Sacking doctors who cost Sh20bn

Who wins in this cat-and-mouse game?

As the country gradually recovers from the doctors’ strike, which was punctuated by the dramatic arrest, kidnapping and brutal torture of Doctors’ Association chairman Dr Steven Ulimboka, the government’s decision to sack 300 doctors will cost the country more than the benefits it is expected to gain.

With the government announcing that it had sacked 300 doctors who were on strike last week, Tanzania stands to lose a whopping Sh20 billion, The Guardian on Sunday can reveal today.

This loss doesn’t include the services that they would have rendered to the country after the taxpayers had invested heavily in training them.

The Guardian on Sunday’s survey used a study conducted by Canadian scientists last year, which was published in November 2011 by the British Medical Journal as a benchmark to calculate the costs for medical education and the loss of returns on investment for Tanzania and the rest of sub-Saharan Africa.

With Tanzania being among sub-Saharan Africans countries which lost about $2 billion (Sh3.1 trillion) by mid last year invested in the training of doctors, who, however ended up migrating to more prosperous developed nations, the loss resulting from the sacking of the 300 doctors could worsen the health situation.

According to a research conducted by Canadian scientists, it cost between $59,000 and $21,000 to train a single doctor in East and Southern Africa - putting an average cost of training a doctor in a country like Tanzania at $40,000.

To put things into perspective, the 300 doctors sacked by the government last week cost the taxpayers $12 million(Sh18.96 billion) to train.

According to a survey conducted by The Guardian on Sunday, sacking of 300 doctors means losing about Sh20 billion in taxpayers’ money used to fund their training, as well as hampering the underfunded health sector in the country, which is already facing shortage of trained and qualified medical personnel.

The study found that while poor countries like Tanzania invested heavily in the training of doctors, the countries ended up suffering in terms of brain drain due to the doctors emigrating, while Australia, Canada, Britain and the United States benefited the most from recruiting doctors trained abroad.

The scientists, led by Edward Mills, chair of Global Health at the University of Ottawa, called on destination countries to recognise this imbalance and invest more in training and developing health systems in the countries that lose out. "Many wealthy destination countries, which also train fewer doctors than are required, depend on immigrant doctors to make up the shortfall," Mills' team wrote in the study, which was published in the British Medical Journal in November last year.

"Developing countries are effectively paying to train staff who then support the health services of developed countries," it said.

Experts say the migration, or brain drain, of trained health workers from poorer countries to richer ones exacerbates the problem of already weak health systems in low-income countries battling epidemics of infectious diseases like HIV/Aids and tuberculosis (TB) and malaria.

The countries studied included Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.

The research team then added the figures to estimate how much the origin countries paid to train doctors and how much the destination countries saved in employing them.

The results show that these governments spent between $21,000, the figure for Uganda, and $59,000, for South Africa, to train a doctor, only to see them in many cases migrate to richer countries.

"Among the nine sub-Saharan African countries most affected by HIV/Aids, more than $2 billion of investment was lost through the emigration of trained doctors," the researchers said.

The findings suggested the benefit to Britain was around $2.7 billion, and to the United States was around $846 million. Australia was estimated to have benefited to the tune of $621 million and Canada was $384 million better off.

According to a World Health Organisation (WHO), Tanzania has one of the lowest doctor-to-patient ratios in the world: one doctor for every 30,000 people.

In the United States there is one doctor for every 300 people. To provide even basic healthcare, Tanzania is 89,000 healthcare workers short. By 2019, without intervention, the gap is expected to exceed 100,000.

One out of every nine Tanzania children does not live to see their 5th birthday. One out of 24 Tanzanian mothers will die during childbirth. In the developing world, for every mother who dies giving birth, another twenty will suffer long-term disabilities. With relatively simple interventions, 75 percent of maternal deaths and disability are preventable.

“There is too much politics in solving the doctors’ demands…the truth is that Tanzania can’t afford to sack 300 doctors,” a doctor specialist who spoke under condition of anonymity told The Guardian on Sunday.

Commenting on the government’s move to sack the 300 doctors, the specialist added, “We are already feeling the pinch of the sacking because of the sacked doctors at Muhimbili National Hospital…the cost is bigger than the desired objective.”

SOURCE: GUARDIAN ON SUNDAY