“There’s a lot of guilt in that. Some cocoa farmer worked very hard to pay his taxes so I can go to school.”
Those are the words of Dr George Ofori-Amanfo, an associate professor of paediatric cardiology in an American hospital. But America isn’t Dr Oforio-Amanfo’s home country, nor did he complete his training in the US. The Ghanaian-born doctor is one of the many medical practitioners from developing countries practising within high-income earning countries. This emigration of talent is contributing to the ‘brain drain’ that is crippling low-socio-economic countries.
Like Dr Oforio-Amanfo, many developing states send students and healthcare practitioners abroad to gain world-class training and experience. The issue is, they never return home.
It’s not hard to see why medical practitioners are leaving their homes. Higher wages and modern facilities serve as incentives for doctors to migrate to greener pastures throughout the world. Surgeons in the US earn on average US$216,000 per year. Their counterparts in Kenya make just US$6,000. In a global world, the countries that pay the best attract the world’s best talent. That’s the way the world works.
However, this practice has been labelled as “looting” and “theft” from the world’s poorest countries. A crime against the world’s most desperate people. Kenya serves as a stark example of this, more than half of the country’s locally trained doctors are now practising overseas. As a result, Kenya has just 20 doctors per 100,000 people. Comparatively, Australia has 202 GPs per 100,000 people and this number does not include specialists.
High-income producing countries such as the US, UK, Australia and Canada are able to maintain high levels of physician-to-population ratios by recruiting doctors from developing states. But it’s not just doctors. Nurses, pharmacists and dietitians just to name a few are also being attracted by the promise of greater pay and high-quality medical equipment and hospitals. In one year alone, 500 nurses left Ghana, which was double the amount of Ghana’s nursing graduates for that year.
According to the World Health Organisation, Africa bears 24 percent of the world’s disease burden. However, the entire continent only has access to three per cent of health workers and one per cent of the world’s financial resources.
When practitioners from developing states complete their residency programs in states such as the US and UK it is rare for them to return home. In fact, these states provide them with incentives to stay, they are offered licences to practice medicine and permanent visa status. This has generated much criticism, but whose responsibility is it to police this? Developing states who produces the talent or developed states who recruits the talent?
Some states have introduced bonding systems to ensure that doctors like Dr Oforio-Amanfo return home and repay their scholarships to their home countries. Trinidad, for example, has already implemented such a system, with doctors who have trained overseas are required to return home to practice for five years to repay their government scholarships.
The World Health Organisation established a task force in 2010 and implemented a Code of Practice on the Recruitment of Health Professionals. The Code outlines the primary framework under which states and health agencies should organise agreements. However, the Code is voluntary and by 2014, only 37 states had made any progress towards implementing any of the recommendations.
However, the United Nations spoke to Dr Bowa, a doctor who studied in Scotland but returned to his home of Zambia, to practice and repay his scholarship suggested other means to resurrect the brain drain. He said that African doctors “must have an opportunity to rise.” Without greater investment in modern medical equipment and facilities, access to housing and a clear-cut career path, doctors in developing states often feel little incentive to stay.
Dr Bowa spoke out against the lack of resources in developing countries that often resulted in disillusionment with the system and dis-empowerment within their role.
The obvious solution for developing states to retain their medical talent is to offer more residency programs to prevent practitioners from being lured away. This solution however assumes that the developing states have the resources to do so. There are, however, initiatives currently in place, seeking to improve the outcomes for medical practitioners and their patients in developing countries. The US has financed a $130 million program in 13 sub-Saharan medical skills to train and equip medical graduates.
However, the inequities of the global economy and global healthcare system have perhaps generated an irreversible cycle. Regardless of how much money or equipment is donated, if these countries don’t have the specialists to use these medical facilities it is largely redundant. What these countries don’t have, what can never be donated, is enough doctors to fill the void.
Dr Kunj Desai became disillusioned with the lack of resources when he was practising in a Kenyan. As there was no available ventilator, Dr Desai often stayed at the hospital overnight manually pumping air into the baby’s lungs in the neonatal-intensive-care unit. Dr Desai later emigrated to the US, yet now his previous hospital has three ventilators, donated by the Japanese government. Yet these ventilators had been rendered useless for two years as no doctor knew how to operate them.
It is clear that the current problems raised by the medical brain drain requires a global response. Developing states do not have the resources to retain their medical practitioners. Developed states investing more money in those states does not seem to be able to fix these problems alone.
