DOCTORS WITHOUT BORDERS?

Sub-Saharan Africa is experiencing a critical shortage of healthcare professionals, largely due to the emigration of skilled labour to Europe and North America. This human capital flight, or ‘brain drain’, is widely recognized as a contributor to weak healthcare systems in low-income countries and unfortunately is expected to continue.

According to research published by the British Medical Association, sub-Saharan African countries that invest in training medical personnel are collectively losing billions of dollars. Many wealthy destination countries, which also train fewer doctors domestically than they need, depend on immigrants to provide the necessary services. In 2011 the United States saved $846 m in training costs by attracting doctors that migrated from nine African countries – Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. These countries spent between $21 000 to $59 000 to train each doctor, and the overall lost investment of domestically educated doctors sat at over $2 bn.

The cost of educating doctors is considerable indeed when tallying up the lost human capital, the money spent on training replacements and, at times, paying expatriates huge sums of money to make up the shortfall. If you also take into account the lost opportunities of passing on invaluable skills to the next generation of Africans, it’s clear that there’s an immediate need for the continent to somehow reverse the brain drain and harness the full potential of its citizens.

But how?

Some African governments are attempting to woo professionals back home by engaging with diaspora networks in the West. Ethiopia, Ghana, Tanzania and Uganda are amongst the countries that have set up institutions (at the agency or ministerial level) to reach out and encourage the return and contributions of the African diaspora. These are encouraging steps but the difficulty lies in that unless there is a marked upswing in optimism about economic and social conditions improving back home, the skilled are unlikely to return.

If little can be done at present about the ‘pull’ factors from abroad – higher salaries and professional advancement opportunities to name a few – could African governments instead mitigate some ‘push’ factors by creating conducive work environments to help retain their health professionals?

One option could be donors assisting countries to increase salaries and benefits in the sector. Currently the proportion of development assistance that goes into the training of medical practitioners is variable and limited. While meeting the salary packages of the West is unrealistic, a higher salary can still have a significant impact given the differences in the cost of living. Increased remuneration could also take different forms such as housing allowances for civil servants and paid sick days.

Such actions, though, should be part of a multifaceted approach taken to combating the brain drain, lest the country becomes too dependent on aid. This year in Liberia, for example, International Non-Governmental Organizations (INGOs) shifted the responsibility of paying more than half of the country’s public healthcare workers back to a government with insufficient funds to cover the paychecks.

Addressing workplace safety concerns and risks should also be considered. A lack of protective gear, poor infrastructure and medical equipment, and workplace violence are frequently cited reasons for health care workers emigrating.

The role of other stakeholders, such as tertiary institutions, could be closer examined. A recent study showed that final year health students across Africa are more negative about economic prospects at home, more pessimistic about the future and display a greater interest in emigration compared to students studying other disciplines. A concerted effort to modulate medical students’ attitudes may be worth exploring.

While no single solution is clear, what is uncomfortably certain is that the brain drain is likely to continue in future and needs urgent attention if the continent wishes to stem the flow.

 

For a list of African diaspora organizations: http://www.royalafricansociety.org/africa-online/178.html?Reference=174.

 

May Lew is a volunteer contributor whose background includes research in youth entrepreneurship and health at the Overseas Development Institute, and social enterprise consulting for the Malawi Millennium Villages Project.