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Global Competition for Health Care Workers from Africa Steffen Angenendt, Anne Koch, and Melanie Müller

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Global Competition for Health Care Workers from Africa Steffen Angenendt, Anne Koch, and Melanie Müller NO. 64 DECEMBER 2020 Introduction Foresight*: Global Competition for Health Care Workers from Africa Steffen Angenendt, Anne Koch, and Melanie Müller Pretoria, 12 February 2024: During a ceremony, the German Minister of Health and his South African counterpart sign the “Together We Care” agreement on the training and assignment to Germany of 20,000 South African nurses. “Together We Care” is part of a comprehensive cooperation agreement. Training centres for medical per- sonnel are to be set up in several South African cities. The agreement also contains commitments to support a vocational training system and the facilitation of visas. The event has received extensive media coverage and a predominantly positive recep- tion. The German weekly newspaper FAZ publishes a front page article with the head- line “Germany can hold its own in global competition”, and the weekly taz welcomes the agreement with an article entitled “Germany remains a country of immigration”. The agreement is the result of intense nego- How It All Began tiations between Germany and South Africa. The long-standing shortage of skilled nurs- For these reasons, since the beginning of ing staff in Germany has worsened dramati- 2021, the Federal Government has been cally since the outbreak of the Covid-19 pan- prioritising the improvement of staffing demic in 2020. Meanwhile, many Eastern levels in the nursing sector. In doing so, European governments are making efforts it is following the recommendations of to keep their health care workers in their the German Hospital Institute (DKI) of own countries or to encourage them to 2019, which aim to expand training capac- return by offering financial incentives. As ities, reduce the proportion of part-time a result, the shortage of medical personnel workers, activate the “hidden reserve” of and trainees has become so severe that it former health care personnel, and ensure puts the functioning of the entire German that workers stay in nursing care longer. health care system in jeopardy. The situa- Due to widespread public concerns about tion is similar in neighbouring European non-European immigration, the DKI’s countries. In 2016, WHO predicted that by recommendation that additional nursing 2030, an additional 18.2 million health care staff be acquired from abroad is initially workers would be needed across Europe. ignored. Soon, however, the German Eco- This forecast seems increasingly realistic. nomic Institute (IW) has to significantly * Foresight deals with conceivable events in the future. It offers insights on a fictitious event (not an analysis of real-life developments) with the aim of working through non-linear or unexpected developments. revise its 2018 forecast – which predicted hinders negotiations for extended periods a need for an additional 130,000 to 150,000 and delays the project. new full-time care workers by 2035 in the Nevertheless, in view of the urgent need elderly care sector alone – upwards. As a for action, the ministries finally agree to result, there are growing calls from policy exploratory talks with a number of the Afri- makers and civil society alike for increased can countries that – in the ministries’ recruitment efforts abroad. view – meet at least some of these criteria, The German government must react. In and with which Germany can build upon an interdepartmental meeting convened existing cooperation agreements. These by the Chancellery in October 2021, depart- include the Ivory Coast, Ghana, Kenya, mental representatives discuss which non- Morocco, Senegal, Tunisia, and South Africa. European countries would be suitable for Since many young Africans would like to the recruitment of nursing staff. The Fed- work in Europe, the ministries are optimis- eral Ministry of Health (BMG), the Federal tic that they will be able to conclude initial Foreign Office (AA), the Federal Ministry recruitment agreements with some coun- of Labour and Social Affairs (BMAS), the tries of origin within a year. Federal Ministry for Economic Cooperation and Development (BMZ), and the Federal Ministry of the Interior (BMI) participate. “Germany Is Late to the Party” Early on, the group decides to focus on the African continent in order to create syner- Just before summer break, June 2022: gies with the Federal Government’s ongoing Disillusionment is spreading in the Federal efforts to establish a new partnership be- Government. In the first round of negotia- tween the European Union (EU) and Africa. tions, none of the states approached show Together, the ministries agree on several any interest in the German government’s criteria: The BMG attaches great importance offer to upgrade the skills of foreign nurs- to the fact that the respective countries have ing staff in a crash course format, and to been successful in dealing with the linger- employ them in German facilities for an ing Covid-19 pandemic, and that the aver- initial period of two years. The reasons age level of education among the general are similar everywhere: “We have already population is high enough to pursue a received more attractive offers from other nursing qualification that meets German countries”, “Why should we send sought- standards. The AA emphasises the added after nurses to Germany without any com- value of existing German language skills pensation?”, and “Germany is late to the party”. among the population and demands that How could this have happened? Appar- language institutions such as the Goethe ently, the global competition for health care Institute already exist in the respective coun- workers intensified within a short period tries. The BMZ urges that the focus of atten- of time, when not only European countries tion should be the surplus of youth as well started recruiting nurses from Africa, but as the levels of youth unemployment, as also China, Australia, and Canada. Reports these factors can increase the development- in the media further accelerated the pro- policy benefits of possible recruitment pro- cess. The responsible German decision- grammes and dispel concerns about brain- makers underestimated this development. drain. The BMI, which is still highly critical One reason for this was their inward-look- of the acquisition of skilled workers from ing focus and their preoccupation with the abroad, intervenes repeatedly to raise secu- concerns of the electorate. Other European rity concerns. The weekly magazine Der Spie- countries – above all the former colonial gel quotes the Federal Minister of the In- powers France and the United Kingdom – terior as saying: “First we worked for years used confidential bilateral channels to nego- to keep Africans out of Germany, and now tiate beyond public view due to the general we are inviting them.” This kind of mindset level of reservation about the issue. SWP Comment 64 December 2020 2 France has reached agreements with The German ministries need to discuss Algeria, Morocco, and Tunisia, and the how the concerns of South Africans can United Kingdom with Kenya. The Chinese be addressed. In view of China’s aggressive government, for its part, has been able to offers, it is no easy task putting together a build on existing exchange programmes tailor-made package that not only takes for African students and promoted them South Africa’s specific needs into account, effectively at the last Forum on China- but that is also more attractive than com- Africa Cooperation. Because there was peting offers. In addition, smaller European already an immense and rapidly growing countries, such as the Scandinavian coun- demand at home before the pandemic tries and the Netherlands, have now entered began, Beijing promised Senegal, Côte the global competition for health care d’Ivoire, and Ghana considerable direct workers. They are offering the South Afri- investment if the three countries granted can government the prospect of extensive China comprehensive access to trained trade and investment partnerships. nurses. As a result, these countries rejected To speed up the development of a com- similar offers from other countries. South petitive offer, the German government Africa managed to avoid being pressured quickly sets up consultations with country into any such nearly exclusive recruitment experts from research and development co- agreements. However, emboldened by the operation, the health care sector, chambers negotiation successes of other African coun- of commerce, the labour ministry, and the tries, it made significant demands. South African diaspora. These consultations Against this backdrop, the German offer show that the vocational training sector is to poach temporary care workers without a top priority for the South African govern- substantial compensation is not competi- ment for reducing the high levels of youth tive. The media are increasingly concerned unemployment among secondary school about the growing difficulties in attracting graduates. With this in mind, the BMZ urgently needed skilled workers to Ger- proposes an idea that has been discussed in many. Disturbing reports about neglected expert circles for years: transnational train- elderly people in understaffed nursing ing partnerships. Such partnerships would homes are further fuelling the debate. The provide for the establishment of two-tier press accuses the government of having nursing schools in South Africa that are co- failed at negotiating and defending German financed by Germany, providing training interests with sufficient determination. for South Africa’s and Germany’s health sec- tor in parallel.
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