Emily Bell — Is “brain drain” responsible for the shortage of health workers?

The Who Cares? Campaign Blog is exploring the issues of “brain drain” and attrition for the month of November.

Tanzania faces one of the worst health worker shortages in the world. The country has only 822 doctors and 13,292 nurses who deliver healthcare for almost 40 million people. This means doctor and nurse to patient ratios are 100 and 25 times lower, respectively, than they ought to be to meet basic healthcare needs.

To what extent is this shortage of health workers in Tanzania due to “brain drain” – the phenomenon whereby skilled workers migrate to other places in search of better paying or more satisfying work conditions?

Interestingly, the Touch Foundation report, Catalyzing Change: Molecular Strengthening of the Health System in the Tanzanian Lake Zone, found that external migration of doctors, nurses and other health workers is not as significant a challenge in Tanzania as in other sub-Saharan African countries: “Only 6-15 percent of doctors and less than five percent of nurses in Tanzania emigrate, compared with 37 percent of doctors and 34 percent of nurses in some countries. The low rate of external migration can be attributed to structural factors – political stability, economic growth, and large numbers of ‘paraprofessional’ health workers such as Assistant Medical Officers (AMOs) and Clinical Officers (COs) whose qualifications are not easily transferrable outside Tanzania.”

Despite relatively low rates of external migration, Tanzania faces other challenges with respect to the shortage of health workers. The low production of health workers is a major cause of the shortage. In the Touch Foundation report, Action Now on the Tanzanian Health Workforce Crisis: Expanding Health Worker Training – The Twiga Initiative, we determined there are six major reasons for low production, including a shortage of qualified students and financial support, shortage of clinical faculty, limited non-clinical faculty, fragile clinical and non-clinical (basic science) infrastructure, and overall financial resources.

The small number of new health workers who graduate each year do not always stay in the healthcare profession.   Twenty percent of graduates will not enter the workforce at all and many switch careers within the first year of being deployed. Attrition stems from a variety of causes. Those who choose to become health professionals often experience challenging conditions, including low pay, lack of supplies, and poor management. These challenges ultimately lead to low job satisfaction.

The Touch Foundation is planning to address attrition and other challenges facing health workers in the Lake Zone region of 15 million people by creating a regionalized training network to increase capacity and healthcare access in the region. Our work will draw on our in-depth analytical studies on health worker production and health systems challenges as well as our practical experience in supporting Weill Bugando’s medical school and hospital.

Emily Bell is Head of Advocacy and Communications at the Touch Foundation.