers are further threatened by inadequate training programmes and external migration (<a href="http://www.bmj.com/content/343/bmj.d7031.full">‘brain drain’</a>) to rich countries. A WHO Voluntary Code of Practice on International Recruitment of Health Personnel has failed to impact positively on such losses. The clear challenge remains for health human resource shortages to be urgently and effectively addressed.</p>
<p><strong>What does he need to do to deal with these challenges?</strong></p>
<p>Ghebreyesus needs to use his strong mandate – notably from the Global South – to truly reform the WHO and its operations in favour of the world’s poor majority. </p>
<p>To do this, he needs to push strongly for member states to honour their commitments to the WHO and to rapidly and significantly increase their financial contributions.</p>
<p>He also needs to ensure that the influence of the food, beverage, alcohol and tobacco industries to control non communicable diseases is resisted. This will be difficult given that a framework has been passed that allows non-state actors to participate in WHO policy-making processes.</p>
<p>On top of this Ghebreyesus must ensure that the health systems of low and middle income countries are strengthened so that health emergencies such as infectious disease outbreaks can be contained.</p>
<p>The <a href="http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_16-en.pdf">current investments</a> in building surveillance capacity for infectious diseases are welcomed. But these efforts will remain inadequate without sustained investment in health systems. </p>
<p>This will ensure that agenda for health security isn’t focused on securing the health of rich country populations against contagion from the poor but on protecting all, particularly the most vulnerable. </p>
<p>What will be interesting to watch over the next five years is whether the evident solidarity between low and middle income counties in voting in Ghebreyesus as their candidate is maintained during the debates and decisions about world health. Until now, rich countries have been dominant in WHO meetings.</p><img src="https://counter.theconversation.com/content/78277/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Sanders is the co-chairperson of the People's Health Movement, which sponsored his trip to the World Health Assembly in Geneva. </span></em></p>There are a number of challenges that the World Health Organisation’s new leader, Ethiopian-born Tedros Ghebreyesus, will have to navigate during his tenure.David Sanders, Emeritus Professor, School of Public Health, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/767112017-05-04T06:20:26Z2017-05-04T06:20:26ZShould India’s skilled workers worry about new US visa policies?<figure><img src="https://images.theconversation.com/files/167544/original/file-20170502-17285-13lavkr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The review of H1-B visas might lead to the disappearance of high-skilled Indian IT workers, whom Raj in the TV series Big Bang Theory is based on. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nasablueshift/5198239775">NasaBlueShift/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>In his latest border-closing move, US President Donald Trump issued an <a href="http://www.huffingtonpost.com/entry/h1-b-visa-program-policy-is-changing-and-heres-what_us_590124e9e4b06feec8ac9340">April 18 executive order to review</a> the H1-B visa program, which enables educated migrants with specific skills to work temporarily in the US. </p>
<p>Silicon Valley was critical of Trump’s move, saying that <a href="https://www.nytimes.com/2017/04/18/technology/h1b-visa-facts-tech-worker.html">there is a shortage of qualified</a> Americans working in the industry. US companies, especially those in the technology sector, often employ H1-B visa holders to fill positions that are difficult to recruit for within the country. </p>
<p>Beyond hurting American tech companies, the executive order would disproportionately impact one international ally: India. <a href="https://www.bloomberg.com/politics/articles/2017-04-09/in-trump-s-visa-crackdown-indian-students-weigh-canada-ireland?utm_content=asia&utm_campaign=socialflow-organic&utm_source=twitter&utm_medium=social&cmpid%3D=socialflow-twitter-asia">Over 70% of all H1-B visas</a> issued each year are given to Indians, and <a href="http://www.hindustantimes.com/columns/trump-s-h1-b-tweaks-to-aussie-visas-why-india-s-middle-class-needs-to-reinvent-itself-again/story-UIiLorMCSWKo72AcDaKkdO.html">85% of H1-B visas</a> in the technology sector go to Indians.</p>
