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The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7031 (Published 24 November 2011) Cite this as: BMJ 2011;343:d7031

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Re: The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis

After reading the report, I was amiss as to why in the last two sections titled Possible mechanisms and implications for clinicians or policy makers and Unanswered questions and future research, no reference was made to emphasizing that host countries could require contractual agreements with new doctors to remain X number of years "paying back" to said country their services. Of course, this would mainly apply to countries with publicly funded education or subsidized education, it would further beg the question as to why you also didn't consider recommending that privatized education might not be the best solution until said countries improved their conditions.

In western countries, the incentive to remain is based on the capacity of that country to offer work with a "good" salary. Clearly, this is not the case in the countries you studied. And since it's assumed that any country that hasn't established a base line of economic and social standard, should at least consider alternatives to what the west practices UNTIL they can offer such higher standards.

I worry that not dealing with this point reflects on a possible bias in the report to support a western bent that ultimately favors international approaches to helping the sub-saharan african countries without considering solutions that each country can enact in their own interest.

thank you.

robin mulligan

Competing interests: No competing interests

27 November 2011
robin mulligan