The financial cost of doctors emigrating from sub-Saharan Africa

Human capital analysis

Edward J. Mills, Steve Kanters, Amy Hagopian, Nick Bansback, Jean Nachega, Mark Alberton, Christopher G. Au-Yeung, Andy Mtambo, Ivy L. Bourgeault, Samuel Luboga, Robert S. Hogg, Nathan Ford

Research output: Contribution to journalArticle

Abstract

Objective: To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Design: Human capital cost analysis using publicly accessible data. Settings: Sub-Saharan African countries. Participants: Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. Main outcome measures: The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. Results: In the nine source countries the estimated government subsidised cost of a doctor's education ranged from $21 000 (£13 000; €15 000) in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Conclusions: Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their health systems.

Original languageEnglish (US)
Article numberd7031
JournalBMJ (Online)
Volume343
Issue number7835
DOIs
StatePublished - Dec 10 2011
Externally publishedYes

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Africa South of the Sahara
South Africa
Economics
Costs and Cost Analysis
Malawi
Zimbabwe
Uganda
HIV
Medical Schools
Acquired Immunodeficiency Syndrome
Gross Domestic Product
Zambia
Ethiopia
Tanzania
Kenya
Emigration and Immigration
Nigeria
Canada
Outcome Assessment (Health Care)
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mills, E. J., Kanters, S., Hagopian, A., Bansback, N., Nachega, J., Alberton, M., ... Ford, N. (2011). The financial cost of doctors emigrating from sub-Saharan Africa: Human capital analysis. BMJ (Online), 343(7835), [d7031]. https://doi.org/10.1136/bmj.d7031

The financial cost of doctors emigrating from sub-Saharan Africa : Human capital analysis. / Mills, Edward J.; Kanters, Steve; Hagopian, Amy; Bansback, Nick; Nachega, Jean; Alberton, Mark; Au-Yeung, Christopher G.; Mtambo, Andy; Bourgeault, Ivy L.; Luboga, Samuel; Hogg, Robert S.; Ford, Nathan.

In: BMJ (Online), Vol. 343, No. 7835, d7031, 10.12.2011.

Research output: Contribution to journalArticle

Mills, EJ, Kanters, S, Hagopian, A, Bansback, N, Nachega, J, Alberton, M, Au-Yeung, CG, Mtambo, A, Bourgeault, IL, Luboga, S, Hogg, RS & Ford, N 2011, 'The financial cost of doctors emigrating from sub-Saharan Africa: Human capital analysis', BMJ (Online), vol. 343, no. 7835, d7031. https://doi.org/10.1136/bmj.d7031
Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M et al. The financial cost of doctors emigrating from sub-Saharan Africa: Human capital analysis. BMJ (Online). 2011 Dec 10;343(7835). d7031. https://doi.org/10.1136/bmj.d7031
Mills, Edward J. ; Kanters, Steve ; Hagopian, Amy ; Bansback, Nick ; Nachega, Jean ; Alberton, Mark ; Au-Yeung, Christopher G. ; Mtambo, Andy ; Bourgeault, Ivy L. ; Luboga, Samuel ; Hogg, Robert S. ; Ford, Nathan. / The financial cost of doctors emigrating from sub-Saharan Africa : Human capital analysis. In: BMJ (Online). 2011 ; Vol. 343, No. 7835.
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abstract = "Objective: To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Design: Human capital cost analysis using publicly accessible data. Settings: Sub-Saharan African countries. Participants: Nine sub-Saharan African countries with an HIV prevalence of 5{\%} or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. Main outcome measures: The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. Results: In the nine source countries the estimated government subsidised cost of a doctor's education ranged from $21 000 (£13 000; €15 000) in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95{\%} confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Conclusions: Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their health systems.",
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