<p>India-based outsourcing companies Tata Consultancy Services and Wipro processed 7,149 and 4,022 H1-B visas, respectively, for American firms in 2014, according to the <a href="https://www.nytimes.com/2017/04/18/technology/h1b-visa-facts-tech-worker.html">New York Times</a>. </p>
<p><a href="https://theconversation.com/trumps-immigration-ban-will-it-undercut-american-soft-power-72156">Trump’s executive</a> order follows through on his campaign pledge to “<a href="https://www.whitehouse.gov/the-press-office/2017/04/18/president-trump-promotes-buy-american-and-hire-american">buy American, hire American</a>”. The H1-B review is intended to tackle “<a href="https://www.whitehouse.gov/the-press-office/2017/04/17/background-briefing-buy-american-hire-american-executive-order">fraud and abuse</a>” in the system and may impose greater regulation, such as raising salary thresholds and only awarding visas to the most highly-educated and skilled applicants among those who qualify.</p>
<h2>Are techies from India over-represented?</h2>
<p>India-founded firms have an <a href="https://www.theguardian.com/technology/2014/apr/11/powerful-indians-silicon-valley">important presence in the US</a>, and many CEOs of Indian origin, including Sunder Pichai from Google, have expressed disappointment with Trump’s policy review. </p>
<p>They claim that the Trump administration statement about H1-B visa holders being “cheap labour” that “displace[s] American workers” <a href="http://money.cnn.com/2017/04/19/technology/h1b-visa-reform-india-reacts/">is inaccurate</a>.</p>
<p>And in what seemed to be a response to the executive order, the Bangalore-based Indian technology company Infosys <a href="http://www.livemint.com/Industry/Y9OnR44QmD3txzGNXlDBVO/H1B-visa-reforms-effect-Infosys-to-hire-10000-US-workers.html">announced on May 2</a> that it would hire 10,000 American workers in the next two years. </p>
<p>Infosys currently employs some 200,000 people in several offices worldwide and plans <a href="https://www.infosys.com/newsroom/press-releases/Pages/technology-innovation-hubs-usa.aspx">to open four new hubs in the US</a> “focusing on cutting-edge technology areas, including artificial intelligence, machine learning, user experience, emerging digital technologies, cloud, and big data”, according to a recent press release.</p>
<p>The first hub is set to open in the state of Indiana in August 2017.</p>
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<figcaption><span class="caption">A video portrays the ‘father of USB’ Ajay Bhatt.</span></figcaption>
</figure>
<h2>New Delhi watches silently</h2>
<p>Trump’s executive order sends a strong signal to New Delhi, which is a strategic ally for the new US administration. Trump has called India a “<a href="http://timesofindia.indiatimes.com/india/trump-calls-modi-says-india-a-true-friend-invites-pm-modi-to-us/articleshow/56769802.cms">true friend</a>” to the US.</p>
<p>Though Prime Minister Narendra Modi has refrained from discussing the issue publicly, Indian officials have expressed disappointment, <a href="http://www.financialexpress.com/india-news/trumps-h1b-visa-row-modi-government-hits-back-says-us-companies-also-operate-in-india/636731/">saying that US companies based in India</a> will be affected. Members of the prime minister’s cabinet <a href="http://www.livemint.com/Politics/anGcvC39sVDEVQbF58SmrI/Arun-Jaitley-takes-up-H1B-visa-issue-with-US-commerce-secre.html">have also voiced concerns</a>. </p>
<p>Indian professionals in the US are strong contributors to the American economy, they note, and thus to the global economy. </p>
<p>The result of the move, it is hinted, <a href="http://timesofindia.indiatimes.com/world/us/trumps-h1b-hacking-gets-hammered/articleshow/58264990.cms">could be a trade war between the countries</a>. </p>
<p><a href="http://siteresources.worldbank.org/EXTABCDE/Resources/7455676-1292528456380/7626791-1303141641402/7878676-1306699356046/Parallel-Sesssion-6-Homi-Kharas.pdf">The Indian middle class</a> has witnessed a surge of growth and is set to dramatically increase in the near future, nearly a decade after the state’s <a href="http://www.firstpost.com/business/25-years-of-liberalisation-a-glimpse-of-indias-growth-in-14-charts-2877654.html">official adoption of neoliberalism</a> and privatisation. </p>
