What is Brain Drain, Anyway?
I am really worried about what the future looks like for my small village here in Karamoja, My three children are all under ten years old and I am scared they may get any disease. Truth be told I am scared to go to the doctors, it’s a long journey to get to the closest hospital, doctors are unequipped and some don’t have enough training. I recently lost my grandmother because the doctors were unable to attend to her heavy bleeding as the doctor ratio in our country is one for every twenty-four thousand patients. I think the government does not care about the health of people like us.
This story portrays the life of so many more Ugandans facing the consequences of brain drain without even really knowing what it is.
What is brain drain, anyway?
Brain drain can be described as the process in which a country loses its most educated and talented workers to other countries through migration. This trend is considered a problem, because the most highly skilled and competent individuals leave the country, and contribute their expertise to the economy of other countries. The country they leave can suffer economic hardships because those who remain don’t have the ‘know-how’ to make a difference.
From this general perspective, regarding healthcare, the difficulties go above economic to affect the lives of the citizens, and the consequences therein are cross-sectoral. In Africa, brain drain in healthcare is one of the many root causes of malfunctioning healthcare systems. According to the British Broadcasting Agency (2018), $ 2 billion mitigating and covering for the consequences of brain drain in healthcare. While many can argue that this is due to the impoverished conditions within the countries in Africa, it is far from reality.
Nigeria, considered to be an economically thriving body, shows significant sequels of the medical brain drain. As according to the World Health Organisation (2018), a 50% of medical staff trained in Nigeria works abroad while within the country, one doctor attends to six thousand patients a year as opposed to the minimum requirement by world Health Organisation of one doctor for at most six hundred patients. This informs there is a 10% availability of healthcare in Nigeria. A more alarming situation is in Uganda, where one doctor serves twenty-four thousand patients annually, simplifying this proportion, a doctor is meant to serve around seventy-two patients a day.
Why is it happening?
The current situation has been the conversation. Still, as the government resiliently denies any form of healthcare brain drain, the push factors in this sector are consistently driving a large number of health practitioners out. It is not a myth. Brain drain in Uganda is not a theoretical humanitarian subject; it is a reality that applies to the whole workforce in this sector, from midwives to nurses to general health practitioners. Informed by a case study conducted by the African Institute of Health and Leadership Development in the year of 2017; the qualified health workforce in Uganda in 2015 stood at 81 982 of which, two thirds (55 206) were nurses, medical doctors numbered 4811,3 6% of the total health workforce. General practitioners(GPs) alone were estimated to constitute 83% of the available medical doctors.
Furthermore, records from the health professional councils show that 42 530 (52%) of the health workforce were employed in the public sector in 2015, 9798 (12%) in the Private Not-for-Profit industry, while 29 654 (about one third) were private practitioners, were unemployed or had emigrated. The push factors exist in the policies as well as social perspectives.
From the low paycheques, poor quality of facilities, and scarce human and financial resources to practice their skills, this labor force experiences job dissatisfaction. This has mainly been attributed to inadequate absorptive capacity and labor market imperfections, generating short-run structural unemployment of qualified health workers in the economy. Also, the terms and conditions in the public sector are often deemed unattractive, adversely affecting employment, deployment, and retention, especially for rural posts.
Is public health affected?
The healthcare brain drain does have a significant share in the already weak public health. About 42% of health care positions remain unfilled in the public sector. Meanwhile, nearly 30% of graduating physicians in Uganda choose to emigrate each year (Soucat 2013). As these different situations occur in the public workforce, the country has high maternal mortality rates, with 17 women dying each day in childbirth. It also has rising HIV rates. This reflects the lack of access to health care, which does not derive from lack of facilities or financial capacities but scarce human capital.
As of the health of women and children, it is tough to implement any measure if there is only one nurse to tend to eleven thousand patients annually. This environment does not only drive the healthcare workforce away but strangle the present one. The latter leads to little to no innovation and creativity in public health due to hectic work hours and exhausted resources. The society perceptions also have a lot to do with this medical brain drain, as this sector has been unattractive through the complicated processes to attend medical doctors’ faculties and the population diverting from any local health practitioner.
While multiple studies have shown that well-executed pre-hospital care by first responders can lead to a reduction in mortality, the lack of appropriate critical care education of first responders in rural settings actively contributes to the constant increase of morbidity and mortality rates. The scarcity of health care practitioners in rural settings creates a threat to the proper management of risks like epidemics, STDs, and other sanitary infectious diseases.
The bright side of brain drain.
The effects created by brain drain in health care are enormous and seem to be critical; however, opportunities are a bright side of this dark stage in Uganda. The High-Level Commission on Health Employment and Economic Growth, established in March 2016, affirm that there is a compelling relationship between investing in the healthcare workforce and sustainable development. Hence, the government of Uganda loosening policies to allow more private sector investments as well as creating a supportive economic and social environment from the youth to develop venture that innovates the delivery of public health services would redefine the image of the health care sector and transform a push factor into a pull factor.
A good start would be to allow private health care organizations to apply for tenders for government programs and projects. The public sector needs to build connections and a strong partnership with the diaspora to train the current healthcare workforce in Uganda to reduce the traffic of health practitioners moving outside for training and advanced practice. The youth would need to leverage globalization as a tool for healthy competition and partnership with more innovative healthcare ventures to account for the scarcity of facilities, human capital, and financial capital that limit quality and profitability in this sector.
In conclusion, there is a need for more integration of skills between medical practitioners from foreign countries and those in Uganda. There should also be better payment for the amount of work the doctors do.
This issue of brain drain should remind us that the issue hits close to home, this could be our neighbor, our family member, a friend, us? sharing this online, in conversations, can inform and encourage people to be involved in the process of finding a solution for brain drain. It can disrupt Government policies, healthcare systems, so choose to disrupt with this hashtag.
Omaswa,, F., Kadama,, P., Eriki, P., Odedo, R., & Gidudu, H. (2017). BRAIN DRAIN TO BRAIN GAIN:. Case study, Kampala.
British Broadcasting Channel. (2018). How is ‘brain drain’ affecting Africa? – BBC What’s New? [Video]. Retrieved from https://youtu.be/msaTfbWGc9g
Next Media Uganda. (2019). Brain Drain in the Health Sector [Image]. Retrieved from https://youtu.be/MP-frhyUBH4
TED Archive. (2019). Stopping the brain drain of African doctors | Christopher Ategaka [Video]. Retrieved from https://youtu.be/_4L-ngajspU
PBS NewsHour. (2018). Resisting the African ‘brain drain’ that has created a health care crisis [Image]. Retrieved from https://youtu.be/HltYNzlqAy4
Kendall, D. (2017). Medical Brain Drain in Uganda: Causes and Potential Remedies. Annals Of Global Health, 83(1), 50. doi: 10.1016/j.aogh.2017.03.108