Dr. Sultan Ababulgu, Senior Expert/Internist
Addis Abeba – This is a follow up to the article in commentary section, “Why I believe Ethiopia will soon be drained of its physicians” published on your website on 14 February 2023.
The article reminded me of a study I did nearly three decades ago. The title was “Problem of Physician Migration in Ethiopia”. The result of this study was presented at the 1996 Ethiopian Medical Association Annual Scientific Conference. Because it was not published, many people may not be aware of it.
Bringing it forward now, I thought, can be helpful in some ways. First, the problem of migration of doctors from Ethiopia was well recognized even then. Secondly, it may help to reflect on the steps taken to curb this problem. Were they appropriate, adequate or effective? In addition to bringing forward some data not seen by the public this brief communication may stimulate discussion on the way forward.
At the time of this study, the number of specialists in the country was fairly small. Sub-specialty trainings were at their very early phase. Hence, many physician staffs of the three medical schools were sent abroad for sub-specialty training.
For instance, among 34 physician staffs of one of these medical schools sent abroad for training, 20 of them (58.8%) didn’t return. Out of the small number of specialists trained in the different departments of Addis Abeba University Faculty of Medicine, from one department, 55% have already migrated. Within 5 years of their graduation, 35% of the 1983 graduates of Addis Abeba University Faculty of Medicine have already left the country.
“Over the years, Ethiopian doctors voiced their dissatisfaction through all available venues. Professional associations provide the most important forum to vent their grievances.“
These are just few examples of what we found. The numbers were small but the proportions are alarming.
We also did a questionnaire survey of doctors in different parts of Ethiopia to understand important push factors. Three factors stood out. Very low pay,(described as intolerably low by over 60%), inconvenient residences (offered by the government in most rural areas), low prospect of joining post graduate program.
Over the years, Ethiopian doctors voiced their dissatisfaction through all available venues. Professional associations provide the most important forum to vent their grievances. Recent times, this has grown to level of public demonstrations and threatening of strikes. The outflow of doctors also continues.
What does the response look like? At one time, the government thought the proper response to shortage of doctors and their demand for better pay and standard of living was the so called “flood and retain” strategy. The number of doctors produced yearly increased dramatically. The sudden surge in numbers raised questions on the quality of medical training. An article that dealt with this strategy reported that not much was done on the side retention. Moreover, in recent years we have witnessed gra doctors complaining of unemployment. Under this circumstance, no wonder, if one asks is this, a “flood and retain” or a “flood and despair” strategy!
What is next? The living and working conditions of Ethiopian doctors need to be improved. Salary increments, arrangements for affordable housing, health insurance coverage, and career development routes should be enhanced to alleviate anxiety of doctors. The other factor our respondents’ ought to change is the standard of private health care facilities. These standards often demand over inflated capital costs hindering doctors’ aspiration for self-employment. Despite decades of request by the Ethiopian Medical association and other societies, Office Practice is yet to be allowed in Ethiopia.
I hope, policy makers at the federal Government, Ministry of Health, Ministry of Education, and other stake holders will work together to improve the quality of training and retention of Ethiopian physicians. AS
Editor’s Note: Sultan Ababulgu, MD, is Senior Expert/Internist based in Ethiopia. he can be reached at firstname.lastname@example.org