<p>The rise of multinational Indian tech firms such as Infosys, Tata, Cognizant, and Wipro (leading the IT outsourcing Indian industry <a href="https://qz.com/901292/indian-it-firms-like-wipro-tcs-and-infosys-have-been-preparing-for-changes-in-h1b-visa-laws-and-donald-trumps-america-for-several-years/">valued at US$150 billion</a>) <a href="https://www.ibef.org/industry/information-technology-india.aspx">have employed a generation</a> of well-educated workers.</p>
<p>Other <a href="http://www.migrationpolicy.org/article/indian-immigrants-united-states">Indian IT professionals migrated</a> to the US, filling, among other positions, a large labour gap in that country’s surging technology market. Indian Americans now represent the second largest diaspora in the US, <a href="https://blogs.wsj.com/indiarealtime/2016/01/19/india-has-worlds-biggest-diaspora-and-this-map-shows-where-they-are/">totalling two million</a> citizens. </p>
<p>Indeed, <a href="https://www.forbes.com/2009/02/24/bobby-jindal-indian-americans-opinions-contributors_immigrants_minority.html">Indian Americans</a> have been depicted as the newest “model minority”, with high levels of education compared to other groups of Americans and <a href="http://www.pewsocialtrends.org/asianamericans-graphics/indians">above average annual household incomes</a>. </p>
<h2>A pro-Trump “model minority”</h2>
<p>A majority of these Indian American citizens <a href="http://naasurvey.com/wp-content/uploads/2016/10/NAAS2016-Oct5-report.pdf">identify as Democrats</a> but during the 2016 presidential election, a small and highly visible minority of Republicans emerged. </p>
<p>The grassroots initiative “<a href="https://theconversation.com/why-donald-trump-is-winning-over-many-american-hindus-67518">Hindus for Trump</a>” and the policy-oriented Republican Hindu Coalition (RHC) both openly endorsed Trump’s candidacy in the 2016 election. The RHC acts as an advocacy organisation to be the “<a href="http://www.rhcusa.com/about-m.php">bridge between the Hindu-American community and Republican policymakers and leaders</a>” on issues pertinent to the US and India, such as trade and political relations, as well as security cooperation on Islamic extremist terrorism.</p>
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<figcaption><span class="caption">A campaign by the RHC shows Donald Trump speaking in Hindi, echoing Narendra Modi’s election campaign of 2014.</span></figcaption>
</figure>
<p>Chicago-based industrialist and billionaire Shalabh Kumar, who has been dubbed “<a href="http://economictimes.indiatimes.com/nri/nris-in-news/meet-shalabh-kumar-donald-trumps-favourite-hindu/articleshow/57102053.cms">Trump’s favourite Hindu</a>”, is the co-founder of the RHC along with the Republican Newt Gingrich, a former congressional leader and presidential hopeful. Kumar, a <a href="http://www.firstpost.com/politics/trump-campaign-gets-1-1mn-from-indian-american-republican-nominee-pledges-strong-indo-us-ties-3054362.html">prominent Trump booster</a>, donated $US1 million to Trump’s campaign in 2016.</p>
<p>Recently, Kumar was named by <a href="http://indiatoday.intoday.in/story/sundar-pichai-google-satya-nadella-gopichand-hinduja-indra-nooyi-dev-patel-aziz-ansari-india-today-global-indians-salman-rushdie-waris-ahluwalia/1/927880.html">the weekly India Today as one of the top 20 “global Indians”</a>, and has an ear in the White House as part of the Asian Pacific American Advisory Committee and the National Committee of Asian American Republicans.</p>
<p>At a February 2017 press conference, <a href="http://www.thehindu.com/news/international/No-executive-order-on-H-1B-on-cards-Shalabh-Kumar/article17153908.ece">Kumar assured reporters</a> that there would be no executive order on H1-B visas and that, to the contrary, the number of migrant workers would increase. He has yet to make a public statement about the Trump administration’s recent decision.</p>
<p>This situation highlights the tension Trump has faced at many moments in his young administration: in appealing to his nativist American base, he alienates other key demographics. The H1-B order may turn off wealthy Indian American Republicans, who are potential political and business allies. </p>
