How is local training changing the face of African healthcare?

Zambian surgeon Dr Alex Makupe completed his surgical residency at Tygerberg Hospital in South Africa’s Western Cape, because there were no teaching hospitals catering for surgeons in his home country.

At the end of his residency, as he was planning to return to Zambia, one of his colleagues said to him: “You’ll be back in six months!”

This is typical of the healthcare worker brain drain Africa is faced with – many doctors who leave their home country to complete their training do not come back.

Doctors tend to seek out the professional, lifestyle and income benefits of living in developed economies, but the drain isn’t only from developing to developed nations.

More developed countries in Africa frequently attract doctors and specialists from nearby countries who are behind the curve.

This leaves poorer countries with fewer medical resources – which has a knock-on effect on mortality rates and overall health outcomes.

According to the Lancet Commission on Global Surgery, countries with fewer than 20 specialist surgeons, anaesthetists and obstetricians (SAOs) per population of 100 000 have worse health outcomes.

To achieve the Sustainable Development Goals (SDGs) healthcare targets by 2030, 1,27 million new SAO providers would need to be trained in that time frame.“In the same way that doctors prefer to stay in an urban environment rather than a rural one, they prefer to go to more developed countries than the less developed ones. So serious is that matter that the World Health Organisation even passed a resolution about it trying to stem it, to mitigate it,” said South Africa’s health minister Dr Aaron Motsoaledi at the World Economic Forum in Durban earlier this year.

The WHO resolution states that no country should actively recruit doctors from their developing counterpart.

Within the Southern African Development Community (SADC), there is an additional agreement barring the poaching of medical staff between countries in the region – nonetheless, health professionals who have not actively been recruited may still make the jump because they know their skills are in demand.

A TEACHING HOSPITAL IS BORN

That demand is what Makupe’s colleague anticipated would draw him back to South Africa.

Instead, Makupe elected to be part of the solution back home.

“If all of us just went back to our countries, it would make a very big difference,” he says.

“I went back to my province where there were only two Zambian surgeons for a population of 2,5 million.”

In 2009, Makupe elected to get involved in starting a surgeon’s teaching hospital in the Ndola province, believing surgeons trained in Zambia would be more likely to stay in Zambia.

Until this time, the University of Zambia’s School of Medicine had been the single public medical school in Zambia for over 43 years and had produced just over 1 200 doctors.

The starting of a second medical university was considered an urgent priority.

Ndola Central Hospital and Arthur Davidson’s Children’s Hospital were selected as the initial location of the administrative offices and the clinical training site and on 14 November 2011, the training hospital admitted its inaugural class of 72 students – 26 were in the bachelor of dental surgery and 46 in the bachelor of medicine and bachelor of surgery degree programmes.

Today, Ndola is an 800-bed university teaching hospital under the Copperbelt University. It serves a wide catchment area and is a tertiary referral hospital for northern Zambia, with an estimated population of 2,4 million.

But the teaching hospital doesn’t limit its activities to surgical training. There is a great focus on primary healthcare, with the intention of heading off medical conditions before they require hospitalisation and surgery.

To this end, the hospital has a one-year training programme for community health assistants.

“These are people at the forefront in our communities, chosen by the chiefs, who send them for acceptance at the school and after their training, they immediately get back into the community,” Makupe says. “With their help, health promotion and disease prevention are targeted better.”

PPPS FOR MORE HOSPITALS

Until now, hospitals in Zambia’s health infrastructure were 90% run by the government, but Makupe says that is set to change.

“The government’s position has changed and we now want companies to come to Zambia and partner with us so that we can see the growth of other healthcare facilities starting up. We stand ready to partner with companies that would be willing to come.”

Such public-private partnerships (PPPs) were a key theme that emerged as a solution for Africa’s healthcare challenges at the Africa Health Exhibition and Congress held in Johannesburg earlier this year.

“As far as health infrastructure is concerned, the public sector on its own will possibly never be able to cater for all the required infrastructure,” says Namibia’s former minister of health and social services, Dr Bernard Haufiku.

“Improving healthcare requires money and the private sector could be a very important component in delivering infrastructure and providing human resource training.”

THE BIGGER PICTURE

Training medical practitioners in the country of their birth certainly goes a long way to retaining them after graduation.

A study, ‘The Retention of Medical Doctors in Ghana through Local Postgraduate Training’ concluded that the “availability of local postgraduate medical training to Ghanaian doctors has been effective in retaining them in the country. This is because the evidence suggests that currently, only a small portion of physicians consider emigrating after completion of basic medical training as opposed to the larger majority that actually migrated in the past”.

However, the report cautions: “Since postgraduate training is not the only reason for physician migration, failure to take additional action, such as providing state-of-the-art equipment for learning and improved working conditions, provide better infrastructure, improve remuneration and career paths, will eventually erode the gains made with establishment of the Ghana College of Physicians and Surgeons.”

Essentially, while local postgraduate training plays an important part in retaining doctors, it is not the only reason for their migration to other countries.

Those African nations that can get the bigger picture right will fare better on their journey towards achieving SDG healthcare targets by 2030.

– BBC