Sub-Saharan African countries that train, and invest in, their doctors end up losing billions of dollars as the clinicians leave to work in developed nations, finds new research.
According to the study: The financial cost of doctors emigrating fomr sub-Saharab Africa: human capital analysis by the University of Ottawa published on British Medical Journal’s website, South Africa and Zimbabwe have the greatest economic losses in doctors due to emigration, while Australia, Canada, the UK and the US benefit the most from the recruitment of physicians educated in other countries.
“These findings are concerning,” says principal investigator Edward Mills, professor in the Interdisciplinary School of Health Sciences at the University of Ottawa and Canada Research Chair in Global Health. “Wealthy countries are trying to strengthen the health systems of Africa and are providing essential medicines, but they are benefitting from Africa’s financial loss in training health workers that emigrate to the wealthier settings.”
The authors are now calling for destination countries to invest in training and health systems in the source countries.
“No-one is saying that people should not be permitted to make decisions about where they live or want to succeed in their careers,” says Dr Nathan Ford, a study author from the University of Cape Town. “But how can we make progress in building health systems when local university budgets and school places are depleted by physicians who then go and work in a wealthy nation?”
The migration of health workers from poor countries contributes to weak health systems in low-income countries and is considered a primary threat to achieving the health-related Millennium Development Goals, says the study.
“While wealthy countries are benefitting from the doctors who choose to move, there is a responsibility to ensure we are not damaging local health systems in Africa,” adds study author Ivy Bourgeault, professor in the Interdisciplinary School of Health Sciences at the University of Ottawa and CIHR Health Canada Research Chair in Human Resources for Health Policy. “Some countries, such as the US, have recognised this and pledged to train 130 000 new health staff in Africa; other countries, such as Canada, are providing much less.”
There is a critical shortage of doctors in sub-Saharan Africa, which has a high prevalence of diseases like HIV/AIDS. Mills and colleagues estimated the monetary cost of educating a doctor through primary, secondary and medical school in nine sub-Saharan countries with significant HIV-prevalence. The research team added the figures together to estimate how much the origin countries paid to train doctors and how much the destination countries saved in employing them.
The results show that governments spend between $21 000 (Uganda) to $59 000 (South Africa) to train doctors. The countries included in the study paid around $2-billion to train their doctors only to see them migrate to richer countries, say the authors. They add that the benefit to the UK was around $2,7-billion and about $846-million USD for the US.