<p>It could also hurt the US economy. The Hindustan Times says that a significant number of Indians living in the US <a href="http://www.hindustantimes.com/india-news/h1b-visas-more-indians-seek-jobs-back-home-as-trump-signs-order-to-hire-american/story-0c6S4m3jIQjk1kTE0mLpWM.html">may now be looking for a job “back home”</a>.</p>
<p>Donald Trump has invited Narendra Modi <a href="http://www.hindustantimes.com/india-news/pm-modi-to-visit-us-this-year-says-white-house-after-trump-phone-call/story-hqqwo450dKejsfVJMecosO.html">to visit the US later this year</a>. It remains to be seen whether a trip (to, presumably, Mar-a-Lago) will help smooth the H1-B waters between these two “true friends”.</p><img src="https://counter.theconversation.com/content/76711/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eviane Leidig does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Trump’s review on H1-B visa will directly impact high-skilled Indian workers.Eviane Leidig, PhD candidate, Center for Research on Extremism, University of OsloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/702212016-12-13T22:35:06Z2016-12-13T22:35:06ZWhy Kenyan health workers are on strike and what can be done about it<figure><img src="https://images.theconversation.com/files/149837/original/image-20161213-1629-1qjl8le.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Kenyan nurse participates in a march during their strike following failed negotiations between health unions and the government.</span> <span class="attribution"><span class="source">Reuters/Thomas Mukoya</span></span></figcaption></figure><p><em>Doctors and nurses in Kenya’s public hospitals downed their tools in the latest round of strikes to press for <a href="http://tinyurl.com/j8qw693">higher pay</a>. Thousands of desperate patients have been left without care. Public hospitals are the easiest health service to access for the vast majority of Kenyans. They also offer the most affordable care. Health and Medicine Editor Joy Wanja Muraya spoke to Moses Masika about the reasons for the strike, and its impact.</em></p>
<p><strong>What are the main reasons for the strike?</strong></p>
<p>The current doctors’ strike is a result of the government failing to implement a collective bargaining agreement <a href="https://www.standardmedia.co.ke/health/article/2000225884/details-of-the-disputed-salary-deal-signed-by-kenyan-doctors-and-nurses">signed in</a> June 2013. The agreement was based on negotiations between the government and the doctors’ union which started after another doctors’ strike in December 2011. </p>
<p>Over the last two years the union has reached out to several government organs to have the agreement implemented, but without success. These have included the Ministry of Health, the Salaries and Remuneration Commission, the National Assembly and the courts. </p>
<p>There have been more than two dozen strikes since the devolution of health services in 2013. At the end of 2013 most health services were decentralised from the central government to county governments in keeping with Kenya’s new constitution. The process was done hurriedly and the newly established county governments were faced with the responsibility of providing health services with no proper structures in place.</p>
<p>For example, the health bill – which was supposed to guide the health sector under the new dispensation – has not yet been passed into law. </p>
<p>Poor human resource management in the counties is another major problem. This has exposed medics to poor pay, salary delays, lack of a fair structure for career progression and training as well as discrimination and harassment.</p>
<p>The national government has the mandate to ensure Kenyans get the highest standard of health care as envisaged in the constitution. But it has done little to streamline the health sector after the devolution. </p>
<p>These issues – emanating from both national and county governments – have frustrated Kenya’s health workers and doctors. They have exhausted all other options except withdrawal of services which is a measure of last resort.</p>
<p><strong>How do the pay and working conditions offered to public sector medical workers in Kenya compare with those in other African countries?</strong></p>
<p>Working conditions for health care workers in Kenya are challenging. There are several issues. </p>
