Doctors and Soccer Players — African Professionals on the Move

This article hits upon the immense problem of "brain drain" of African trained doctors, who seek their fortune abroad. Even those who stay in their home countries often migrate to urban areas, leaving the rural poor without access to adequate healthcare. As the medical director of the ECWA hospital in Jos, Nigeria told me, "It is a "sacrifice" for the country to stay and take care of Nigerians as opposed to working abroad.

Another doctor noted that at his salary of $500/month it was very difficult to provide for his family, esp. since he was sending his two children to mission schools at a tuition of $100/month, as the public schooling in Nigeria is abysmal...

"It's the same for football players as it is for doctors," I was told by Tsiri Agbenyega, dean of the medical school in Kumasi, Ghana. "We have to train a lot more than will end up in Ghana, because they all leave. The football players go to Europe, and the doctors to America and the U.K." Agbenyega spoke with a mixture of frustration, pride, and resignation. He was pleased that Ghanaian athletes and physicians were competitive internationally, but their success meant a loss to the country — a loss more problematic in medicine than in football.
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But not so. For much of the past decade, health improvement in Ghana has been at a standstill, and health statistics in many sub-Saharan African countries are sliding backward.3,4 AIDS is a culprit, but so is the exodus of doctors and nurses who are lured by U.S. training and employment opportunities. According to the Ministry of Health, Ghana has about 13 physicians per 100,000 population (as compared with 256 in the United States) and about 92 nurses per 100,000 (as compared with 937 in the United States). Today, there are 532 Ghanaian doctors practicing in the United States. Although they represent a tiny fraction of the 800,000 U.S. physicians, their number is equivalent to 20% of Ghana's medical capacity, for there are only 2600 physicians in Ghana. An additional 259 Ghanaian physicians are in practice in the United Kingdom and Canada — and this group includes only those who have successfully been licensed after leaving Ghana. In other countries, the situation is even worse: 60% of Liberia's physicians are in practice in the United States or Britain.

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Nonetheless, much can be done in the developed world to help build the health workforces of developing countries, including continued investments in training and retention programs and an increased commitment by U.S. health care professionals to work in developing countries. However, the single most important contribution that the United States could make would be to train more doctors at home. About 25% of the physicians practicing in the United States went to medical school abroad — as did roughly the same proportions in the United Kingdom, Canada, and Australia.5 For years, we have been educating about three quarters of the doctors we need and relying on the rest of the world to supply the balance. For 25 years, the number of students admitted to U.S. allopathic medical schools has remained constant, while the number of physicians we import has climbed steadily. Without ever enunciating a strategy of dependence on the world, we have created a huge U.S. market for physicians educated elsewhere, inadvertently destabilizing the medical systems of countries that are battling poverty and epidemic disease.

A commitment in the United States to ramp up medical school opportunities to a level closer to national needs would do much to slow medical migration and bring stability to medical programs in poorer countries. Perhaps soccer players will always migrate to the elite leagues of the world, but if doctors and nurses stayed closer to home, lives would be saved.