One of the perpetual debates in the African blogosphere is the significance of the “brain drain”. Well-educated Africans are often able to emigrate to North America or Europe, where their skills are in demand. On the one hand, this emigration takes some of the best and brightest out of local economies. On the other hand, these emigrés often send substantial sums of money home – in many countries, remittances often are one of the major contributors to a national economy.
Whether you believe that the economic contributions of the diaspora outweigh the costs of losing great minds from the continent, it’s hard to ignore the disastrous effects on Africa’s national health systems the loss of trained doctors to jobs in the North is having. Sokari Ekine has written extensively on the topic; David Gyewu spoke about the problem at Pop!Tech this past weekend.
With a recent article in the New England Journal of Medicine and an accompanying article in the New York Times, the issue is now getting some attention outside the African/Afrophile community. Dr. Fitzhugh Mullan’s research shows some stunning numbers. Looking at national databases of physicians in the US, UK, Canada and Australia, he discovers that 23 to 28% of new physicians studied medicine outside the country where they are practicing. Of those emigré physicians, 40-75% are from lower income countries. This means that many nations are exporting a large portion of their trained physicians – of the 20 countries who export the highest number of physicians proportional to the number trained, 9 are in the Carribean or Sub-Saharan Africa.
The consequences for African and Carribean hospitals are dramatic. The New York Times interviewed Dr. Agyeman Akosa, director general of Ghana’s health service, who said, “I have at least nine hospitals that have no doctor at all, and 20 hospitals with only one doctor looking after a whole district of 80,000 to 120,000 people.” According to Dr. Mullan’s study, Ghana loses 3 of every 10 doctors trained to the US, UK, Canada or Australia. Ghana has roughly 6 doctors for every 100,000 people – the four wealthy nations in the study all have at least 220 doctors for 100,000 people. It’s even worse in Jamaica, where 41 of 100 doctors leave the country, or Haiti, where 35 of 100 leave.
Why does this happen? Two major factors contribute – African and Carribean nations can’t pay their doctors attractive salaries, so they’re encouraged to leave for more lucrative salaries in the North. And the North needs doctors because nations like the US don’t train enough medical school graduates. There are 22,000 spaces for first-year residents in American hospitals, and only 17,000 US medical school graduates to fill the spaces.
Which leaves me wondering – what do all those fresh-faced Harvard students I see every Tuesday go on to do with their lives? There’s a reported shortage in Computer Science students in the US, and so many international graduate students in the hard sciences – in part because there are so few US-born graduate students – that many schools are offering ESL (English as a second language) classes for teaching assistants. Please tell me that not all these smart young people are becoming lawyers, consultants and bankers.
Some African nations are demonstrating that they can bring back business talent by creating environments for entrepreneurship – many of the Ghanaian entrepreneurs I know lived and worked in the US or the UK, developed robust business skills and some capital, and came home to start businesses when the environment looked sufficiently promising. Is it fair to expect African nations to spend sufficient money on their national health services that they can attract doctors to stay home? Or do the US and other nations need to take some responsibility for ensuring they don’t leave poor nations devoid of trained medical professionals?
If the latter, don’t hold your breath for the US to change immigration policy, as my friend David Gyewu suggests, to allow high-skill personnel in for only five years as a time. A few years back, a college friend was chief of staff for a prominent conservative US Senator. I visited him at the Senator’s office and joked that, if only we had a single issue in common, I could lobby him. He pointed out that we probably had more agreement on immigration than I thought, as the Senator was working hard to make it easier for immigrants to come to the US. The reason? The Senator’s mostly rural state had a large number of hospitals without medical staff – the only way to staff those hospitals with doctors and nurses, he felt, was to welcome medical professionals from the developing world.
At the time, I was encouraged to discover that a politician I’d always dismissed as a neanderthal had at least one issue where he’d seen the light. And now I wonder whether this wasn’t yet another issue where I should disagree with the man.