This month, Rwanda and Kenya became the next countries that are planning to remove visa requirements for all African Countries. They will soon be joining Benin, The Gambia, and Seychelles in offering visa-free access to African countries. In 2017, 54% of African countries required African nationals to have a visa before arrival, 24% of countries offer visa on arrival for African nationals, and no visa is required for African nationals in 20% of countries. Visa requirements pose challenges for people trying to move within the continent
Are we getting closer to establishing the free movement of people on our continent? The Free Movement of People Protocol in addition to the Africa Continental Free Trade Area can have several benefits for public health, particularly the public health workforce.
The African Continent is experiencing major shortages in the healthcare workforce which inhibits the ability to provide quality healthcare services. The WHO recommends a threshold of 2.3 doctors, nurses, and midwives per 1,000 population. In 2015, only 11 World Health Organization African Region (AFRO) member states met this threshold, and the remaining 36 member states are classified as having a health workforce crisis. Only 4 AFRO countries exceeded this ratio which are Mauritius, Namibia, Seychelles, and South Africa. The projected shortage of healthcare workers in Africa is expected to be 5.3 million by 2030. In January 2023, the World Health Organization launched the draft Africa Health Workforce Investment Charter to achieve the goal of reducing the healthcare worker shortage by half. This shortage of workers is so severe that during the height of the pandemic, engineering students from Dakar’s Ecole Superieure Polytechnique (ESP) developed robots to run tests on patients. This helped to minimize the risk of COVID-19 infection to healthcare professionals, made clinic visits more efficient and ensured service accessibility to rural areas.
A contributor to the healthcare workforce crisis is the inadequate number of facilities for health education and training capacity. There are only 168 medical schools in AFRO with 11 Member States having no medical school and 24 only having one medical school. Currently, the African Union (AU) has a Free Movement Protocol, which allows for the free movement of citizens between African countries without visa issues and has 32 signatories. A study by the AU and the International Organization of Migration (IOM) indicates that the free movement of people across the continent facilitates intra-Africa knowledge and skills transfer. Will the free movement of people for educational purposes allow for education, technical skills exchange, and transfers? These aspects are core to strengthening human capacity for health systems.
Presently, regional authorities in West and East Africa have established protocols for the free movement of people. The Southern African Development Community (SADC) is the only regional authority that has a free movement of people for educational purposes known as the Protocol on Education and Training which came into force in the region in 1997. A Qualifications Framework has also been established to promote cross-border recognition of qualifications and credentials based on international guidelines.
SADC students are treated as local students concerning tuition, application, and examination fees in public universities and there is a proposal to introduce a regional visa. The student mobility ratio in SADC is 5.8% compared to the world average of 2.0%, which can partly be attributed to the Protocol on Education and Training. Within the region, there is a high percentage of students studying in other SADC countries with 1 in every 2 students staying within the region for educational purposes. Presently 69% of students in non-SADC Sub-Saharan countries study elsewhere in the world such as in France, Germany, the United Kingdom, the United States of America, and Canada. UNESCO states that sub-Saharan Africa has the highest outflow of students from their region to pursue tertiary education.
Could The Free Movement of People provide an opportunity for people living in areas with limited health educational opportunities to pursue educational opportunities in other African countries, facilitating the transfer of knowledge and skills? And would this be an efficient way to respond to health emergencies where healthcare workers are limited?
For this to be successful, there needs to be a continental-wide qualifications framework and discussion on tuition and application fees for regional students. Should authorities expand the free movement protocol to also include free movement for education? Other lingering questions that arise are should students be incentivized to return to their home countries to work and/or contribute to establishing educational facilities?
The Free Movement of People Protocol could be an opportunity to ensure a sufficient distribution of healthcare workers for a strong health system and build a continental network of healthcare workers.