By Dr. Ivan Edwards, FAAPMR, FRSA
AFRICA’s URGENT NEED
Africa’s urgent need has been, and still is, to stop or even slow the brain drain that is sapping its shrinking pool of valuable skilled human resources. Not only are many African countries lagging in technological advancement and adequate facilities needed to provide essential services, at par with advanced economies, but they are also beset by a dwindling mass of well-educated people exiting the continent in search of better opportunities. This brain drain is particularly damaging to the already ailing health sector on the African continent.
The statistics provide a pitiful diagnosis. The World Health Organization estimates that the minimum number of skilled health professionals (physician workforce, predominately) to people is 23:10,000 (or 1:435), a ratio deemed feasible to keep a country’s health system satisfactorily functional (1). Yet, Africa, on average, has about 1 physician for every 5,000 (2). In some countries, the numbers are worse. In Uganda, for instance, the doctor-to-patient ratio is 1:25,725 with a nurse-to-patient ratio of 1:11,000 (3). Only three African countries, Libya, Mauritius, and Tunisia have a physician to people ratio of 1:1000 (4), a ratio, notwithstanding, still considered to be inadequate.
The major countries that have reaped the most benefit from emigrant doctors are the United States, the United Kingdom, Canada, and Australia (1). In 2015, over 13,000 doctors emigrated to the US, and about 86% of all African trained doctors practicing there were educated in Egypt, Nigeria, Ghana and South Africa (4). In the UK, one in ten doctors emigrated from Africa (4).
The costs associated with this medical brain drain are revealing.
From the front end, it costs between $21,000 and $59,000 for an African country to train a medical doctor. That cost is a monetary loss to each African country from which a doctor migrates overseas to practice medicine. Africa does not reap the benefits; the overseas countries are the beneficiaries of the doctors Africa has painfully paid to train. It is reported that nine African countries, viz. Nigeria, Ethiopia, Kenya, Uganda, Tanzania, Malawi, Zambia, Zimbabwe and South Africa lost more than $2.0 billion since 2010 from the doctors that had emigrated. Meanwhile, US, Australia and Canada save about $846 million, $621 million and $384 million respectively — via African countries training doctors for them (5). On the back end, foreign countries get well trained doctors who see their patients.
Obviously, the main reasons doctors elect to emigrate are varied, some of which include inadequate pay, poor working conditions, limited research funding, lack of advanced high-tech facilities, poor career development, unstable political environment, and war/regional unrest (1).
Most of the foregoing reasons are correctable, at least in the medium term, to slow the medical brain drain.
For one, African countries must prioritize the importance of good health, amongst its people, in the construct of their political agendas. This would require more than just mere dialogue, or utterance of a vague or generic health policy. Prioritization of a sound health policy requires an actionable agenda with allocated funding dedicated to addressing sickness and disease. Moreover, the allocation of African government expenditure on health policy must take precedence over spending on other non-essential sectors, even over exorbitant military spending (a topic unpopular amongst many African leaders). It is a shame that the leading causes of death in Africa, viz. HIV/AIDS, respiratory infections, diarrhea, malaria, and stroke, are largely correctable when priority spending on health prevention and treatment are judiciously undertaken. What African governments must realize is that a healthy populace makes a healthy country that boosts production and the economy, improves quality of life in its citizenry, and reduces high and future expenditure, in the long term, in the fight against sicknesses and diseases that could have been prevented in the first place. Such a drive would even provide the political capital that many governments seek to earn in their quest for good governance. Thus, prioritization of a good health policy backed by prominent funding is key.
Secondly, African countries must compensate their physicians well to lessen the temptation of their migration to countries that will pay them better. Most governments would argue that they have limited resources to do just that. That is undeniably false. Poor sub-Saharan economies that pay as little as $300 per month to their doctors can come up with subsidies and aid (with priority given to the health sector) to reimburse their doctors and keep them practicing in their home countries. This can be done. If African countries can surely keep their government delegates and executive staff from migrating overseas for better opportunities, they can implement the same for their doctors. The will and determination to do this has to take root in solid and fundamental policy and implementation.
Thirdly, the idea of circular migration has been widely floated in the educational circles, as a measure that can curtail the brain drain of skilled labor — like doctors. Circular migration involves short-term migration, in which professionals can work in foreign countries for a few years, before returning to their country of origin. This concept of circular migration is supported by the Expert Council on Integration and Migration in Germany. Under this concept, mutually beneficial practices between host country and country of origin can operate in which African professional entities can cooperate and do host exchanges with other similar entities in advanced economies (6).
SOURCES
1. El Saghir NS, Anderson BO, Gralow J, Lopes G, Shulman LN, Moukadem HA, Yu PP, Hortobagyi G. Impact of Merit-Based Immigration Policies on Brain Drain From Low- and Middle-Income Countries. JCO Glob Oncol. 2020 Feb; 6:185–189. doi: 10.1200/JGO.19.00266. PMID: 32023124; PMCID: PMC7051246.
2. Abairdqz. Africa has about one doctor for every 5000 people. https:qz.com/520230/Africa-has-about-one-doctor-for-every-5000-people.
3. Mwesigwa, A., et al. Cost of sacking 1000 doctors. https://observer.ug/news/headlnes/56053-cost-of-sacking-1-000-doctors.html.
4. Mo Ibrahim Foundation. Brain drain: a bane to Africa’s potential. https://mo.ibrahim.foundatio/news/2018/brain-drain-bane-africa’s-potential.
5. Kingsley, Ighobar. Diagnosing Africa’s medical brain drain. AFRICA RENEWAL. https://www.un.org/africarenewal/magazine/december-2016-march-2017/diagnosing-africa%E2%80%99s-medical-brain-drain#:~:text=It%20costs%20African%20nations%20between,and%20%24384%20million%20to%20Canada.
6. The UNESCO Courier, 2018 1, e-SSN 2220–2293. Africa’s brain drain: is there an alternative? https://en.unesco.org/courier/january-march-2018/african-brain-drain-there-alternative.
