Too many African doctors lost to local NGOs – we need to fix the ‘internal’ brain drain.

A recent article in the British Medical Journal brought to the world’s attention the significant financial cost of the external brain drain. It studied 9 African countries that typically export doctors, and 3 western countries that tend to import doctors and assessed the cost. The final tally – African countries lost $2.6billion dollars training doctors who are now living in western countries. According to this article 25-50% of African-born doctors are now living and working abroad. These numbers are impressive and concerning. If we are to address the severe shortage of physicians in Africa we certainly need to plug this leak and encourage western countries to find ways to become self-sufficient in producing enough doctors.

There’s another brain drain that doesn’t seem to get as much attention – the internal brain drain. Of those medical graduates who chose to stay in-country after training, many don’t go on to clinical practice – they get lured into non-clinical jobs by governments or local NGO’s. Foreign NGO’s pay better and offer better benefits. I remember when I was in a hospital in Tanzania a few years ago talking to the one internist working there – he complained that so many of the residents he trained would go off to do a Masters in Public Health because then they could get a job with the Clinton Foundation – have a good salary and still feel like they were improving the health of their country.

The Sub-Saharan African Medical School Study examined the plight of faculty in medical schools. These faculty often see patients in public hospitals along side their teaching responsibilities. This study found that in a 5-year span, 25% of faculty were lost to internal brain drain (either working for the government or NGOs).

Ironically, when I’ve talked to physicians in Africa who have moved from clinical to policy or public health work, they miss their patients. In fact, in a recent trip to Ethiopia some of these docs say they would be happy to see patients on a part-time basis or in the University clinic with residents but their jobs would not allow them that option.

There are two questions that need to be addressed:

– What are the real numbers of this internal brain-drain? A brief look at physician tracking systems in Africa reveals that these numbers are likely not being captured. We need tracking systems that gather this data and we need more research done to understand the breadth and scope of this problem.

– What can NGOs do to address this issue? Can they allow or even require their physician on staff to do some amount of clinical work? Can they partner with governments or Universities to allow their employees to work in public clinics or medical schools? If NGO’s made this a policy, it could apply to all doctors working in the country – not just the African-trained doctors. Imagine if all doctors who come to Kenya for research or policy work were required to spend even one day a month in a clinic – access to specialists would certainly improve! 

Both quantifying the internal brain drain and finding innovative ways to address it must be on the table if we are to scale up the physician workforce in Africa.

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