Reversing Africa’s health sector brain drain


Africa’s health sector brain-drain continues to be of concern, given that the continent carries roughly a quarter of the burden of the world’s diseases but only 1.3% of the world health workforce. Sub Saharan Africa is perhaps more affected than other regions.

While countries in sub-Sahara continue to provide government subsidized training to doctors, these investments into medical education are being lost through the emigration of doctors to developed countries.

The College of Surgeons of East, Central and Southern Africa (COSECSA) indicates that in Sub-Saharan Africa there are just 0.5 surgeons per 100 000 population.

But, COSECSA has shown that investing in education has given African doctors an incentive to remain home and make a positive contribution to their patients’ lives – it is the second largest surgical training institute in Sub-Saharan Africa and offers a Membership and Fellowship programme in various surgical disciplines as well as in-service training and an e-learning platform for surgical trainees.

One of the programmes is geared toward getting more women surgeons into operating theatres. It also boasts 94 accredited hospitals with 196 accredited trainers and 350 trainees enrolled.

Recent research showed that 93% of the surgeon graduates from the COSECSA programme are retained in surgery in the Sub Saharan region counteracting the brain drain that occurred in the past.

Non-profit body COSECSA provides postgraduate education and training in surgery.

Professor Pankaj G. Jani, the President of COSECSA in Kenya, says, “Our primary objective is to advance education, training, standards, research and practice in surgical care in this region in order to improve access to surgical care for the neglected surgical patient.”

“We deliver a surgical training programme with a common examination and an internationally recognised surgical qualification. Admission to the College is open to all registered medical practitioners who comply with the professional requirements for admission,” he explains.

The low numbers of surgeons globally and the risks associated with surgical procedures will form a key focal point at the Africa Health conference scheduled to be held in Johannesburg later this month.

Prof. Jani explains, “6.5% of the global burden of disease is amenable to surgery”, and adds that, “Africa has approximately 25% of the burden of the world’s diseases but only 1.3% of the world health workforce [and] most surgeons are based in urban areas.”

In sub-Saharan Africa, women make up half the population yet represent only 9% of surgical healthcare professionals, according to Operation Giving Back.

“The primary goal for this scholarship programme is to support women in surgical residency to complete their training and encourage other women in medicine to consider surgery as a profession,” says Prof. Jani.

Meanwhile, a new voluntary code urges governments and private agencies benefiting from doctors immigrating, to provide financial and technological support for developing countries with a shortage of health care professionals.

Dr. Bijendra Patel, Head of Research and Content at Medical Realities and Consultant Surgeon and Course Director at Barts Cancer Institute in London, suggests using virtual reality as a solution.

“In 2005 I pioneered the curriculum for the world’s first masters in surgical skills and science using virtual reality simulation,” says Dr. Patel.

“I am researching and developing courses and curriculum for technology enhanced learning for acquiring surgical skills by simulation, virtual reality and augmented reality. My vision is globalisation of surgery and global transfer of surgical skills.”

Patel says these distance learning programmes place students at the heart of the operating theatre using the latest in virtual reality technology and allows for accelerated training in the rapidly evolving world of surgery.

These programmes, says Dr. Patel, are open to any student trainee with a computer, Internet access and Virtual Reality headsets, and can be conducted on a smart phone.

Both Jani and Patel will be sharing their experiences at the Surgery Conference that will take place at the Africa Health Exhibition & Congress from the 29-31 May 2018 at the Gallagher Convention Centre in Midrand.


Additional notes:

*Professor Jani is also the Vice Chair of the Board of the G4 Alliance and past Chair of the Senate, ECSA, College of Health Sciences. During his tenure as chair of Senate and with the advocacy efforts of the G4 A, the ECSA college of OBGYN and the College of Physicians were inaugurated.

*A 2014 World Health Organisation (WHO) report, ‘A Universal Truth: No health without a workforce’ declared a deficit of 7.2 million skilled health professionals worldwide in 2013, with an estimated increase to 12.9 million by 2035.  Of the 313 million surgical procedures undertaken globally each year, only 6% take place in the poorest countries which house 33% of the world’s population.  A 2015 Lancet Commission report, ‘Global Surgery 2030’ states that 143 million more operations are needed each year and that 2.2 million surgeons are required to treat the five billion people without access to safe and affordable surgery.

*A BMJ article published in 2011, says that while South Africa incurs the largest costs related to medical education, it loses the most doctors to emigration to wealthier countries. This brain drain is exacerbated by the demand for higher education in medicine which far outweighs the available placements in schools globally. Data from UNESCO indicates that by 2025 there will not be enough placements in higher education to accommodate more than 100 000 students.


*Operation Giving Back (OGB), the volunteerism initiative of the American College of Surgeons (ACS), serves as a comprehensive resource center where you can find information to investigate and participate in surgical volunteer opportunities. OGB provides the necessary tools to facilitate humanitarian outreach among ACS members of all specialties, at all stages of their profession, and with an emphasis on domestic and/or international service. Through a network of high-impact partner organizations, OGB directs you to volunteer opportunities that align with your skills, passions, and beliefs.

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