Career intentions of final year medical students in Uganda after graduating: the burden of brain drain

BMC Medical Education

Nelson Sewankambo²  Achilles Katamba²  Robert Kalyesubula²  Adrian Nampogo¹  Stella Nambasa²  Joyce Nakitende²  David Mukunya²  Samuel Kizito² 

[1] Mbarara University of Science and Technology, Mbarara, Uganda;Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda

关键词: Uganda;    Doctors;    Brain-drain;   

Others  :  1224510
DOI  :  10.1186/s12909-015-0396-0

 received in 2014-11-04, accepted in 2015-06-19,  发布年份 2015

【 摘 要 】

Background

Uganda has severe shortage of human resources for health despite the heavy disease burden. The country has one of the highest fertility, and population growth rates in the world and is in dire need of trained health workers. The current doctor: patient ratio of 1:15000 is inadequate and this is further constrained by trained health workers leaving the country while others abandon the health sector. The aim of the study was to determine the career intentions of the final year medical students to leave the county and health field after graduating and the associated factors.

Methods

We conducted a cross-sectional study among 251 final year medical students from Makerere, Mbarara, Gulu and Kampala International Universities. We enrolled all the eligible final year medical students. The study was conducted using face-to-face questionnaires in each university. We determined the demographics, reasons for leaving the country and health sector and the intended destinations of medical students who planned to leave the country. Data was entered in Epidata then exported and analyzed in stata 12.

Results

Of the 251 students enrolled in the study, 28(11.2 %) wanted to leave the health sector, with Mbarara University of Science and Technology (MUST) having the highest percentage, 16.7 % and Kampala International University (KIU) the least, 7.7 %. Of the 28 who intended to leave the health sector, 82.1 % wanted to join the business sector, 10.7 % agriculture, and 7.1 % politics. Reasons given for the intent to leave were; lack of equipment and supplies in hospitals, over whelming patient numbers, very risky working environment, low payment to doctors, and political reasons. Overall, 112 (44.6 %) of the participants wanted to leave the country with 30.3 % intending to migrate to United States of America (USA), 11.9 % to United Kingdom (UK), 11.0 % to South Africa among others. Some of the reasons given were; doctors are paid a high salary abroad, safe working environment, and desire to continue academics. Age was associated with intention to leave the country (OR = 1.64; 95 % CI: 1.00 – 4.82).

Conclusions

In a country in dire need of health workers, the study showed high proportion of trainee health workers planning to abandon their professions or emigrate from Uganda after training.

