Brain Drain of Medical Doctors in Rwanda
Brain drain is the migration of medical practitioners from one area to another, looking for greener pastures. When we talk about greener pastures, we mean more favorable geographic, economic, or professional environments. This migration can either be internal or external.
In Africa, there is an internal brain drain when medical practitioners move from the countryside to the cities in search of better-paying jobs or when they move from the public sector to the private sector and work for Non-Government Organizations.
In Rwanda mainly, brain drain is an issue, though there is little research that has been conducted to display the consequences of this professional migration. Statistics of the Ministry of Health prove that one doctor is in charge of treating 16,046 patients, one pharmacist serves 20,000 inhabitants, one midwife serves 18,790 women, and one nurse takes care of 1,227 inhabitants (Ministry of Health, 2015). The data shows that the number of doctors is still limited due to medical practitioners’ envy to study or work abroad.
There was research conducted by interviewing medical students at the University of Rwanda. The research aim was to find out the desires of the students in working for the public sector or moving abroad. The graph below shows the intentions and career plans of these future graduates. (Rubagumya, 2016)
As seen from the graph above, 42.70% of the medical students desire to study/work abroad, as 11.50% of the students are interested in public health. It is indeed a challenge, and it becomes more challenging when the brain drain is not only external but also internal.
Further statistics show that the internal brain drain is a challenge in Rwanda since 75% of the doctors are in Kigali, and Kigali covers 20% of the entire population (The East African, 2015). You may wonder how the remaining 80% is treated by only 25% of the doctors found in the country, and realize that brain drain is a stumbling block to the provision of sufficient medical healthcare since most of the people move from the countryside to Kigali for treatment. Brain drain is a problem that needs to be addressed before we move to the means that can be used to prevent this brain drain, let us first look at the causes of brain drain.
CAUSES OF MEDICAL BRAIN DRAIN
Various causes lead to the Medical brain drain in a developing country like Rwanda. Better earning opportunities. Most doctors in developing countries migrate to developed countries looking for better earning opportunities and social adjustments.
In Rwanda, poor remuneration is a push factor of the medical brain drain. The average salary earned by one person in developed countries motivates medical doctors to change their professional workplace(Tahir et al… 2018). For instance, if a medical doctor is making 300,000 Rwandan Francs per month in Rwanda and hears that the same salary is given to a cleaner in a given office in the United States of America. When the doctor calculates his/her monthly income, which is not in line with the skills acquired, they decide to move abroad to earn more where he/she thinks they can value his/her skills.
Fewer opportunities for further studies in developing countries such as Rwanda are a significant factor to the emigration of medical practitioners. Passionate Physicians and specialists often want to learn new things that can make them better in their careers. Due to fewer opportunities in developing countries, they opt to horn their skills in developed countries where they would interact with other experts(University World News, 2019). Some healthcare institutions lack advanced infrastructures that discourage medical practitioners in the course of their career journey. With an ongoing increase in population in most developed countries, yet weak healthcare systems are affected on a large scale. It is a critical challenge that pushes Medical Doctors as they think a rapid population growth perpetually poor, will not help them to reach anywhere. It is in line with a high burden of both epidemic diseases among the sparse population, which decreases energy to deliver effectively and efficiently to medical doctors when remuneration still weak. (Tahir et al… 2018) .
Lack of leadership skills in Healthcare workplaces is a crucial determinant of migration of skills health personnel. The administration underrates most health centers and public hospitals. When the administration of health is not able to take care of medical practitioners, they leave, and patients become the victims of irresponsible administration (The Conversation, 2019). Lastly, medical schools in developing countries are also seen as role models encouraging brain drain, when they are openly expressing pride having trained students who are practicing in the developed countries.
EFFECTS OF MEDICAL BRAIN DRAIN
Both the internal and external brain drain of medical doctors have a massive impact on Rwanda as well as Africa. This problem hinders the socio-economic development of the country in the following ways:
The brain drain of medical doctors leads to increased expenditure on education and training to compensate for those who have left, hence a significant loss to the country (Rubagumya, F. et al… 2016). Rwanda invests many funds in health sciences, with the hope that the graduates will benefit the country in return, but the graduates prefer to stay in foreign countries, and it turns out to be a loss for the country.
The prevalence of different communicable and chronic diseases and the miseries of people are linked with brain drain (Tahir et al…2018). The emigration of doctors reduces the already low quantity of skilled manpower available in Rwanda which presents the shortage of doctors in the country, and this increases the doctor to patient ratio. The increase in this ratio also increases the burden on a medical practitioner that is in charge of treating thousands of people.
