Ethiopia’s Physician Brain-Drain Problem; What to Do?

October 25, 2012 (Opride) — Since the advent of “organized medical practice” in 1896, when the Russian Red Cross built the first hospital, Ethiopia has experienced a rapid expansion of the delivery of healthcare that lasted well into the 20th century. The establishment of the Ministry of Health in 1948 played pivotal role in centralizing healthcare and leading a concerted effort that resulted in the construction of 93 hospitals (public and private), and a sizable increase in the number of physicians in the public sector.

But, even with donor-funded and much celebrated projects such as the community-based health extension program,the trends in the past twenty years tell a different story. A population boom, with a record rate of growth averaging 2.1 percent over the last five years according to a World Bank report, coupled with minimal infrastructural development has taken a heavy toll on every aspect of the country’s livelihood, especially on the healthcare sector.

In a 2005 strategy report, the World Health Organization, found Ethiopia’s population per primary healthcare facility to be 24,513, a ratio triple the rest of sub-Saharan Africa.  With only 13,469 hospital beds in the entire country, the figure comes to one hospital bed per 5,276 people and exceeds the average ratio for the rest of sub-Saharan Africa five-fold. As bewildering as these figures may seem, facilities and material resources are only a fraction of the complex problems that weigh on healthcare in Ethiopia.

This brings me back to a topic that I began to tackle while I was back home and promised to share regarding healthcare in the country.  I wrote a blog about the state of healthcare delivery in Ethiopia but decided not to publish it while I was actually in the country. Taking the extra time to ponder my statements, however, proved to be an eye opening experience and I hope that translates into what I share here.

In one blog entry during my trip, I wrote about a humanitarian project that is taking aim at remedying the symptoms of a broken system. While such efforts are dire and help thousands of patients every year, they cannot solve the problem at its root.  The issues are complicated and involve many facets of healthcare. One obvious problem is the overall lack of medical resources in the country, which could easily be attributed to the still fledgling economy however a growing issue has become the lack of medical personnel, especially physicians, to handle the expanding healthcare burden.  How is it that a country with more medical schools than Ghana and South Africa has significantly lower ratio of physicians to population than most of sub-Saharan Africa?

In a conversation with medical faculty at one of Ethiopia’s premier medical schools, I learned that the incoming class size for first year medical students has grown to 400 every year.  These are the best and brightest, so let’s indulge and say only 75 percent graduate (even though it is much higher), we’re still talking about 300 new doctors generated from one medical school in one class.  A veryconservative extrapolation of this data could suggest an average of anywhere from 1000 to 1500 new physicians graduating every year from Ethiopia’s 12 medical programs.  Compare that to the most recent census data from the CIA Fact Book, which estimates Ethiopia’s population at 94 million and the problems seem to take shape before our eyes.

–Read Full Report  Opride