Exodus of doctors, why Rwanda’s story is different

The sad reality of African countries having more doctors and nurses that are working in richer nations than their own continues to throttle this continent.A study done in 2011 by Canadian scientists found that Sub-Saharan Africa was losing close to $2 billion as combined investment in training physicians and other health care professionals who eventually leave home to find work in more developed nations.This study looked at the lost investment of domestically educated doctors migrating from Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda, Tanzania, Zambia and Zimbabwe to Australia, Canada, United Kingdom and the US.It equally found that as Africa was losing over $2 billion, these four developed nations gained a combined sum of up to $4.5 billion from recruiting Africa’s physicians.Some other studies paint a gloomier picture. For example, some studies show that countries like Mozambique and Angola have more doctors in one single foreign country than at home. In Liberia, for every doctor, there are two working abroad.There has long been concern about the exodus of Africa’s health personnel but with little progress made in reversing this trend. The reasons for this brain drain are diverse but draw a similarity across the continent. What is clear is that these brains are not poached out of Africa but rather forced to migrate due to bad politics of our governments.A number of factors explain this exodus: Poor remuneration, poor working conditions, civil strife, political instability and economic stagnation of most of Africa’s nations. For many years, the case on Rwanda was not any different. A study released in 2005 carried out by the Center for Global Development in Washington and looking at census records collected between 1999 and 2001 showed that due to civil strife, Rwanda had lost almost 43 per cent of its medics to greener pastures.However, the situation has since changed. Almost all the doctors that Rwanda sends out for specialisation return to do their work in the country. We have close to 150 specialised doctors today and almost all, trained from outside. We have another 100 currently training in different fields of medicine abroad, but who certainly will all return.So while the rate of return in most African nations is minimal, in Rwanda the situation is the opposite.A number of factors explain this.First is the fairness of the system in according whoever is competent an opportunity to specialise. Whereas in some countries, you need to be well ‘connected’ to access these scholarships, in Rwanda the system is driven by merit. Therefore, because of these opportunities of continuous professional development, Rwanda’s medics feel indebted to serve their country.Secondly and most important, though our health professionals are relatively remunerated well, compared with their colleagues in the region, their motivation is not necessarily money driven but rather derived from working in an environment that is progressive.What do I mean here? That the sweat or energy they put into their work results into strong dividends for the sector. They derive satisfaction from associating with a country where HIV/AIDs prevalence figures are down, child and maternal mortality are declining, death due to malaria is headed for history books, immunization figures surpass those of developed nations, and geographical and financial accessibility to healthcare gives the best ratios.A farmer, who wakes up every morning to till his land and harvests nothing at the end of it, will either migrate from that area or switch trades. But the situation is different if the harvest is handsome. This is the same case with health care providers. A heath care provider who works in an environment where these key health indicators are endemically high will always feel demoralised professionally.In other words, for Rwanda the satisfaction is derived from being part of a successful story and working in an environment that is not static or stagnant in all aspects.Across Africa, we are treated to stories of dilapidated health infrastructure, stock-outs of medicines in health facilities and absence of basic equipment to facilitate service delivery. We read stories of money meant to procure medicines that ends up purchasing helicopter gunships or is diverted into some people’s pockets.In some countries, systems have collapsed in such a way that doctors steal medicines to sell in private clinics because of the inconsistencies in their salaries or because politicians take the lion’s share of the public service salary structure at the expense of other civil servants.Sadly, when these politicians suffer from a small ailment like flu, the first thing they do is charter a plane to Paris, New York or London for treatment on a bill footed by the tax payer.This is what brings out the difference with Rwanda. Our system is not yet perfect – in fact, it is far from perfection but what is certain is that the roadmap or ingredients for making it a good system are already in place and functioning. This roadmap is driven by one thing – the collective desire to bring dignity to the Rwandan people.This is what drives a Rwandan physician every morning to perform their clinical work as opposed to being a nomadic professional.The author is the Director General of Health Communication Centre/ Rwanda Biomedical Centre.On twitter @aasiimwe

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Exodus of doctors, why Rwanda’s story is different