August 2015
Migration of Healthcare Workers: A Major Contributor to Health Disparities
Abraham Openy
FUMSA - Uganda Gulu University
abrahamopeny@rocketmail.com
Looking at Africa, and more specifically at Uganda, through a lens to try and assess the migration of health workers we are confronted with here, we can see that it is dependent on many factors, which we call “push” and “pull” factors. Examples of push factors are poor working conditions, limited educational and career opportunities, low pay, poor government health policies, economic and political instability. Pull factors are the opposite. These contribute to the “brain drain” phenomenon. In early 2015, the Ugandan government wanted to export 283 highly skilled health workers to Trinidad and Tobago0, despite the fact that the ratio of doctorsto-patient in Uganda currently stands at 1:25,0000 and the ratio of nurses-to-patients stands at 1:11,000, which way below the WHO recommendation. This move was revoked after being challenged by many individuals and non-governmental organizations. A group of students in a Social Medicine class wrote an anonymous letter to the president of the republic asking for increased government budget allocation for health (up to at least 15% GDP as was previously agreed). The letter argued that, in signing onto the Abuja Declaration in April 2001, the Ugandan government committed itself to continue efforts to designate a full 15% of its budget towards tangible health sector improvement1. As of 2013 this spending totaled less than 9%2. In order to meet the WHO International Sustainable Development Goals, the group advocated for a strong push towards increased budget allocation, especially in the areas of healthcare worker recruitment and retainment. The lack of support for healthcare providers in areas such as health facility infrastructure, access to medical resources, and remuneration remains a significant problem in Uganda. In 2012, a cross-sectional study of Ugandan health students indicated that 63% of recent graduate left Uganda within five years of their graduation while 84% intended to pursue post-graduate www.ifmsa.org
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studies abroad. Seventy percent of nursing students surveyed at one Ugandan institution intended to practice outside the country3. The Uganda Medical and Dental Practitioners Council found that, of the 4,200 physicians registered in Uganda in 2013, only 1,200 were actively practicing clinical medicine. An estimated 2,000 left the country over the past 10 years4. These numbers are extremely troublesome, especially when the current healthcare worker to patient ratio is only 1:1,298. To meet basic healthcare needs, the WHO recommends a health care worker to patient ratio of 1:4395. A 2011 study performed at 18 Ugandan hospitals indicated that 63% of physicians who ultimately choose to stay in Uganda are dissatisfied with their work, while 47% are considering leaving their jobs or the country. Reasons cited include poor compensation, lack of medical resources, poor quality of facility infrastructure, and patient overload6. Ultimately this medical “brain drain” has grave consequences for Uganda. In addition to the estimated $13 million lost annually due to emigrating health professionals, loss of health professionals in Uganda dramatically reduces Ugandans access to healthcare7. Unacceptably common are the dramatic and tragic stories reported by exhausted health care where shortage of providers and/or resources directly resulted in preventable patient injury and death. By examining health sector financing in other countries it becomes clear that increased government spending has huge positive impacts on the health outcomes of its citizens - and this, by extension, positively impacts the country’s economic environment as a whole. Two standout examples are Sri Lanka and Rwanda. In Sri Lanka, the government spends $189 per capita on the health sector, which has resulted in a life expectancy of 75 years8 and a physician retainment rate of 87%9. Rwanda