SEATTLE — Africa as a whole has 2.7 physicians for every 10,000 people, compared to a global average of 13.9. Every year, 25 to 50 percent of African doctors leave their homes, leaving millions of sick or dying Africans without proper care.
This lack of healthcare professionals means that hospitals and other care centers cannot operate at their full capacity or provide all patients with basic healthcare. The doctors who remain in Africa are overburdened with cases of malaria, diarrhea, malnutrition and more. Africa bears 24 percent of the world’s disease burden, but only has access to 3 percent of the world’s doctors.
Why do African doctors leave, and what can be done about it?
- Competitive pay rates
Thousands of African healthcare professionals leave the continent because of the promise of better pay. Surgeons in New Jersey earn an average salary of $216,000; their Zambian counterparts make only $24,000.
Frustrated with their low pay, doctors in Sierra Leone, Uganda, South Africa and Kenya participated in strikes and negotiations to increase their salaries; some of them were able to double their monthly pay. Even so, health professionals may avoid putting patients at risk and receiving the stigma that comes with strikes by creating unions that can advocate on their behalf while they continue treating people. Higher pay would increase doctors’ quality of living and help keep them in Africa.
- Better medical facilities
Still, financial incentives alone are not enough in terms of retaining doctors in Africa. Doctors leave because of outdated, inadequate medical facilities. African countries rank near the bottom on the list of medical devices available. Zambia, for example, has 0.07 MRI machines per million people.
Healthcare professionals need adequate infrastructure to be confident they can do their jobs effectively. According to African Renewal online magazine, Nigerian doctor Folu Songonuga said he migrated to the United States in part to “learn new things and practice in a better environment.”
Retaining doctors in Africa would be easier if African governments allocated generous portions of their budgets to the health sector because hospitals could afford more of the latest medical equipment.
In 2001, African governments pledged to allocate 15 percent of their annual budgets to healthcare by 2015. As of 2013 World Health Organization data, only six countries met this goal and five more spent at least 13 percent of their budgets on health.
- Learning opportunities
Career promotions and training opportunities can also motivate workers to stay in Africa. Many young African-born physicians leave their home country or continent to go through a residency or specialization program because only a handful are available in Africa. After completing a residency in a more developed country such as the United States or the United Kingdom, some doctors opt to stay and work in that country.
A possible solution is to create more specialized programs in African countries, like the ones in Kenya, South Africa and more, that will attract doctoral students and get them to stay where they are most needed. Another option is to create programs that provide doctors with incentives such as high pay rates for returning to Africa after they receive specialization elsewhere.
- A supportive environment
Doctors need professional support as well. Superiors can improve their subordinates’ work outlook through encouragement. And, doctors may feel more valued and respected in society if STEM fields are funded, widely available and encouraged starting in primary school. This will also serve to get more children interested in medicine, which could eventually produce more doctors for Africa.
- International codes of conduct
Several countries in Africa have joined the Global Health Workforce Alliance and developed plans to improve their healthcare systems to retain workers. The Republic of Congo, Djibouti, Nigeria and ten other African nations have created plans that include policies that favor in-country retention, retention of workers in underserved areas and additional investment in the health workforce, among other strategies.
Another initiative for retaining doctors in Africa is in the African Union’s health strategy for 2016 to 2030. The union expects member states to “prioritize human resources for health.” This involves increases in health worker recruitment, support and retention.
African countries cannot solve their brain drain alone. High-income countries like the United States and the United Kingdom should reduce recruitment of health care workers from low-income countries and encourage return migration of studying physicians.
The World Health Organization Global Code of Practice on the International Recruitment of Health Personnel calls for recruiting ethically and supporting return migration. As with most international guidelines, adherence to the code is voluntary. Retaining doctors in Africa will pay off for the continent. Currently, it is losing more than $2 billion dollars per year from subsidizing training for doctors who end up taking their expertise elsewhere.
Retaining doctors will also improve African countries’ quality of living. Having more doctors can ensure patients are properly treated and live longer lives. With better health, people will spend less on medical expenses and be physically able to work. Healthier people can rise above poverty and, in turn, contribute to the prosperity of their nations.
– Kristen Reesor