The financial cost of physician emigration from sub-Saharan Africa
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6817 (Published 24 November 2011) Cite this as: BMJ 2011;343:d6817
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I am not completely agree with Mr. Ramaprasad Prasad as you said that countries like UK or USA are getting ready made doctors , nurses, engineers free of cost & of good quality but one thing you should keep in mind that it is also their(emigrants) responsibility to serve the nation too, so they are not following their responsibilities.
But the sufferers are the developing nations ,where the nation has to bear the financial costs of making a doctor or an engineer.
So, it is basically responsibility towards nation which is lacking in emigrant physicians.
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Both UK and USA take advantage of the Developing countries in recruiting ready made Doctors, Nurses, Engineers and other skilled personnel luring them with better salary, but less than what they pay for their people. They get them free of cost. The major sufferers are the countries from the Indian subcontinent.
Competing interests: No competing interests
Re: The financial cost of physician emigration from sub-Saharan Africa
Professor Buchan has made some interesting comments about the WHO code of conduct in recruiting overseas doctors and health workers. However the more he described it the more it sounded like the voluntary code that WHO is trying to squeeze out of the food manufacturers in relation to the explosion of obesity and diabetes in the world or the failed attempts in the past to make the tobacco industry adhere to a Code.
There is a tough world out there and voluntary codes have been notoriously ineffective. Economic pressures always seem to triumph.
This is not to say that we should not try by instituting voluntary codes. But the best way of developing countries to protect themselves in the short to medium term is to concentrate on the most effective health worker per dollar/training, that is one who cannot migrate and take their qualification with them ie the assistant medical officer of Tanzania or the clinical officer of other countries.
An interesting analysis from the other side of the globe by Kimberley Oman and others (1) takes a qualitative look at why trained doctors stayed or left the Fijian Health Service. The sentiments are very similar to those one hears in Africa. There is frustration at not being valued by their health service, not having further training or sufficient autonomy. Political instability and the kind of place you want to raise your children is a strong influence. Personal reasons like the work of one's spouse and or money may be influences but do not seem to be the major reasons.
I would endorse the 'broad based approach to the support of health system development in Africa and elsewhere', especially in providing postgraduate education locally or regionally and supporting the salaries and conditions of work of medical officers as has been tried in Malawi. We should resist the idea that African health services are improved by systematically taking health workers to developed countries for further training except in exceptional circumstances.
It is difficult being on call for 365 days a year and having a house that is falling down with intermittant water. However a quote from Fiji says a lot...' but I love this place. I love the work, I love the people and I love the atmosphere here.'(1)
There is a great desire by many doctors to remain in their own country as was encapsulated by a Tanzanian doctor who responded to an offer of work in Germany by saying 'my people need me here'.
We need to support them.
(1)Specialist training in Fiji: Why do graduates migrate, and why do they remain? A qualitative study
Kimberly M Oman, Robert Moulds and Kim Usher
Human Resources for Health 2009, 7:9 doi:10.1186/1478-4491-7-9
Competing interests: No competing interests