Tanzania is among nine sub-Saharan countries that invested about $2 billion in educating doctors it finally didn’t benefit from, due to brain drainage, a new study has revealed.
According to study published in the British Medical Journal in November, 2011, nine sub-Saharan countries, Tanzania, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda, Zambia and Zimbabwe invested some $2 billion in costs of educating doctors who subsequently emigrated to the United States, United Kingdom, Australia, or Canada.
The receiving countries gained an estimated $4.55 billion from these investments, in savings from medical education that they did not have to finance.
The familiar phenomenon of “brain drain,” it is clear, should also be seen as a subsidy from developing to developed countries, the study says.
The study’s objective was to estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States.
Participants in the study were nine sub-Saharan African countries with an HIV prevalence of 5 percent or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries.
Main outcome measures: The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors.
Results of the study show the overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95 percent confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa.
The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m).
The migration of health workers from developing countries to developed ones is a well recognised contributor to weak health systems in low income countries and is considered a primary threat to achieving the health related millennium development goals.
In 2010 the World Health Assembly unanimously adopted the first code of practice on the international recruitment of health personnel, which recognises problems related to the global shortage of health
staff and calls for all countries to mitigate the negative effects from the migration of health workers.
The code also calls on wealthy countries to provide financial assistance to source countries affected by the losses of health workers. The code is particularly important for sub-Saharan Africa
where, according to the World Health Organisation, the majority of countries are experiencing a critical shortage of doctors, nurses, and midwives.
Many doctors from these countries have left to pursue better career opportunities in developed countries. The problem is exacerbated by the continent bearing the greatest burden of diseases such as HIV/Aids.
While Africa experiences 24 percent of the global burden of disease, it has only 2 percent of the global supply of doctors, and less than 1% of expenditures are on global health. Countries with a high prevalence of HIV are particularly affected by shortages of health workers for several reasons.
Firstly, HIV has been documented as a leading cause of death among health workers – in the first five years of the AIDS epidemic, for example, an estimated 1 in 10 health workers in Malawi died of AIDS. Secondly, HIV leads to health workers’ absenteeism owing to illness among staff or their relatives. Finally, the increased workload resulting from HIV/Aids illness has not been met by a commensurate increase in staff, leading to increased burnout and fatigue.
The shortage of doctors in most African countries is attributed to institutes lacking the capacity to train sufficient numbers of doctors, coupled with an inability to retain doctors, who choose to emigrate for what they consider better career opportunities.
Many wealthy destination countries, which also train fewer doctors than are required, depend on immigrant doctors to make up the shortfall. In this way developing countries are effectively paying to train staff who then support the health services of developed countries.
Although developed countries often provide development assistance to resource limited countries, the amount that goes into the training of health workers is variable and limited.
Although the code of practice is voluntary, specific recommendations are to report data on the migration of health staff and to establish research programmes on migration. The ability of wealthy countries to produce such data is mixed as non-licensed health workers are often not counted.