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Medical Brain Drain from Africa

Submitted by on August 8, 2012 – 1:24 AM 6 Comments

According to World Health Organisation (WHO), 1500 women die everyday from pregnancy or childbirth related complications1. This simply means that before even a minute elapsed (57.6 seconds), a woman has died due to the above complications. And if we are to go by what we are always told, “Let us keep a moment of silence…” when someone has passed on, then we may forever remain silent because according to Carol Bellamy, UNICEF Executive Director “The same number died yesterday, and the same number will die tomorrow.”

 


Unfortunately, 99% of these cases occur in the developing countries where 85% of the population live and are in urgent need of 4.3 million health care professionals (HCPs).I have a belief that one of the best ways of solving this is by tackling medical brain drain.

 
Whereas even the United Kingdom (UK) is affected, Africa seems to have been hit hardest as there are more African born scientists and engineers in the USA than in the whole of Africa. This is saddening because 24% of the global disease burden is in Sub Saharan Africa which has just 3% of the world’s health workforce.

 
Although Africa is lamenting, the developed countries seem to be benefiting greatly from it. Take an example of Chicago (USA) and Sierra Leone; First of all, there are more Sierra Leonean doctors in Chicago than in the whole of Sierra Leone yet the doctor to patient ratio of the former is 1:390 compared to 1:33,333 of the latter. The maternal mortality rate of the two countries is 9 deaths per 100,000 live births (Chicago) and over 1000 deaths per 100,000 live births (Sierra Leone) while the life expectancy of Sierra Leone is 34 years. What a disparity!

 
Such stories do not stop there as the loss of doctors has been very striking; Ghana has a doctor to patient ratio of 1:11,000 yet 20% of the doctors in New York City are Ghanaians. Also, 20% of doctors in Saskatchewan earned their first degree in South Africa.

 
My home country, Uganda is no exception to this quandary when South Africa is employing over 250 Ugandan doctors even when Uganda used to produce about 220 doctors annually. In 2009, 13 senior surgeons left Uganda for Rwanda due to poor pay.What an ignominy! Australia, the UK, USA and Canada also employ many more Ugandan doctors. If truth be told, the doctor to patient ratio in Uganda worsened from 1:12,500 in 2006 to 1:24,725 in 2010 yet all these seem to go unnoticed.
The depressing bit of such stories is that many of the doctors go when they are in their most productive stages of their lives and come back (if they at all do) when they are “spent forces” not even suited for their own native countries.

 
This could partly explain why nearly all child deaths occur in developing countries. Statistics indicate that a child born in Sierra Leone is 3-5 times more likely to die before the age of five than one born in India and 100 times when compared to those born in Singapore. Such alarming statistics do not vary so much in many other African countries.

 
Therefore, medical brain drain should be considered a priority issue to be dealt with urgently because we could be moving along the path Philippines has used or even overtaken them. David Llorito, a Philippine journalist notes that 85% of their nurses are working abroad and the government is puzzled by rate at which many doctors are now training to become nurses “nursing medics” so that they can easily leave the country. (About 4,000 doctor-turned nurses have already left and an equal number in training). He adds that number of persons applying to sit examinations to qualify for medical practice in the country is reducing by 13% annually.This has resulted into closure of 200 hospitals and another 800 partially closed.

 

In conclusion, the participation of all stakeholders especially in terms of research and influencing policies aimed at advocating for “sufficient resource to work, supportive management, work autonomy, recognition, safe working environment and a manageable work load.” is key.In addition, a well structured and organized financial system to monitor and cater for the salaries and allowances should be put in place. A brighter future similar to or better than Cuba’s doctor to patient ratio of 1:170 and Japan’s life expectancy of 82 years5, 6 is attainable in Africa if the medical brain drain is curbed.

 

 

About the Author:  Ephraim Kisangala is a Ugandan medical student and the  Chairperson of the Standing committee on Medical Education and Research (SCOMER) at the Federation of African Medical Students’ Associations (FAMSA). He is also a research assistant at the Communicable Diseases Research Unit (CDRU, KIU-WC) as well as an E-health researcher at the Computer Careers Development Initiative (CCDI-Africa). He can be reached at : [email protected]

 

About this article: This article is competing for the JPMS International Medical Writing Contest 2012 for the theme: Medical Education

To learn more about the contest and to participate in it, follow this link: http://blogs.jpmsonline.com/writing-contest/

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  • kasule joseph

    Ephraim, i thank u 4 putting this forward. Its an issue that needs very very very urgent attention. My humble request is that u give some practical solutions 2 the problem 4 example given Uganda’s budget and the amount of money allocated 2 the health sector, how much money do u thunk can be allocated 2 the health sector, what salary is satisfactory 2 health workers, to what extent can the working conditions of health workers be improved given the resources available. Wish u all the best during the competition Ephraim.

    • Ephraim

      Many thanks Joseph, that for further highlighting the point.
      Practically speaking, the budget allocation is for the east african region in healthcare is way below their commitment in the “Abuja Declaration” where African countries pledged to allocate 15% to health.
      The government has a big part to play here since reforms are needed; 1. Establish a well structured and organized financial system to monitor and cater for the salaries and allowances. Health workers’ pay is and varies from country to country,In the Equity theory, workers consider seriously how fairly they are being treated
      compared to others. So the payment of technocrats, and other civil servants will determine the ideal salaries for health workers in Uganda. And also rewards/ allowances count (expectancy theory- when they perform well, they expect to be rewarded and the reward motivates them to work more)These 2 theories are key to salary satisfaction.Working conditions need to be as good as possible. If 15% of the budget is allocated to health, and then this utilised well; the working conditions can be fair enough for the doctors to stay.

  • kelvin mutonga

    nice article, i will share it to my friends

    • Ephraim Kisangala

      Many thanks Kelvin.
      Mambo

  • Anne Gladys Luggya

    dear Ephraim this is a great achievement and alot of effort put in thanks for creating awareness to the world about the impact, magnitude and consequences of brain. Its like an emergency situation that needs urgent attention to overcome. thanks man thank you very much.

  • HalimahLawal

    well written article…..very enlightening and deeply touching…..reminds me again how much help Africa needs when it comes to health issues…Thanks for the enlightenement