CENTRINO: Each year over four hundred Nepali docto..

Posted by: CENTRINO November 7, 2008

Brain Drain of Medical Doctors - Who is Responsible? Current scenario

Each year over four hundred Nepali doctors are moving to US and another half of that to other countries like UK, Australia and others. At the same time, when government calls for vacancy for doctors, there are few doctors who apply. Government again complains of brain drain. The question arises here, as who is accountable for enormous brain drain?
Let's discuss what types of doctors are leaving the country. First of all, majority of the doctors are those who studied under government scholarship. Government had borne the expenditure on their education. They were selected by government either directly into medical colleges or by Ministry of Education. Some of them received either full scholarships or subsidized tuition fee grants. The country bears the cost of each medical graduates, which is from 8,000 US$ to 10,000 US$. But after graduation, how many of them contribute to Nepal. They were provided scholarship to build professionals in the country and to serve the people of Nepal. But in reality, they migrate to other countries without working or contributing anything to the mother country. Straight away, after graduation they prepared for the licensing examination of other countries and then they migrate there for better future. However, that is their right to decide where to work. But if country is investing on them, then, the country should as well anticipate some inputs from them. The accountability for this situation goes to the Government of Nepal, predominantly with Ministry of Education and Ministry of Health.
Let's see the impact of this kind of migration. Firstly, the total loss of resources invested on them. Some may think that they are generating foreign currency by working abroad. However, this is negligible at a cost of health of people of Nepal. If they were in Nepal, they could have satisfied the professional human resource gaps in the country and could have contributed to improve health status of the country. In every Primary Health Care Center there are positions of medical doctors. But if we look at the existing situation, there are many PHC, where we don't have doctors. To fulfill this position Ministry of Health has to hire the paramedics, which is another investment. For the same position government has to invest two people; one for sending abroad and one for that position.
Next is the impact on quality of health services. People are supposed to get the services from the qualified medical doctor which is their basic health rights; as an alternative, they are receiving services from others. I don't signify that the paramedics who are serving in those areas are not competent. They are competent but with some limitations. Nevertheless, there are some differences in six years of intensive trainings of medical graduation and the six months to two years training for paramedics. However, the backbone of health services of Nepal is still the paramedics, who have been working in rural, remote and inaccessible areas and contributing to the health care of Nepal.
Thirdly, let's discuss on economic impact of this situation. It costs almost around 10,000 US$ per medical graduate to the government. After graduation they migrate to other countries. Let's see if two hundred doctors migrate in a year then government has a loss of two million dollars per year in a country, whose per capita income is less than 200 US $. This is only direct cost, which is a tip of iceberg only. Let's discuss on submerged part of the iceberg. Nepal has one of the highest infant, child and maternal mortality. These high rates of mortality contribute to less years of life expectancy of the people of Nepal. Beside that we don't have an account of total morbidity (Being an ill) and impact on economy of the country. 37% of population and 82 % of population are living below 1$ per day and 2 US$ per day respectively. When these people get sick, apparently they have to spend there hard earned money for health and they become poorer. There are other factors, which contribute to their poverty and illness. But when they don't receive the appropriate treatment, they have to travel to the places where the doctors are available. Thus you can calculate the extra cost people have to bear like; cost of absenteeism from work (daily income source), cost on traveling, cost of accommodation and extra expenditure on doctors and access to other facilities. Sometimes these costs are so high for these people that all the family members including children have to work leaving the schools for survival. Then you can envisage the net loss of resources to the country. Researches are revealing the centrality, the catalytic role, and this oomph that population health has on the related processes through which national incomes increase and through which poverty and human misery are mitigated. Population health appears to be an exceedingly robust a powerful predictor of economic growth. By rule of thumb, 10 years gain in life expectancy translates into nearly 1 additional percentage point in annual income growth and which is within the grasp of our country.
Who is accountable for this loss of the country's human and economic resources? Whole responsibility exclusively goes to Government of Nepal, not those doctors who have migrated. There is no legislation for these people to work for the country at least for some duration. Government provides them scholarship and without making them to contribute to the country and allows them to migrate. Of course, there are limited resources in the country and government cannot employ all of them, however, they can contribute working in different places like medical colleges, organizations and wherever they like to do. Why everyone has to stay in major cities. Some have to work in rest of the areas also. Already there is scarcity of doctors in many sectors. Almost many of these doctors will definitely get the opportunity either in government sector or private sector. Wherever they work either in private or government sector they will contribute to people of Nepal.
Government should revise the scholarship criteria (MBBS)by giving points according to the region and ask for certified letter about the home income from their respective VDC or Municipality.The points should be account of student permanent address school/college who has passed their SLC and +2/I.Sc rather than the total percentage average. This will improve the system and many minority, low home income students will get chance to study, further less chance of brain drain. They will also work in their respective regions. Every scholarship students who passed Medical college goverment, private in Nepal or abroad or through Embassy who wants to register at Nepal Medical council, should have to do at least 2 years work at Primary Health Center level.
Accordingly, I have only one suggestion to the government of Nepal to keep them in the country in order to get return of the investment by providing services to the people of Nepal. This is high politics and should be done from all levels and ministries. There must be legislation that after graduation under scholarship completely or partially, they have to work in the country for two years. To implement such regulation government has to make decisions at all levels even at diplomatic forums. In order to implement this regulation medical council has to play a pivotal role. They have to issue the license for those who have worked two years in the country. With this regulation, there won't be shortage of skilled manpower and in the long run we can expect a healthy Nepal and necessary further steps from Ministry of Health and population , Ministry of Education.