Guest blog by Evance L Mmbando, 3rd year medical student, Weill-Bugando University College of Health Sciences, Tanzania
According to the World Health Report 2006, the population of Sub-Saharan Africa totals over 660 million people with a ratio of fewer than 13 physicians per 100,000 people. The continent bears 24% of the global burden of disease but has only 3% of the health care workforce and 1% of the world’s financial resources.
Sub-Saharan Africa needs about 700,000 physicians to meet the Millennium Development Goals, the international framework to halve poverty by 2015. The UN Economic Commission for Africa has sounded the alarm on the mass exodus, the so-called “brain drain”, estimating that some 20,000 African professionals leave the continent each year.
African institutions invest heavily in the training of health professionals, and their loss has far-reaching effects. Tired of sitting idly as our country, Tanzania, watches its physicians leave, we medical students organized a movement to highlight the brain drain to our local communities and, critically, develop prescriptive policy recommendations to our national governance.
Our medical college, the Weill-Bugando University College of Health and Sciences and the country-wide Tanzania Medical Students Association partnered to seed this movement, highlighted by a conference in July of 2008. We wrote a proposal for such a movement, raised funds locally and sponsored influential thought leaders from across public and private sectors to attend our conference. Participants included students, faculty, deans and ministry of health representatives. Notably, the location of this conference, Weill Bugando, is a successful example of the twinning process, by which universities in the global North (in this case, Weill Cornell) partner with African universities (in this case, Bugando Medical College) in the realm of education.
Drivers and Impact of the Brain Drain in Tanzania
From our shared experience, there are four essential components to the brain drain that we described at the conference which compel us to consider leaving.
- The first, and perhaps most widely cited, is the prospect of higher quality of life in developed countries.
- The second is the lack of funds for research and innovation in Tanzania. It is difficult, if not impossible, to find research positions at our medical colleges. And if found, the resources to carry on long-term research programs are lacking.
- Third, inadequate stocks of medicine, supplies and equipment demoralize our efforts to deliver required services. It is difficult to avoid feeling frustrated when the quality of care is substandard.
- Finally, the academic climate in our country is not a healthy one – intellectual freedom is stifled, not nurtured, and it is difficult to operationalize one’s ideas into new programs.
Naturally, there are also parallel “pull” forces at play which further incentivize health professionals leaving our country: better wages, working conditions, career options, access to sizeable research funds and a higher quality medical service environment.
The impact of the brain drain is seen everywhere, in both developed and African countries. In the United States, for example, an estimated total of 130,000 foreign medical graduates (FMG) have saved the US more than $26 billion in training costs. The WHO estimates that every time Malawi educates a doctor who practices in Britain, Britain saves $184,000.
Most health professionals in “source countries” (those countries from which there is a brain drain) are trained at the public’s expense. When these professionals leave, the vacancies are often filled by imported expatriates who are highly paid.
Losing highly trained professionals through brain drain also contributes to contracting the economy: you cannot pay income taxes if you are not here anymore. Development contracts in both health and non-health sectors. For example, even though there is a government sponsored clinic within 5 miles of any village in Tanzania, there is often no one present to staff it.
Intriguingly, an internal brain drain is now in full effect, the phenomenon in which professionals are steered toward private, high-end, urban settings rather than resource-poor, rural ones. In the coastal regions like Arusha, Tanzania, there is one doctor for every 40,000 people compared to one doctor for every 300,000 in Mwanza, the home city of our medical college.
I asked 30 medical students at my medical school (15 male, 15 female) their opinion on brain drain and possible interventions by government towards thwarting the problem:
- Twenty seven said that working conditions for doctors are inadequate.
- Twenty five said that the government’s response to the brain drain problem has been poor to average.
- However, despite the dissatisfaction with the status quo, only 7 of the students actively plan to emigrate (in order to seek a better standard of living as well as reputable training and career opportunities).
- Interestingly, when given a choice of three possible solutions to brain drain, 24 students chose an increase in salary incentives as the most important solution (over increase in medical facilities or openness in intellectual freedom).
- The much-quoted notion that medical students are all on public subsidies, and therefore are doubly hurting the government if they leave, may be over-estimated. Over half the students in this survey were borrowing money to pay for their education.
To help organize around next steps, stakeholders at our conference laid out the following proposed recommendations for our national government and other sub-Saharan African countries. We acknowledge that it is not a perfect list, but this is our collective voice:
- The governments in Sub Saharan Africa should take deliberate actions to provide equally competitive salaries and wages for health professionals in an effort to offer a more attractive quality of life.
- There should be adequate work incentives for rural practice. Health workers who practice in rural communities should be reimbursed at the same pay as those in the cities in order to retain them and attract more health workers.
- The governments should put emphasis on training students on research methodology and deliberately allocate funds specific for researchers who train and mentor medical students.
The first priority of health budgets should focus on improving health facilities and services. We have decided to take deliberate actions towards the problemsby introducing and forming a new organization named “Medical Students for Neglected Tropical Diseases Organization.” This organization will work to provide public health education to rural communities as well as opportunities for students to do hands-on research, to evaluate the burden of neglected tropical diseases locally, and to get involved in eradicating neglected tropical diseases (such as lymphatic filariasis and onchocerciasis).
I call upon medical professionals and students globally to recognize the ongoing brain drain from Africa. Help us ensure safe, reliable and high quality medical services.
I thank the major participants of the conference, Prof. William Mahalu Dr.Gozibert Mutahyabarwa , Dr Safari M. Kinung’hi S, Dr. Kamugisha Erasmus Dr.Magambo Kinanga, Dr.Barnabas , Dr. Sweya M. K M , Dr.Stella Mongela, Ms. Zanaida Marwa and fellow students Mr.Charles Mguta, Mr. Magambo Fabian, Ms Adela Luhigo and Mr.Kamuli Simon. I thank Sandeep Kishore and Marilyn Michelow for editorial assistance.