According to World Health Organisation (WHO), 1500 women die everyday from pregnancy or childbirth related complications1. This simply means that before even a minute elapsed (57.6 seconds), a woman has died due to the above complications. And if we are to go by what we are always told, “Let us keep a moment of silence…” when someone has passed on, then we may forever remain silent because according to Carol Bellamy, UNICEF Executive Director “The same number died yesterday, and the same number will die tomorrow.”
Unfortunately, 99% of these cases occur in the developing countries where 85% of the population live and are in urgent need of 4.3 million health care professionals (HCPs).I have a belief that one of the best ways of solving this is by tackling medical brain drain.Whereas even the United Kingdom (UK) is affected, Africa seems to have been hit hardest as there are more African born scientists and engineers in the USA than in the whole of Africa.
This is saddening because 24% of the global disease burden is in Sub Saharan Africa which has just 3% of the world’s health workforce.
Although Africa is lamenting, the developed countries seem to be benefiting greatly from it. Take an example of Chicago (USA) and Sierra Leone; First of all, there are more Sierra Leonean doctors in Chicago than in the whole of Sierra Leone yet the doctor to patient ratio of the former is 1:390 compared to 1:33,333 of the latter. The maternal mortality rate of the two countries is 9 deaths per 100,000 live births (Chicago) and over 1000 deaths per 100,000 live births (Sierra Leone) while the life expectancy of Sierra Leone is 34 years. What a disparity!
Such stories do not stop there as the loss of doctors has been very striking; Ghana has a doctor to patient ratio of 1:11,000 yet 20% of the doctors in New York City are Ghanaians. Also, 20% of doctors in Saskatchewan earned their first degree in South Africa.
My home country, Uganda is no exception to this quandary when South Africa is employing over 250 Ugandan doctors even when Uganda used to produce about 220 doctors annually. In 2009, 13 senior surgeons left Uganda for Rwanda due to poor pay.What an ignominy! Australia, the UK, USA and Canada also employ many more Ugandan doctors. If truth be told, the doctor to patient ratio in Uganda worsened from 1:12,500 in 2006 to 1:24,725 in 2010 yet all these seem to go unnoticed. The depressing bit of such stories is that many of the doctors go when they are in their most productive stages of their lives and come back (if they at all do) when they are “spent forces” not even suited for their own native countries.
This could partly explain why nearly all child deaths occur in developing countries. Statistics indicate that a child born in Sierra Leone is 3-5 times more likely to die before the age of five than one born in India and 100 times when compared to those born in Singapore. Such alarming statistics do not vary so much in many other African countries.
Therefore, medical brain drain should be considered a priority issue to be dealt with urgently because we could be moving along the path Philippines has used or even overtaken them. David Llorito, a Philippine journalist notes that 85% of their nurses are working abroad and the government is puzzled by rate at which many doctors are now training to become nurses “nursing medics” so that they can easily leave the country. (About 4,000 doctor-turned nurses have already left and an equal number in training). He adds that number of persons applying to sit examinations to qualify for medical practice in the country is reducing by 13% annually.This has resulted into closure of 200 hospitals and another 800 partially closed.
In conclusion, the participation of all stakeholders especially in terms of research and influencing policies aimed at advocating for “sufficient resource to work, supportive management, work autonomy, recognition, safe working environment and a manageable work load.” is key.In addition, a well structured and organized financial system to monitor and cater for the salaries and allowances should be put in place. A brighter future similar to or better than Cuba’s doctor to patient ratio of 1:170 and Japan’s life expectancy of 82 years5, 6 is attainable in Africa if the medical brain drain is curbed.