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The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis
Edward J Mills1, Steve Kanters, Amy Hagopian
1Faculty of Health Sciences, University of Ottawa, Canada. Edward.mills@uottawa.ca
Insights
Sub-Saharan African countries face significant financial losses due to doctor emigration. Destination countries should invest in strengthening health systems in source nations to mitigate this brain drain.
Area of Science:
- Health Economics
- Medical Migration
- Human Capital Development
Background:
- Emigration of healthcare professionals from sub-Saharan Africa (SSA) represents a significant challenge.
- Understanding the economic impact of this 'brain drain' is crucial for policy development.
- Previous estimates of lost investment due to migrating doctors are limited.
Purpose of the Study:
- To quantify the financial loss incurred by SSA countries due to the migration of domestically educated doctors.
- To analyze the investment lost to Australia, Canada, the United Kingdom, and the United States.
- To estimate the financial benefits received by destination countries from these migrating doctors.
Main Methods:
- Human capital cost analysis utilizing publicly accessible data.
- Focused on nine SSA countries with high HIV/AIDS prevalence and medical schools.
- Calculated education costs, lost investment, and savings for destination countries.
Main Results:
- Estimated government-subsidized education costs per doctor ranged from $21,000 (Uganda) to $58,700 (South Africa).
- Total estimated lost investment for doctors in destination countries reached $2.17 billion.
- The United Kingdom and United States received the largest financial benefits from recruited doctors.
Conclusions:
- The emigration of doctors from SSA countries results in substantial lost investment.
- Countries most affected by HIV/AIDS experience the greatest financial impact.
- Destination countries should consider investing in source country training and health system strengthening.
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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