A JAMAICAN nurse, Mary Seacole, cared for British soldiers during the Crimean war in the 1850s. Many more have followed in her footsteps. According to a report last month by the World Bank, almost three-quarters of the nurses who train in the English-speaking Caribbean leave to work in the United States, Britain or Canada. That is causing a problem. Only 7,800 nurses are left in a region with a rapidly ageing population of 6m—and 3,300 unfilled nursing posts. Many rich countries have ten times as many nursing staff per head.
One answer, says the bank, is to train more nurses. There is no shortage of applicants. Countries that recruit them might help by contributing to the costs of nursing education in the Caribbean. But even if the region trained twice as many nurses, hospital wards would still be understaffed by 2025. A few come in from Cuba, India, Nigeria and the Philippines, but most of them quickly move on to North America.
Another answer is to improve pay and conditions. Qualified nurses in Jamaica start on just over $600 a month. The matron of a 500-bed public hospital earns only about three times that amount—or around the same as a trainee nurse in Britain. Three-quarters of Jamaican nurses are fed up with their working conditions, says a survey quoted by the bank. The disillusioned move to other careers as much as to other countries.
Nurses are not allowed to leave before they have repaid their student loans. This restriction rankles, and is ineffective: some recruitment agencies lend Caribbean nurses the money to pay off their debt. Graduates in accountancy or advertising are free to travel, repaying their loans from wherever they choose to settle.
The World Health Organisation is developing a code of practice regarding the international recruitment of health-care staff, to be discussed at its general assembly in May. It wants to strike a balance between the human right to health, and the right of health-care professionals to make their own career choices. These are fine principles. The reality for small debt-laden Caribbean countries is that they will have to find ways of spending more to keep more nurses at home.