The shortage of medical doctors as a result of brain drain in Rwanda encourages wealthy people to travel out of the country to seek medical care. while th population only access is basic care in the nearest community (The East African, 2015). And as a result, the reliability of Rwanda on foreign technical assistance increases, which signifies a weak health system. This also reduces the trust that the local population has on the health system, as they prefer to rely on foreign support because they don’t trust the local medical practitioners.
Brain drain negatively affects the scientific output of the country since the medical practitioners who were meant to conduct scientific research for the country have already left, and they end up contributing to the research process of the host countries (Rubagumya, F et al… 2016). The loss of these practitioners hinders the innovation of new medical products or the scientific contribution that people would have received from outgoing doctors.
The public sector should provide incentives for doctors to remain in their working areas. Since the doctors are incentivized by the Non-Government Organizations (NGOs) and the foreign countries to leave their jobs, the government should provide incentives that motivate the doctors to stay in their working areas. These incentives include raising the salary, providing rental fees and transportation fees (fuel), and exempting taxes on the purchase of cars for the medical practitioners. These incentives would at least mitigate the desires of medical students to want to leave their countries for better opportunities. It would also reduce the internal brain drain since practitioners from the countryside would be receiving favors that facilitate them to stay there.
The medical practitioners should also be encouraged to acquire managerial and leadership skills. It is because you find that doctors have skills in treating people, but they lack skills in managing the day-to-day activities of the hospital. Whenever a medical practitioner observes an unchangeable behavior in the leadership, he/she may be bothered by that environment and choose to move to a conducive environment. It would be a loss to the hospital and the country at large. It is, therefore, a necessity for the doctors to have such skills to handle the operations of the hospital. The Government of Rwanda has taken reasonable measures of establishing the University of Global Health Equity that provides skills related to the delivery of quality healthcare services. It will not only help in creating a conducive environment for the doctors but also assist patients in receiving quality healthcare.
We also recommend researchers to publish papers on brain drain since there is little to no information about the current status of the brain drain in Rwanda. Considering the research that we have conducted, we realized that there is only one research paper that wrote on brain drain in Rwanda. The research paper talked about the survey that was conducted on university medical students to understand their desire to study/work abroad. This research was beneficial in showing the mentality of the medical students in Rwanda. However, we need more research to know about the statistics of medical practitioners operating outside Rwanda, and the reasons behind the internal migration of doctors from home villages to the capital city. If this research were conducted, it would help in minimizing the limitation of finding data related to brain drain in Rwanda since people consult newspapers to get the current information, and newspapers shouldn’t be the only source of information related to brain drain in Rwanda.
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We are Second-year Global challenges students at African Leadership University. Our passions lie in healthcare. We believe that adequate medical practitioners are crucial components of advanced healthcare systems. As we want to innovate different solutions in healthcare, our blog serves to raise awareness on medical brain-drain through outlined causes, consequences and appropriate recommendations to alleviate it in Rwanda.
The East African. (2015). Rwanda MPs call for policy to stop brain drain of medics. [online] Available at: https://www.theeastafrican.co.ke/rwanda/News/Rwanda-MPs-call-for-policy-to-stop-brain-drain-of-medics/1433218-2792704-vnbejt/index.html [Accessed 9 Oct. 2019].
Rubagumya, F. et al. (2016) ‘Physical brain drain in Sub-Saharan Africa: The career plans of Rwanda’s future doctors; Rwanda Medical Journal, 73(1), pp. 5-10
Rwanda Ministry of Health(2015) ‘Health Sector Policy; Available at http://www.moh.gov.rw/fileadmin/templates/policies/Health_Sector_Policy___19th_January_2015.pdf
The Conversation. (2019). Rwanda university sets out to teach doctors medicine and management.[online] Available at: http://theconversation.com/rwanda-university-sets-out-to-teach-doctors-medicine-and-management-110527 [Accessed 15 Dec. 2019].
Tahir et al.. (2018) “Brain Drain of Doctors ; Causes and Consequences in Pakistan,” (March 2011). Available at https://www.researchgate.net/publication/287480268_Brain_drain_of_doctors_causes_and_consequences_in_Pakistan. [Accessed on 14th Dec. 2019]
University World News. (2019). Solving the problems of medical brain drain. [online] Available at: https://www.universityworldnews.com/post.php?story=20160921114508155 [Accessed 15 Dec. 2019].