By Ngumbo Njoroge
A new report on good governance has revealed that Kenya and other African countries lose about $2 billion a year due to doctors and health practitioners leaving the continent. The report on the state of public services in Africa, released by the Mo Ibrahim Foundation, is a damning indictment of the failure by African leaders to deliver on some of the continent’s most pressing areas of development.
“This trend and this crisis are particularly noticeable in the African medical sector, says the report which also assesses the current state of public services in Africa and its main challenges, namely the attractiveness of employment and services provided”. According to Internews, a data dredger, Kenya is one of the top six countries in Africa in exporting doctors.
Its data shows that there are close to 4000 Kenyan doctors living and working abroad, 2,733 in the United Kingdom, 865 in the United States and a further 180 in Canada. The migration or brain drain of trained health workers from poorer countries to richer ones exacerbates the problem of already weak health systems in low-income nations battling epidemics of infectious diseases like HIV/AIDS and tuberculosis (TB) and malaria.
Only three countries in Africa, namely Libya, Mauritius and Tunisia, have at least one doctor per thousand people, says the document. The World Health Organisation (WHO) recommends one doctor per 2,778 people. Internews data shows that Kenya currently has one doctor serving 5882 people, double the number recommended by the world health body. The report states that Kenya is among nine countries that have lost more than Sh200 billion since 2010 from training doctors who then emigrate.
The others are Ethiopia, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. According to Internews data, it costs the country Sh4.2 million to train a doctor currently, with approximately 360 doctors who graduate every year from Kenyan universities.
This means that it costs the country Sh1.5 billion annually to train doctors. On the continent, it costs each country between Sh2.1 million and Sh5.9 million to train a medical doctor, said the Foundation. “In 2015, the number of African- trained International Medical Graduates (IMGs) practicing in the US reached 13,584, a 27.1 per cent increase from 2005. This is equivalent to about one African educated physician migrating to the US per day over the last decade,” said the report.
The Foundation noted that destination countries do not pay for the cost of training African doctors they recruit, burdening the local taxpayer with training of doctors who practice elsewhere while straining the local health sector of needed human resource. “One in ten doctors working in the UK come from Africa, allowing the UK to save on average $2.7 billion on training costs, followed by the US ($846.0 million), Australia($621.0 million) and Canada ($384.0 million).
In total, these four top destination countries have saved $4.6 billion in training costs for the Africa-trained doctors they have recruited,” said the Foundation. The repercussion of this shortage is felt by parents and their families across the country. One of them, Margaret Wambui who has cervical cancer, says she has heard politicians make promises on the campaign trail to transform the health sector which are never fulfilled when they clinch power.
“We hear promises every election year. Those contesting promise to make the health sector better for the common mwananchi but this never happens. I have sought care in public facilities but they are always citing that there are no doctors or that machines are not working,” said Wambui.
She is one of the Kenyans who feel thoroughly let down by the state but even with sufficient investment in facilities and personnel, still a significant number of Kenyans do not go to hospitals when they are sick. According to the Kenya Service Provision Assessment, conducted by the Health Ministry, almost 40 per cent of patients who attended government facilities said service providers were rude to patients.
In the same study, it was also documented that medical personnel would come in late, sometimes drunk and leave early, telling patients to report the next day for a similar experience. In order to curb brain drain, the African Union, in its Migration Policy Framework recommends the promotion of the New Partnership for Africa’sDevelopment (NEPAD) strategy for retention of Africa’shuman capacities and generating gender-responsive economic development programs, providing gainful employment, professional development and educationalopportunities to qualified nationals in their home countries.
The continental body further recommends the establishment of policies for the replacement of qualified persons, who have left their country of origin, including strategies to attract the diasporas and retention policies, The WHO adopted a code of practice in 2017 on international recruitment of health personnel that highlighted the problem of a doctors’ brain drain and called on wealthy nations to offer financial help to poorer ones affected.
The code is seen as particularly important for sub-Saharan Africa, which suffers from a critical shortage of doctors against the backdrop of a high prevalence of diseases such as HIV, TB and malaria.