Migration of Health Workers: A major contributor to global health disparity?

The Brain Drain

In a globalised world, where the movement of people is made ever easier – migration of health workers is a growing issue. Although there is no doubt it can be beneficial, for many developing nations and health systems it can pose a huge threat – a combination of push and pull factors that lead to a ‘brain drain’ where the some of the brightest leave to work and live elsewhere.

This has been a considerable problem for Uganda, where up to 63% of healthcare students left the country within 5 years of graduation, (2010 estimates).

Although 84% of these leave to study on postgraduate courses, many do not return. A survey of one Ugandan Institution found that 70% of their nursing students intended to practice abroad.

It is estimated by the Uganda Medical and Dental Practitioners Council that over the past 10 years some 50% of registered physicians have left the country (Daily Monitor)

Surveys completed across 18 Ugandan Hospitals find that the majority (63%) of physicians were dissatisfied with their work and nearly half (47%) have considered leaving their jobs or the country. (Rev Bras Ter Intensiva)

This loss of graduates and practitioners costs Uganda, economically and socially by reducing access to health services by locals – and as with other African nations, the Ugandan health system is further threatened by the lack of governmental support, underfunded infrastructure and inadequate access to basic resources. These issues are some of the ‘push’ factors leading to a lack of well trained, motivated health workers.

Health Financing as a Push Factor

On examining health sector financing in other countries it becomes clear that increased government spending can have huge positive impacts on health outcomes; both directly through increased resources, better facilities and as discussed above by keeping the students they train – this, by extension, also positively impacts the country’s wider economic development.

In Sri Lanka, an island with a life expectancy of 57 years and physician retainment rate of 87% the government spends $189US per Capita on their Health Sector.

Uganda allocates a similar amount – $108US dollars per Capita so one would expect similar outcomes – however outcomes in Uganda continue to lag – with a Ugandan having a life expectancy of 47 years. Why is it then that Uganda doesn’t see the same outcomes?

Some possible explanations to think about are:

– In excess of 85% of the health budget is paid for from outside funding and international donors.

– Poor government funding of the Public Health sector has resulted in a shift of focus towards privatized institutions, often at the expense of public ones.

– A low Doctor: Patient ratio

– Despite this Doctor: Patient ratio in Uganda being below WHO Recommendations, the Ugandan Government, in January 2015 attempted to exporthighly skilled health workers to Trinidad and Tobago. This move was inevitably challenged by many advocacies, individuals and non-governmental organizations.

So, we can see that poor funding of health systems not only hinders professionals from doing their work but actually is the main cause of health professionals leaving Uganda – this is why a group of us, medical students from Uganda, Zimbabwe, USA, Rwanda, Lebanon, Jordan, Argentina and Haiti met in St. Mary’s Hospital, Lacor, Uganda under Social Medicine (a Global Health Initiative) and at the end; came up with a letter to the President of the Republic of Uganda – this letter was to challenge our leaders, and call on the government to increase the health budget allocation to at least 15% of the National Budget – as was agreed in the 2001 Abuja Declaration – this we hope will improve Uganda’s ability to recruit and retain health workers.


Abraham Openy is a 4th year medical student Gulu University, who is passionate about research and a keen advocate for health equity and social medicine. He serves as the Vice President for External Affairs of the Federation of Uganda Medical Students’ Association and is the Secretary for International Affairs of Northern Uganda Village Health Outreach Project which the MCR Global Health Society co-organises.

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