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Research Article

Physician Emigration from Sub-Saharan Africa to the United States: Analysis of the 2011 AMA Physician Masterfile

  • Akhenaten Benjamin Siankam Tankwanchi mail,

    Akhenaton.tankwanchi@gmail.com

    Affiliation: Department of Human and Organizational Development, Peabody School of Education, Vanderbilt University, Nashville, Tennessee, United States of America

    Current address: independent consultant

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  • Çağlar Özden,

    Affiliation: Development Research Group, The World Bank, Washington (D.C.), United States of America

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  • Sten H. Vermund

    Affiliations: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America, Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America

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  • Published: September 17, 2013
  • DOI: 10.1371/journal.pmed.1001513

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A Proposal to Stem African Healthcare Brain Drain: Human Capital Contracts for Global Health

Posted by anandreddi on 17 Sep 2013 at 22:14 GMT

I applaud Tankwanchi, Özden, Vermund for their paper. I agree with the authors that "policy proposals to address the inequities of global physician distribution will depend not only on credible data to influence the US and other doctor-importing high-income OECD countries to train larger number of physicians to meet their own workforce needs, but also on a social justice agenda and global health initiatives that promote the creation of opportunity structures necessary to enhance career development, improve workplace conditions, and encourage the recruitment, training, and retention of resources, talents, and skills in SSA and other LMIC source countries."

I propose a solution to increase the number of physicians educated in African resource limited settings through the use of human capital contracts for global health.

Briefly, human capital contracts for global health work like this: an investor, such as a donor nation, charitable foundation, or global health initiative, will cover the entire cost of a student's medical training. In exchange, the student will work for the first 10 years of their medical career in a government or NGO sponsored health clinic in their respective country of medical education. Their medical license will be contingent on this obligatory national service. Additionally, a multilateral “binding” agreement between the African country and destination countries (such as Australia, Canada, New Zealand, United Kingdom, and the United States)-brokered by the investor- could prevent migration during the term period.

For example, in Malawi, the College of Medicine (the country’s only medical school) has graduated 372 students (≈19 students per year) since 1991. Currently, the school anticipates 60 graduates per year with the intention to scale-up to 100 graduates per year. The Malawian government subsidizes nearly 100% of students’ medical education, currently estimated to be $32,952 USD per year.

In the case of Malawi, assuming a donor, such as the President’s Emergency Plan for AIDS Relief (PEPFAR) or The Bill and Melinda Gates Foundation, aims to triple the number of College of Medicine graduates from 60 to 180 students per year, it would cost an estimated $6 million USD per year. This is assuming an annual tuition of $32,952 USD. Ironically, in order to tackle the physician shortage in Malawi, the United Nations Development Program (UNDP) is paying $40,000 USD per year to attract foreign doctors to Malawi. In order to retain physicians after the 10-year term, donors could help supplement physicians income through a public-private partnership with the Malawian government to disincentivize emigration to western countries.

Global health initiatives and donors, such as The President’s Emergency Plan for AIDS Relief (PEPFAR) and the Bill and Melinda Gates Foundation, should explore the use of human capital contracts for global health.

References:

Reddi A, Thyssen A, Smith D, Lange JH, Akileswaran C. Human capital contracts for global health: a plan to increase the number of physicians in resource limited settings. AIDS. 2012 Sep 24;26(15):1979-80. PMID: 22992581

Full text: http://www.anandreddi.org...

Reddi A, Thyssen A: Healthcare Reform: Solving the Medical Student Debt Crisis Through Human Capital Contracts.
The Huffington Post. June 10, 2011

Full text: http://www.huffingtonpost...



No competing interests declared.

RE: A Proposal to Stem African Healthcare Brain Drain: Human Capital Contracts for Global Health

Th3_Tank replied to anandreddi on 04 Oct 2013 at 05:12 GMT

Anand,

Many thanks for your comment. I read with interest your Huffington and AIDS pieces. I will be sure to reference them in relevant publications, although I must be quick to add that focusing on cost and financial benefit alone as a remedy to the physician brain drain and a motivation to go into medicine seems problematic. I think you are on the right track when you state: "A multilateral ‘binding’ agreement between the African country and destination countries could prevent migration during the term period." The operative word is "binding". Personally, I am highly skeptical about the effectiveness of the "non-binding" WHO Global Code of Practice to stem the physician brain drain. But, I intent to make the case elsewhere.

No competing interests declared.