According to the 2006 WHO World Health Report, there were 54million health care workers – which includes service providers and administrative/support staff. Still there was a deficit of 4.3million. Of the 57 countries with critical shortages, 36 are in Africa – leaving the continent with the biggest crisis of healthcare workers. In 2008 the WHO published a document called ‘Scaling up, Saving Lives’ which advocates for scaling up low and middle level providers to improve access. This scale up has already started with 15,000 health extension workers trained in Ethiopia alone. With improved access, comes more demand for higher-level care and an increased need for supervision of these low- and middle level workers. Hence the need for more doctors in Africa. The WHO has estimated that African needs 167,000 more doctors to meet the basic health needs of the continent. With less than 170 medical schools in the country, and an annual throughput estimated at around 11,000, where will all these doctors come from? Looking at the pipeline for physician training in Africa, we need to plug the leaks. The in-country brain-drain to NGOs and ministerial jobs is a challenge. Another leak in the pipeline is the out-of-country brain drain that ranges from 25-50% depending on the country.
As we invest in health system strengthening in Africa, we must invest in strengthening the physician pipeline, putting more students through the pipeline and fixing the brain drain both within and outside the country.