Down the brain drain: a rapid review exploring physician emigration from West Africa

Springer Science and Business Media LLC - Tập 8 - Trang 1-16 - 2023
Tega Ebeye1,2, HaEun Lee3
1Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
3Center for Global Health Equity, University of Michigan, Ann Arbor, USA

Tóm tắt

The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the “brain drain”, has been a topic of discussion in global health spheres for years. With the call to decolonize global health in mind, and considering that West Africa, as a region, is a main source of physicians emigrating to HICs, this rapid review aims to synthesize the reasons for, and implications of, the brain drain, as well as recommendations to mitigate physician emigration from West African countries to HICs. A literature search was conducted on PubMed, EMBASE and The Cochrane Library. Main inclusion criteria were the inclusion of West African trained physicians' perspectives, the reasons and implications of physician emigration, and recommendations for management. Data on the study design, reasons for the brain drain, implications of brain drain, and proposed solutions to manage physician emigration were extracted using a structured template. The Hawker Tool was used as a risk of bias assessment tool to evaluate the included articles. A total of 17 articles were included in the final review. Reasons for physician emigration include poor working conditions and remuneration, limited career opportunities, low standards of living, and sociopolitical unrest. Implications of physician emigration include exacerbation of low physician to population ratios, and weakened healthcare systems. Recommendations include development of international policies that limit HICs’ recruitment from LMICs, avenues for HICs to compensate LMICs, collaborations investing in mutual medical education, and incorporation of virtual or short-term consultation services for physicians working in HICs to provide care for patients in LMICs. The medical brain drain is a global health equity issue requiring the collaboration of LMICs and HICs in implementing possible solutions. Future studies should examine policies and innovative methods to involve both HICs and LMICs to manage the brain drain.

Tài liệu tham khảo

Duvivier RJ, Burch VC, Boulet JR. A comparison of physician emigration from Africa to the United States of America between 2005 and 2015. Hum Resour Health. 2017;15(1):1–2. Eliason S, Tuoyire DA, Awusi-Nti C, Bockarie AS. Migration intentions of Ghanaian medical students: the influence of existing funding mechanisms of medical education (“The fee factor”). Ghana Med J. 2014;48(2):78–84. Woodward A, Lake EG, Rajaraman N, Leather A. Specialist training aspirations of junior doctors in Sierra Leone: a qualitative follow-up study. BMC Med Educ. 2018;18(1):1–5. Ondere L, Garfield S. Role of economics, health, and social and political stability in determining health outcomes. Value Health. 2015;18(7):A564–A564. Kretzmann JP, McKnight J. Building communities from the inside out. Evanston: Center for Urban Affairs and Policy Research, Neighborhood Innovations Network; 1993. Khan M, Abimbola S, Aloudat T, Capobianco E, Hawkes S, Rahman-Shepherd A. Decolonising global health in 2021: a roadmap to move from rhetoric to reform. BMJ Glob Health. 2021;6(3):e005604. https://doi.org/10.1136/bmjgh-2021-005604. Tricco AC, Langlois E, Straus SE, World Health Organization. Rapid reviews to strengthen health policy and systems: a practical guide. World Health Organization; 2017. Hawker S, Payne S, Kerr C, Hardey M, Powell J. Appraising the evidence: reviewing disparate data systematically. Qual Health Res. 2002;12(9):1284–99. https://doi.org/10.1177/1049732302238251. Lorenc T, Petticrew M, Whitehead M, Neary D, Clayton S, Wright K, Thomson H, Cummins S, Sowden A, Renton A. Systematic review of qualitative evidence: findings. In: Crime, fear of crime and mental health: synthesis of theory and systematic reviews of interventions and qualitative evidence, 2014. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:71. Karan A, DeUgarte D, Barry M. Medical, “brain drain” and health care worker shortages: how should international training programs respond? AMA J Ethics. 2016;18(7):665–75. Astor A, Akhtar T, Matallana MA, Muthuswamy V, Olowu FA, Tallo V, Lie RK. Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan, and the Philippines. Soc Sci Med. 2005;61(12):2492–500. Eastwood JB, Conroy RE, Naicker S, West PA, Tutt RC, Plange-Rhule J. Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK. The Lancet. 2005;365(9474):1893–900. Hagopian A, Ofosu A, Fatusi A, Biritwum R, Essel A, Hart LG, Watts C. The flight of physicians from West Africa: views of African physicians and implications for policy. Soc Sci Med. 2005;61(8):1750–60. Ike SO. The health workforce crisis: the brain drain scourge. Niger J Med. 2007;16(3):204–11. Jenkins R, Kydd R, Mullen P, Thomson K, Sculley J, Kuper S, Carroll J, Gureje O, Hatcher S, Brownie S, Carroll C. International migration of doctors, and its impact on availability of psychiatrists in low- and middle-income countries. PLoS ONE. 2010;5(2):e9049. Opoku ST, Apenteng BA. Seeking greener pastures? The relationship between career satisfaction and the intention to emigrate: a survey of Ghanaian physicians. Int Health. 2014;6(3):208–12. Ossai EN, Una AF, Onyenakazi RC, Nwonwu EU. Emigration plans after graduation of clinical medical students of ebonyi state university Abakaliki, Nigeria: Implications for policy. Niger J Clin Pract. 2020;23(7):995–1003. Udonwa NE. Human capital flight challenges within an equitable health system. Niger J Med. 2007;16:4. Loh LC, Ugarte-Gil C, Darko K. Private sector contributions and their effect on physician emigration in the developing world. Bull World Health Organ. 2013;91:227–33. Mullan F. Doctors and soccer players—African professionals on the move. N Engl J Med. 2007;356(5):440–3. Nwadiuko J, James K, Switzer GE, Stern J. Giving Back: a mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems. Glob Health. 2016;12(1):1–8. Okeke EN. Do higher salaries lower physician migration? Health Policy Plan. 2014;29(5):603–14. Mullan F. The metrics of the physician brain drain. N Engl J Med. 2005;353(17):1810–8. Wright D, Flis N, Gupta M. The ‘Brain Drain’ of physicians: historical antecedents to an ethical debate, . 1960–79. Philos Ethics Humanit Med. 2008;3(1):1–8. August E, Tadesse L, O’Neill MS, Eisenberg JNS, Wong R, Kolars JC, Bekele A. What is global health equity? A proposed definition. Ann Glob Health. 2022;88(1):1–6. Patel YM, Ly DP, Hicks T, Jena AB. Proportion of non-US born and noncitizen health care professional sin the United States in 2016. JAMA. 2018;320(21):2265–6. Association of American Medical Colleges (AAMC), 2022. https://students-residents.aamc.org/applying-medical-school/applying-medical-school-international-applicant. Kamarulzaman A, Ramnarayan K, Mocumbi AO. Plugging the medical brain drain. The Lancet. 2022;400(10362):1492–4. Ebeye T, Lee H, Sriharan A. Physician-suggested innovative methods for health system resilience amidst workforce emigration and sociopolitical unrest in Nigeria: a survey-based study. Ann Global Health. 2023;89:1. Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, Au-Yeung CG, Mtambo A, Bourgeault IL, Luboga S, Hogg RS. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011;24:343. Global strategy on Human Resources for Health: Workforce 2030. World Health Organization. World Health Organization; 2016. Available from: https://www.who.int/publications/i/item/9789241511131.