【 授权许可】

   
2015 Kizito et al.

【 参考文献 】

• [1]Lassey AT, Lassey PD, Boamah M. Career destinations of University of Ghana Medical School graduates of various year groups. Ghana Med J. 2013; 47(2):87-91.
• [2]Kollar E, Buyx A. Ethics and policy of medical brain drain: a review. Swiss Med Wkly. 2013; 143:w13845.
• [3]Saraladevi N JPRTJE: Shortage Of Health Care Workers in Developing Countries-Africa. Ethinicity and Disease spring 2009, Volume 9.
• [4]Silvestri DM, Meridith B, Afzal AR, Ben A et al.. Medical and nursing students’ intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa. Bull World Health Organ. 2014; 92:750-9.
• [5]Lincolln Chen DE, Tim Evans, Ritu Sadana, Barbara Stilwell, Phyllida Travis, Wim Van Lerberghe, Pascal Zurn: Working Together For Health. In., WHO edn. Geneva Switzerland. 2006;41–150.
• [6]Muula AS. Nationality and country of training of medical doctors in Malawi. Afr Health Sci. 2006; 6(2):118-9.
• [7]So I. The health workforce crisis: the brain drain scourge. Niger J Med July. 2007; 16(3):7.
• [8]Melanie B: Impact, Regulation, and Health Policy Implication of Physician Migration in OCED Countries. HRH 2004, 2.
• [9]Dovlo D: of The Graduates of The University of Ghana Medical School. A Preliminary Rapid Appraisal. HRH Developement journal 1999, 3.
• [10]Awases M GA, Nyoni J, Chatora R: Migration of Health Professionals in Six Countries: A Synthesis Report. In. Brazaville; 2004, 19–65
• [11]Gupta N, NS K, Kumar Panda A, Anand R, Mishra A. Myotonic dystrophy: an anaesthetic dilemma. Indian J Anaesth. 2009; 53(6):688-91.
• [12]Kinfu YPM, Mercer H, Evans DB. The health worker shortage in Africa: are enough physicians and nurses being trained? World Health Organisation. 2009; 87:225-30.
• [13]Sentongo K: Cerificate of Good Standing In. Uganda Ministry of Health; 2011.
• [14]Loss of health professionals from Sub-Saharan Africa. The pivotal role of Uganda. The Lancet. 2005; 365:7.
• [15]Okeke EN. Brain drain: Do economic conditions “push” doctors out of developing countries? Soc Sci Med. 2013; 98:169-78.
• [16]Likupe G. The skills and brain drain what nurses say. J Clin Nurs. 2013; 22(9–10):1372-81.
• [17]Julia W. Addressing the migration of health professionals: the role of working conditions and education placements. BMC Public Health. 2009; 9:7. BioMed Central Full Text
• [18]VC Burch DM, J van Wyk, S Kiguli-Walube, D Cameron, FJ Cilliers, AO Longombe, C Mkony CO, B Otieno-Nyunya, PS Morahan: Career Intentions of Medical Students Trained In Six Sub-Saharan African Countries. Education for Health 2011 December, 24(3).
• [19]Kirigia JM, Gbary AR, Muthuri LK, Nyoni J, Seddoh A. The cost of health professionals’ brain drain in Kenya. BMC Health Serv Res. 2006; 6:89. BioMed Central Full Text
• [20]Joses Muthuri Kirigia ARG, Lenity Kainyu Muthuri, Seddoh JNA: The cost of health professionals’ brain drain in Kenya. BMC Health Serv Res 2006, 6(89).
• [21]Joses M, Kirigia Akpa R, Gbary JN, Anthony S, Muthuri LK. The cost of health-related brain drain to the WHO African Region. Afr J Health Sci. 2006; 13:1-13.
• [22]Lisa Nguyen SR, Esther Nderitu, Anneke Zuyderduin, Sam Luboga, Amy Hagopian: Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals. BioMedCentral 2008.
• [23]Mandeville KL, Ulaya G, Lagarde M, Gwesele L, Dzowela T, Hanson K et al.. Early career retention of Malawian medical graduates: a retrospective cohort study. TM & IH. 2015; 20(1):106-14.
• [24]Gow J, George G, Mwamba S, Ingombe L, Mutinta G. An evaluation of the effectiveness of the Zambian Health Worker Retention Scheme (ZHWRS) for rural areas. Afr Health Sci. 2013; 13(3):800-7.
• [25]Ebuehi OM, Campbell PC. Attraction and retention of qualified health workers to rural areas in Nigeria: a case study of four LGAs in Ogun State, Nigeria. Rural Remote Health. 2011; 11(1):1515.
• [26]Sherr K, Mussa A, Chilundo B, Gimbel S, Pfeiffer J, Hagopian A et al.. Brain drain and health workforce distortions in Mozambique. PLoS One. 2012; 7(4):e35840.
• [27]Poppe A, Jirovsky E, Blacklock C, Laxmikanth P, Moosa S, De Maeseneer J et al.. Why sub-Saharan African health workers migrate to European countries that do not actively recruit: a qualitative study post-migration. Glob Health Action. 2014; 7:24071.
• [28]Bidwell P, Laxmikanth P, Blacklock C, Hayward G, Willcox M, Peersman W et al.. Security and skills: the two key issues in health worker migration. Global health action. 2014; 7:24194.
• [29]Global Health Workforce Alliance: Why are health workers migrating? In.; 2009.
• [30]Mulondo M. Uganda working on living wage policy. The new vision. The New Vision Printing and Publishing Co, Kampala; 2009.
• [31]Hagopian A, Zuyderduin A, Kyobutungi N, Yumkella F. Job satisfaction and morale in the Ugandan health workforce. Health Aff. 2009; 28(5):w863-75.
• [32]Ayebazibwe A. 2,000 doctors leave country in 10 years. Saturday monitor. daily monitor, Kampala, Uganda; 2013.
• [33]Luboga S, Hagopian A, Ndiku J, Bancroft E, McQuide P. Satisfaction, motivation, and intent to stay among Ugandan physicians: a survey from 18 national hospitals. Int J Health Plann Manage. 2011; 26(1):2-17.