Bill on “Immigration and Integration”: Africa fears more mass exodus of doctors

While the draft law on “immigration and integration” should be submitted to the Council of Ministers on Wednesday 1^Eh In February, a debate broke out on a section that provides for the creation of a specific residence permit for stressful jobs, primarily health issues. belonging to “Improving attractiveness” In France, this new residence permit for a period of thirteen months to four years, called “talented-medical and pharmaceutical professions” applies to foreign doctors regardless of specialty, midwives, dental surgeons and pharmacists. It also plans to lower the income threshold needed to qualify.

On January 7, the forum will be held under the title “Let’s not deprive Africa of doctors”. SPosted by Andre Grimaldi, Jean-Paul Vernat, Xavier Emmanuel and Ronnie Brauman Sunday newspaper (JDD). Emeritus Professor of Diabetology, respectively; Emeritus Professor of Hematology and Member of the Committee of Wise Men of the French Office of Immigration and Integration (OFII); Former Secretary of State and President of this Committee of Wise Men; The four individuals who co-founded Doctors Without Borders asked the government “Remove this sentence from his draft.” (…) To attract medical personnel Which they say will have an effect “Transfer our medical deserts to countries from our former colonies.”

After the European Union (EU), French-speaking Africa is actually France’s leading supplier: Algeria, Morocco and Tunisia lead, but also Madagascar, Senegal, Cameroon, Côte d’Ivoire, Benin, the Democratic Republic of Congo (DRC). .

In 2022, according to the Council of the French Order of Doctors (CNOM), three quarters of the 2,000 practitioners with a diploma outside the EU (Padua) who passed the knowledge verification tests were from the Maghreb and half from Algeria. Five thousand of these doctors are still waiting for their qualifications to be confirmed while they work as interns in government hospitals for more than half their salary. Overall, the Organization for Economic Co-operation and Development (OECD) estimated the number of foreign-born doctors working in France at 25,000, or 12% of the total number of registered doctors. An indicator that multiplied in thirty years.

“four years of uncertainty”

The National Padhue Union was quick to express its surprise at the “reset” effect of this new provision, as many of these practitioners are dual nationals and therefore do not require a residence permit.

“This speech is largely invisible in the CNOM figures, explains Francesca Sirna, a sociologist specializing in migration who is responsible for research at the CNRS. Most of the future doctors come here to complete a specialty or to complete an internship. As for Padhue, the bill offers them no more than four years of immunity, with no guarantee of a future. Their main problem is the verification of skills, which, despite the 2020 reform, is still a real obstacle.

The implementation authorization procedure (PAE) often exceeds four years. “We are preparing future secret doctors who will not return home” Indignant Mohamed Ghanemi, a specialist of Tunisian origin who heads the cardiology department of the Goness Hospital Center (Val d’Oise). A great connoisseur of the French system, in 1998 he created the Association of Doctors of North African Origin in France, which accompanied all the waves of “import” of these practitioners.

Because France’s appeal is not new and is part of a global movement of brain drain from south to north that goes beyond the medical professions. With 16% of foreign-born doctors, this is lower than the OECD average of 25%. For example, in the British civil service, more than one in three doctors come from India, Nigeria or Egypt.

“The pandemic has shown that doctors have become essential to the functioning of our hospitals, which have been victimized by prolonged austerity policies,” Tribune recalls JDD. “Instead of solving the underlying problems, Adds Ronnie Brauman “ world africa” We address this potential reservoir By exacerbating the structural deficit that the continent is suffering from. »

Evidenced by the viability of mobility of African students in faculties and hospitals. For the start of the 2020-2021 academic year, the number of visas issued to young Africans increased by 32.5% and from sub-Saharan Africa by 64%, according to the Campus France agency. And, according to provisional indicators, the increase will be even stronger in 2022. Despite a two-year decline due to the pandemic and an increase in registration fees in 2018, the healthcare sector, including pharmaceuticals, grew by 4%. five years. And, according to the OECD, more than half of students convert the test into winning a job contract at the end of their studies.

“We must deal with the real causes of migration”

“What France is doing to solve the problem of medical deserts is not helping Algeria or any of the supplying countries. explains Mohamed Yousfi, head of the department of infectious diseases at Boufarik Hospital, between Algeria and Blida, and president of the National Union of Specialist Public Health Practitioners. If nothing is done, this trend will accelerate, as in Morocco or Tunisia. However, our country, unlike other poor countries, would have the means to maintain this elite. »

Precisely in Tunisia, the exodus has taken the form of bleeding in the last five years. Young people go en masse, but also doctors and elders who have been there for several years. The political, social and economic climate, the deterioration of the public hospital prompts the exodus. “ France has failed to train enough doctors for its own territory and is depriving our practitioners of equal qualifications with less pay, A piece by Moncef Belhaj Yahia, who chairs the Tunisian Association for the Right to Health, which was created after the 2011 revolution. But this law is only a symptom of a deeper evil. We need to deal with the real reasons for the exodus. »

Consideration, wages, shortage of materials, medicines, daily life of it “white army” They were taken to emergency medicine. In 2021, the Tunisian Medical Order recorded 970 departures, compared to the usual 500 to 600. “The figure is probably underestimated. Tunisia trains about a thousand doctors a year. Therefore, soon more doctors will leave than trained doctors. The pensioner is worried. Pay and working conditions are miserable. Even the private sector is beginning to deteriorate. »

It is therefore necessary for countries on the continent, which spend an average of only 5.8% of GDP on health, to invest heavily in improving their systems, the shortcomings of which have been exposed by the health crisis.

“The salary issue, even if it is decisive, is not everything. The talent we have here is looking for better conditions to use their art, Attests Daniel Mabongo, president of the Cameroon Doctors Syndicate, which sees a third of its specialists emigrate every year. A profession that we must not forget is, first of all, a vocation. »