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. 2011 Nov 23:343:d7031.
doi: 10.1136/bmj.d7031.

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis

Edward J Mills  1 , Steve Kanters, Amy Hagopian, Nick Bansback, Jean Nachega, Mark Alberton, Christopher G Au-Yeung, Andy Mtambo, Ivy L Bourgeault, Samuel Luboga, Robert S Hogg, Nathan Ford
Affiliations

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis

Edward J Mills et al. BMJ. .

Abstract

Objective: To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States.

Design: Human capital cost analysis using publicly accessible data.

Settings: Sub-Saharan African countries.

Participants: Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries.

Main outcome measures: The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors.

Results: In the nine source countries the estimated government subsidised cost of a doctor's education ranged from $21,000 (£13,000; €15,000) in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m).

Conclusions: Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their health systems.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. JN and SL work at universities that have received Medical Education Partnership Initiatives (MEPI) funding from the President’s Emergency Plan for AIDS Relief.

Figures

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Fig 1 Flow of countries through study
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Fig 2 Loss of doctors to destination countries, compared with burden of HIV in nine African source countries. Size of each bubble represents ratio of estimated compounded lost investment over gross domestic product, and y axis corresponds to ratio of doctors working in target countries and doctors currently working domestically
See this image and copyright information in PMC

Comment in

References

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