<p>Poor pay is the first on list. I made enquiries of the net salaries of newly employed doctor in several African countries and compared these salaries with the corresponding GDP per capita as listed <a href="http://data.worldbank.org/indicator/NY.GDP.PCAP.CD">by the World Bank</a>. The net salary of a newly employed doctor in Kenya is 58% of the GDP per capita as compared to 86% in Malawi, 116% in Zimbabwe and 154% in the Democratic Republic of Congo. This means that a doctor in Kenya earns 58% the average income per person while a doctor in DRC earns 154% of the average income in the country. In hard figures, the net salary of a doctor in Kenya is US$ 800 as compared to US$ 1,000 in Zimbabwe and US$ 2,500 in South Africa.</p>
<p>In addition to poor pay, most health facilities are understaffed forcing workers to contend with long hours and inadequate facilities which leads to frustration and burn out.</p>
<p>In other African countries, especially those in southern Africa, doctors are offered better pay to attract and retain them. Better perks are offered to doctors who offer to work rural areas. But this is not the case in Kenya. Currently the country has about 10,000 doctors and less than half are in public service. A third of these are in Nairobi which has less than 10% of the total population.</p>
<p>Kenya, like many other countries on the continent, is suffering a brain drain as its highly-trained workforce – including doctors – moves south or to the developed world.</p>
<p><strong>How do these disputes affect the morale of health workers?</strong></p>
<p>The recurrent disputes have taken a toll on the morale of many health workers, forcing some to leave the counties to seek alternative employment. </p>
<p>Strikes in the health sector are never a good thing. Governments should do its best to avoid them yet the Kenyan government seems to have done very little. </p>
<p>We have no hard figures to quantify the effect of the strike. But the impact is likely to be felt in a number of ways. Even without a strike, many preventable deaths occur in hospitals because of inadequate investment in facilities, training and staff. A strike is likely to worsen this. </p>
<p>In addition, patients who access care late may suffer. The country has hundreds of thousands of patients on treatment for chronic conditions such as diabetes, hypertension and HIV. Many are likely to default on their treatment if the strike is prolonged. Interrupted care for the chronically ill will worsen their conditions.</p>
<p>Some patients may also turn to traditional healers. This could result in them needing more advanced care and longer hospital stays in the future. In turn this will increase the economic burden to patients, their relatives and the taxpayer.</p>
<p><strong>How can governments and other employers avert industrial action?</strong></p>
<p>The government and other employers in the health sector need to work proactively to promote harmony. They need to adopt fair labour practices by engaging unions continuously not only during industrial unrest. </p>
<p>This engagement should be on a platform of mutual respect among the three key partners: the government, employers and unions (employees). This would help address thorny issues promptly and reduce industrial unrest. </p>
<p>Employers, including the government, will find it easier to retain and motivate doctors if they offered decent wages, fair working hours and a clear path for career progression and training. </p>
<p>There should be a conducive working environment where doctors can work safely and in dignity. Doctors have often been harassed and sometimes attacked while executing their duties. </p>
<p>The collective bargaining agreement that the union is agitating for addresses these issues. If implemented it will restore order in the sector, retain more doctors in public service and boost their morale. This would be a good place to start.</p>
<p><em>Author’s note: This article has changed to clarify the methodology I used to calculate the earnings of doctors.</em></p><img src="https://counter.theconversation.com/content/70221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Moses Masika is a member of the Kenya Medical Practitioners, Dentists and Pharmacists' Union</span></em></p>Health workers in Kenya have reached an impasse with the government over working conditions. This has lead to a nationwide strike, leaving thousands without critical care.Moses Masika, PhD Candidate, KAVI Institute of Clinical Research, University of Nairobi, University of NairobiLicensed as Creative Commons – attribution, no derivatives.