Africa’s doctor brain drain a home-made problem

Dear Tingasiga: “Doctor brain drain costs Africa $2 billion.” This headline, supplied by Reuters News Agency last Thursday, hopefully raised an alarm to the rulers of Africa and to the leaders and other policy makers of developed countries that enjoy the services of expatriate African doctors.

The Reuters report was culled from an excellent Canadian-led study published in last-week’s issue of the British Medical Journal. The study, led by Prof. Edward J. Mills, Chair of Global Health at the University of Ottawa, was done to estimate the lost investment of domestically educated doctors migrating from Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda, Tanzania, Zambia and Zimbabwe to Australia, Canada, United Kingdom and the United States of America.

The study found that (1) the overall combined loss of investment for all doctors from these African countries currently working in the destination countries was $2.17 billion; and (2) the benefit to the destination countries which have recruited these doctors was $4.55 billion. These findings have provided further support to the grave concerns about the impact of physician and other health personnel emigration from sub-Saharan Africa to the developed countries.

These concerns have already led some, including Prof. Mills himself, to argue that the practice of active recruitment of Africa’s doctors to developed countries should be considered an international crime.

A less drastic approach to the problem was the adoption by the Sixty-Third World Health Assembly in May 2010, of a voluntary “Global Code of Practice on the International Recruitment of health personnel.” The Code put the onus on developed countries to minimise the outward migration of doctors, nurses, pharmacists and medical technologists from the ‘developing countries, countries with economies in transition and small island states.’

What the Code has not adequately emphasised is that the exodus of sub-Saharan Africa’s doctors is a less a consequence of active recruitment by the developed countries than it is a result of hostile social, political and economic circumstances in their homelands. Africa’s doctors are not poached by the developed countries, but are forced out by their governments, which deny them full respect of their human rights; appropriate work environments; fair wages; and career advancement opportunities, among others.

Sanctuary

Whereas doctors’ salaries are a critical component of their dissatisfaction, the political environment in which they work is equally important. The exodus of Ugandan doctors started in the 1970s when Field Marshall Idi Amin was running the country. The parabolic increase in physician flight from Uganda since the fall of Amin in 1979 says more about the country’s instability and skewed priorities than the recruitment efforts by agents from the developed countries.

Over the last 40 years, the African countries in the study by Mills, et al, have witnessed variations on the theme. State repression, insecurity, inequitable treatment of doctors relative to the politicians, dysfunctional healthcare services and, wages that have kept physicians’ bank accounts severely anaemic, have all conspired to deplete the doctor population on the continent.

The exception is South Africa, where the vast majority of medical émigré are Europeans that either left in protest against apartheid, or who could not accept to live under African majority rule. Others have left because of the gun violence that has troubled South Africa over the last decade or so.

Meanwhile, the developed countries have been very happy to offer Africa’s doctors a sanctuary that has guaranteed them freedom, security, dignity, fair treatment, career advancement and excellent wages.

Clearly, there is a greater need for Africa’s governments to remove the political and other barriers to physician retention and repatriation than for the rich countries to shell out yet more money that may end up being stolen the way the HIV/Aids and Malaria Fund became a piggy bank for some of Africa’s corrupt officials. Nevertheless, with the improved security and political freedoms in sub-Saharan Africa, an opportunity exists for reversing the dangerous depletion of Africa’s physician and other healthcare manpower.

The study by Mills, et al, offers us some concrete figures upon which to base efforts to address the problem. After an excellent analysis and examination of the findings, the study’s authors, who included Dr Sam Luboga of Makerere University College of Health Sciences, recommended that the destination countries “should consider investing in measurable training for source countries and strengthening of their health systems.”

It is a recommendation with which I agree entirely. In recent years, I have advocated an innovative two-pronged programme which would (1) help to reverse Africa’s doctor brain drain through physician repatriation, and (2) enhance retention of physicians currently working in Africa. It is a programme that offers a win-win proposition to both the source and destination countries.

Dr Mulera is a consultant pediatrician and neonatologist. Eamail:mkmulera@aol.com