The "brain drain" of health care professionals in Kenya.

Burden of disease in Kenya.

Kenya is located in East Africa and has a population of over 34 million people, with a 2.1% annual growth rate. In 2004, life expectancy for males was 51 years and females 50 years, and 12% of children die before the age of 5 years. Kenya shares a border with several African countries including Somalia, Sudan, Ethiopia and Uganda, and is home to an estimated 238,000 refugees and 360,000 internally displaced people. Major causes of morbidity and mortality are malaria, diarrhoeal disease, respiratory infections, malnutrition, HIV/AIDs and tuberculosis. Many of these diseases are preventable.

The Kenyan health care system.

The Kenyan health system is divided into three sectors : the public sector provided by the Ministry of Health [MoH], the private sector, and voluntary organizations run by non-government organizations and faith based organizations. These three sectors provide services at various levels of health care. Primary health care is distributed at the lowest level in forms of dispensaries and health clinics staffed predominantly by enrolled nurses and public health technicians. At the next level, a network of health centres provide ambulatory health care services and offer both preventative and curative services, staffed by midwives, nurses, clinical officers and occasionally by doctors. District hospitals are the facilities for clinical care at the district level and are the first level referral hospital. Realistically, district hospitals, health centres and dispensaries are the first point of contact for the population. Secondary health care is provided by provincial general hospitals with more specialized care and services, and is followed by tertiary teaching and referral hospitals which form the pinnacle of the health care system. Other health care services that are not included in the hierarchy include voluntary counseling and testing centres [VCT for HIV/AIDs], private clinics and private maternity and nursing homes. The public sector system accounts for about 51% of the 4700 health facilities in the country and the private sector, including both profit and not for profit, contributes over 40%.

The "brain drain" of health care professionals afflicting the third world.

According to the WHO Health Report 2006, there is a global shortage of 4.3 million doctors, nurses, midwives and health support workers. The African region suffers more that 24% of all disease worldwide yet has access to only 3% of all health care workers. There is a well recognized "brain drain" whereby workers from developing nations migrate to first world countries to work and live, resulting in still poorer health outcomes in their country of origin. In Australia 21% of all doctors are trained overseas, in the UK this figure is 33%, and in the US, 27%.

Why are health care workers from the developing world moving to the first world?

These are classified as "push" and "pull" factors. Push factors include (In the country of origin)

  • low pay
  • poor working conditions
  • heavy workload
  • minimal access to pharmaceuticals and technology

Pull factors include (In the country moved to)

  • Higher pay
  • Better working conditions 
  • Brighter prospects for promotion 
  • Better access to pharmaceuticals and technology

In Kenya

  • There is 1 doctor per 10,000 people
  • There are 12 nurses/ midwives per 10,000 people

The emigration rate for doctors is currently 51%, with the main destination being the UK. The emigration rate for nurses is 8%. Emigration rates for other health care professionals have not been studied but anecdotally are thought to be high.

The result of the "brain drain" for Kenya and other developing nations.

Positives.

  • Health care professionals may send back money to relatives in their country of origin, thereby contributing back to the economy.
  • If health care workers return to their country of origin, they bring back new skills and expertise.

 Negatives.

  • Financial loss to the country of origin, which has financed the education of the health care worker [no return on investment]. One study estimated that the total cost of educating a single doctor in Kenya is US $65,997 and for every doctor who emigrates, US $517,931 worth of return on investment is lost.
  • Less staff for health care facilities
  • Less training for junior staff due to paucity of workers able to supervise and educate them.

 Mikono Association Inc aims to:

Do our small bit to help reverse the brain drain by making a proviso of our grants that recipients must stay in their area for at least two years after graduation, or alternatively financially contribute back to the Association and hence help train the next generation of health care professionals.