If rich countries want to help Africa, stop poaching our doctors

by Kassahun Desalegn
Wednesday, 30 October 2013 05:19 GMT

A child is given an injection as part of a malaria vaccine trial at a clinic in the Kenya coastal town of Kilifi, on Nov. 23, 2010. REUTERS/Joseph Okanga

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Ethiopia has one doctor per 40,000 people. The U.S., where many African health workers end up practicing, has one per 500. Developed countries should avoid recruiting from countries with critical health manpower shortage.

Tangut was 30 years old and lived in the countryside 400 miles away from Gondar, the small city in northern Ethiopia where I practice dermatology. She had been itching for two years because of a treatable skin condition caused by mites. While saving money for the trip to see me, she passed the disease to her child, and they both had advanced cases when they finally reached me.

I practice in a university hospital where I am the only dermatologist for 6 million people. Ethiopia as a whole has a population of 80 million, but only one doctor for every 40,000 people. The United States, where many African health workers end up practicing, has one doctor for every 500 people.

Poor patients often travel miles after months of planning to reach specialised doctors, and by the time they reach us, their diseases have often progressed dangerously. In a normal day at my clinic, I see up to 50 patients, many of whom suffer from tragic complications brought on by these delays.

Where are all the doctors? When I started practicing medicine in 2004, there were 200 newly graduated doctors all over the country. Only a third of them are now in practice. A third work in international organisations in the country and a third have moved to practice abroad.

As a professor of medicine, I also train medical and paramedical professionals and have noticed many newly graduated professionals choose to immigrate to the U.S., Europe, the Middle East and other rich African countries like Botswana and South Africa rather than practice at home. Nearly 30 percent of African doctors leave to work abroad after graduation.

Some countries like Australia actively recruit high-skilled health professionals from other countries, including sub-Saharan Africa. And legislation is pending in the U.S. Congress that would give better immigration benefits to foreign-born doctors.

This shortage of doctors and other health professionals has led many people to turn to alternative medicine as a treatment option. As a result, 80 percent of Ethiopians prefer traditional healing, which can often be harmful when used as the only treatment. Most of my patients have used spiritual healing such as drinking holy water, for diseases they believe to be caused by evil spirits, or applied traditional herbs before coming to me.

To me, one of the most tragic parts of this story is that once they reach foreign shores, many doctors end up quitting medicine and seeking other employment because of the complicated process of medical licensing in foreign countries. You may be surprised by the successful cardiopulmonary resuscitation performed by the foreign-born waiter or bartender at a favourite restaurant in Europe. Unreasonably low wages, poor health systems and unstable politics are often cited as the reasons for doctors migrating to developed countries.

Strengthening the healthcare workforce in developing countries is an important component of international development policy. Dr Lee Jong-Wook, the past director general of the World Health Organization (WHO), has said that brain drain from Africa is severely hobbling the continent’s fight against HIV/AIDS. Africa loses billions of dollars and countless lives because of doctor migration.

But the shortage of health professionals is felt not only in Africa, but also in Europe, the U.S. and other developed countries. Worldwide, an estimated 4.3 million doctors are needed, according to the WHO. While poor countries have attempted to tackle this problem through task-shifting - training middle- and lower-level healthcare providers to do higher-level tasks - developed nations insist on high-skilled and specialised care, which continues and accelerates the medical brain drain from developing to developed countries.

Economic development goals must address the flow of high-skilled healthcare professionals to more fortunate countries. Source countries, recruiting countries, and the international community should address brain drain and improve health care inequity.

First, African governments should provide much better compensation for doctors. Improved wages, pension, housing, tax benefits, childcare, and medical insurance will bring immediate and dramatic results. My colleagues earn monthly wages ranging from $150 in Ethiopia to $2,000 in Botswana, though many employers can pay more. The same doctor can earn up to 50 times more in a Western country. Developing countries could also increase non-financial incentives like improved career paths, good working environments, better availability of drugs and medical supplies, and more personal freedom.

Destination countries should also avoid recruiting doctors from countries with critical health manpower shortage. In May 2010, the WHO developed the Global Code of Practice on the International Recruitment of Health Personnel to mitigate damage to low-income countries struggling to meet the basic health needs of their populations. Unfortunately, its implementation, both by developed and developing countries, has faced enormous challenges. Only Norway has formally adopted this code.

Developed countries should instead improve and expand their education systems to train the healthcare workers they need and ensure the sustainability of their own healthcare systems. Financial compensation should also be paid to source countries through direct aid, and return migration should be encouraged.

As my patient Tangut can tell you, two years is far too long to endure a treatable condition. Finding medical care should not feel like searching for a needle in a haystack.

Dr Kassahun Desalegn serves as department head and assistant professor of dermatovenereology at the University of Gondar, College of Medicine and Health Sciences, in northern Ethiopia. He is a 2013 New Voices Fellow at the Apsen Institute.