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The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers
The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers
Background: Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems.

Aim: To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries.

Design and setting: Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa.

Method: Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach.

Results: The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption.

Conclusions: Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable
0960-1643
e321-e328
Moosa, S.
7569288e-070b-43b8-8f9e-4a80b9c77b3b
Wojczewski, S.
995efd80-7284-4122-88b7-fd91d4ee205f
Hoffmann, K.
508fb53f-53d7-40cd-b6f1-7fd8437dab34
Poppe, A.
3898afaa-8d70-4eb5-9e9d-cd531f0abcda
Nkomazana, O.
54371285-c697-4705-88c1-c09eba9b904d
Peersman, W.
54afe447-2556-4822-8852-5b3d1f5ba04f
Willcox, M.
e2a776d2-dc29-4edd-8c88-33fa791120df
Derese, A.
1b8ea019-bd3b-4f96-aff7-a0df002b8135
Mant, D.
10e94981-cd2c-4e56-8a11-54d9fc107117
Moosa, S.
7569288e-070b-43b8-8f9e-4a80b9c77b3b
Wojczewski, S.
995efd80-7284-4122-88b7-fd91d4ee205f
Hoffmann, K.
508fb53f-53d7-40cd-b6f1-7fd8437dab34
Poppe, A.
3898afaa-8d70-4eb5-9e9d-cd531f0abcda
Nkomazana, O.
54371285-c697-4705-88c1-c09eba9b904d
Peersman, W.
54afe447-2556-4822-8852-5b3d1f5ba04f
Willcox, M.
e2a776d2-dc29-4edd-8c88-33fa791120df
Derese, A.
1b8ea019-bd3b-4f96-aff7-a0df002b8135
Mant, D.
10e94981-cd2c-4e56-8a11-54d9fc107117

Moosa, S., Wojczewski, S., Hoffmann, K., Poppe, A., Nkomazana, O., Peersman, W., Willcox, M., Derese, A. and Mant, D. (2014) The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers. British Journal of General Practice, 64 (623), e321-e328. (doi:10.3399/bjgp14X680089).

Record type: Article

Abstract

Background: Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems.

Aim: To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries.

Design and setting: Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa.

Method: Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach.

Results: The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption.

Conclusions: Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable

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Published date: 1 June 2014
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 403732
URI: https://eprints.soton.ac.uk/id/eprint/403732
ISSN: 0960-1643
PURE UUID: 092d352d-287d-4693-aa1c-7ffeb0a85ca1

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Date deposited: 09 Dec 2016 12:04
Last modified: 15 Jul 2019 19:50

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Contributors

Author: S. Moosa
Author: S. Wojczewski
Author: K. Hoffmann
Author: A. Poppe
Author: O. Nkomazana
Author: W. Peersman
Author: M. Willcox
Author: A. Derese
Author: D. Mant

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