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Brain-drain takes heavy toll on Uganda’s health sector

By Vision Reporter

Added 2nd March 2008 03:00 AM

DR Sam Zaramba, the director-general of health services, was in a class of 40 students at the Medical School in the 1970s. Today, half of his classmates are highly qualified medical practitioners saving lives abroad, while the majority of Ugandans never get to see a doctor when they are sick. “The

DR Sam Zaramba, the director-general of health services, was in a class of 40 students at the Medical School in the 1970s. Today, half of his classmates are highly qualified medical practitioners saving lives abroad, while the majority of Ugandans never get to see a doctor when they are sick. “The

By Charles Wendo

DR Sam Zaramba, the director-general of health services, was in a class of 40 students at the Medical School in the 1970s. Today, half of his classmates are highly qualified medical practitioners saving lives abroad, while the majority of Ugandans never get to see a doctor when they are sick. “The majority (of my former classmates) are super specialists,” says Zaramba.

While half of his classmates are abroad, Zaramba heads a thin national health team strained by a shortage of qualified health workers. With a population of over 28 million, Uganda has only about 2,000 medical doctors registered with the Medical and Dental Practitioner’s Council, including those who are in private and NGO hospitals.

This means there is one doctor to about 13,000 persons. It is much worse upcountry. For instance, Nakasongola, Moroto and Kalangala districts did not have a single medical doctor at the time of the last census in 2002.

Busia District had only three doctors with a population of 360,312, making a ratio of one doctor to 120,000 patients.
By contrast, the US has one doctor for every 390 people, Australia, one for every 404 people, and the UK, one for every 435, according to the World Health Organisation (WHO).

The shortage is just as bad when it comes to nurses. While there is one nurse for every 66 people in Ireland, Uganda has one for every 1,818 people.
Despite the shortage, health workers continue flocking to other countries where the pay is higher.

“There is quite a substantial brain-drain particularly of doctors and nurses,” says Zaramba.

Makerere and Mbarara universities produce about 150 doctors annually. However, nearly one third of these leave for greener pastures abroad, according to a health human resource report compiled by the Ministry of Health and the WHO.

“Incidental reports indicate that 30% of all medical doctors graduating migrate abroad,” says the report entitled Uganda National HRH Observatory. The report was based on review of key documents in the ministries of health, local government, public service, finance and education as well as reports of human resource studies.

The Ministry of Health headquarters alone lost 10 doctors to brain-drain between 2002 and 2006. Overall, every year about 50 medical doctors seek a certificate of good standing from the Uganda Medical and Dental Practitioners’ Council, which is a requirement for medical doctors to practice abroad.

“Obtaining this certificate is only a sign that they plan to go and work abroad, but we do not know how many of them succeed,” says a medical source.
Their biggest destinations are US, Canada, Europe and South Africa.

However, it was not possible to establish how many went to which country.
The cost of educating a medical student for five years is $8,000 (sh13,280,000), going by the foreign students’ fees structure published on the Makerere University website.

If 50 of them go out in a year, that could lead to an annual loss of $400,000 (sh624m) for the country. This does not include the cost of primary and secondary education nor internship.
This loss is not limited to Uganda. Neither is it restricted to the medical profession.

Africa has lost a third of its skilled professionals in recent decades and it is costing the continent $4b dollars a year to replace them with expatriates from the West, says a report by Pollution Research Group at Natal University in South Africa.

Estimates from the United Nations Economic Commission for Africa and the International Organisation for Migration indicate that between 1975 and 1984, more than 40,000 people left Africa for the West.

Since 1990, at least 20,000 people have migrated each year.
A World Bank study estimated that between 1994 and 1997, South Africa lost about 8.4 billion rand in tax earnings and 285,000 rand in Gross Domestic Product, due to emigration of its professionals.

Australia, Britain, Canada and the US have more than 13,000 doctors who were trained in sub-Saharan Africa. This appears to be motivated by the fact that it is cheaper for developed countries to import than to train medical workers.

A 2005 report by Save the Children and Medact estimated that Britain had saved £65m in training costs for doctors and £38m for nurses it had taken from Ghana since 1999.

Dr Margaret Mungerera, former president of the Uganda Medical Association, blames the departures on poor working conditions in both government and non-government health services.

She cites low pay, chronic shortage of medical equipment and supplies, under-funding of the health sector and limited opportunities for further training.

There is also a high demand for health workers in developed countries, where the remuneration is much better than in Uganda.

The way forward, says Zaramba, is to increase funding for the health sector, improve the working conditions of doctors, increase their salaries and give incentives such as training opportunities. “If we had good facilities, they (Ugandan doctors abroad) would come back and practice their skills. They would come back,” he says.

At the moment, the money spent on the health sector is about $12 per capita, while the desired amount is $34 per capita. “This ensures that we will always be in shortage. We are operating at 30% of the requirement,” says Zaramba.

In addition, says Mungerera, the recipient countries should agree to organised brain drain to limit the damage to the countries that are losing the doctors.
“They are taking advantage of the situation. It is cheaper for them to take trained people than to train from scratch,” she said.

Zaramba says whereas Ugandans working abroad bring back money, the country loses a lot by sending Ugandans abroad for medical treatment.
Organised brain drain, indeed, is what a number of international organisations are now pushing for.

In this regard, Uganda is among four African countries to participate in a Commonwealth pilot project involving the exportation of nurses to Europe. The other countries are Malawi, Kenya and Mauritius.

The project entails the training of nurses in the countries and after graduation, they would move to Europe to work for four years and return to their countries to share their experiences and exposure.
However, the debate on medical brain drain is an unending one.

While some say it is a form of looting by developed countries, others think it should be done in an organised way so that developing countries too can benefit from it.

Additional reporting by Arthur Baguma and Jamesa Wagwau

Brain-drain takes heavy toll on Uganda’s health sector

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