Diagnosing Africa’s medical brain drain

19 mars 2019Wathinotes systèmes de santé

Author(s): Kingsley Ighobor

Date of Publication: December 2016-March 2017

Osahon Enabulele, a former president of the Nigerian Medical Association, estimates there are about 8,000 Nigerian doctors in the United States. Yet in their motherland, only about 35,000 doctors attend to the country’s 173 million citizens, according to Folashade Ogunsola, a professor of medicine and chairman of the Association of Colleges of Medicine of Nigeria.

The World Health Organization (WHO), the UN body responsible for promoting international public health, puts Nigeria’s doctor-to-population ratio at 0.3 per 1,000 persons, which is grossly inadequate. The country needs at least 237,000 doctors, says Dr. Enabulele.

According to 2015 WHO data, the doctor-to-population ratio in Liberia and Sierra Leone (two countries recently hit by the Ebola epidemic) is even worse: 51 doctors for Liberia’s population of 4.5 million (0.1 per 1,000 people) and 136 doctors for Sierra Leone’s 6 million people (0.2 per 1,000). Ethiopia has 0.2 doctors per 1,000 and Uganda has 0.12 doctors per 1,000 inhabitants, while South Africa and Egypt, at 4.3 and 2.8 per 1,000 respectively, have better ratios.

In search of greener pastures

“About 44% of WHO member states have less than one doctor per 1,000 population,” reported the health body in 2015. “Countries with the lowest relative need have the highest numbers of health workers, while those with the greatest burden of disease must make do with a much smaller health workforce.”

Africa bears “more than 24% of the global burden of disease, but has access to only 3% of health workers and less than 1% of the world’s financial resources,” according to WHO.

Financial losses mount

Countries that invest in the training of health workers suffer financial losses when these educated professionals emigrate, according to a 2011 research by a group of Canadian scientists led by Edward Mills, chair of global health at the University of Ottawa. The researchers studied nine sub-Saharan African countries (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe) and estimated that these countries suffered a loss of about $2.1 billion from investments for all doctors working in destination countries up to 2010. It costs African nations between $21,000 and $59,000 to train each doctor, the Canadian team found.

Africa’s loss is rich countries’ gain: the research estimated that financial benefits amounted to $2.7 billion to the UK, $846 million to the United States, $621 million to Australia and $384 million to Canada. Rich countries should provide financial and logistical support to Africa’s health institutions, the researchers recommended.

Is brain drain a crime?

Some African and Western aid workers have referred to Africa’s medical brain drain as a crime, stirring a debate on the morality and legality of international medical recruitment.

In a 2011 article published by The Lancet, a British medical journal, the aid workers wrote, “High-income countries, such as Australia, Canada, Saudi Arabia, the US, the United Arab Emirates, and the UK have sustained their relatively high physician-to-population ratio by recruiting medical graduates from developing regions, including countries in sub-Saharan Africa.

In contrast, more than a half of the countries in sub-Saharan Africa do not meet the minimum acceptable physician-to-population ratio of 1-per-5,000 WHO standard.”

WHO’s code of practice on international recruitment of health care workers, adopted in 2010, in an attempt to tackle problems caused by medical brain drain, urged wealthy nations to support affected countries; however, the code is a moral guide rather than an enforceable legal instrument.

Stemming the flow of talent

Indications are that demand for health workers in Australia, Canada, the UK, the United States and other rich countries will continue to rise. The US Council on Physician and Nurse Supply estimates a shortage of 200,000 doctors between 2012 and 2022.

Laurie Garrett, a senior fellow at the US Council on Foreign Relations, concurs: “For the foreseeable future, every health provider [in the United States], from Harvard University’s health facilities all the way down to a rural clinic in the Ethiopian desert, is competing for medical talent, and the winners are those with money.”

A health worker from a poor country is good “for a diabetic or someone with heart disease in rural Nebraska,” writes Matt McAllester, a New York Times editor. “[Patients] may be unaware, however, that their gain is a poor country’s loss.”

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