Exporting Healthcare Providers Abroad: A Short-Term, but Unsustainable Solution

The Problem At Hand

In many parts of the world, poverty, discrimination, poor public infrastructure, and environmental distress have resulted in poor health outcomes[1]. To compound the problem of poor health, many countries lack sufficient healthcare providers to deal with this enormous health burden[1]. Unfortunately, resource-limited health systems, significant disease burden, and a chronic insufficiency of doctors and nurses are the reality in most low-income countries. These countries simply do not have the fiscal resources to support the expense of training and supporting crucial healthcare providers. Furthermore, many of the medical graduates from low-income countries seek opportunities in more developed areas because these other areas can provide them with the resources to do their job [2]. The World Health Organization (WHO) estimates that there is a critical shortage of 7.2 million doctors, nurses and midwives around the world, reporting that 83 countries do not even meet the minimum threshold of 23 health workers per 10,000 people[3].

Why One of Our Current Solutions is not Sustainable

Developed countries have certainly provided international medical assistance to countries in need, focusing on disease specific interventions in areas such as immunizations, maternal and child health, and HIV.2 However, the majority of the interventions thus far have not dealt with an underlying problems facing countries in need of healthcare assistance, which is the serious lack of healthcare practitioners. If a medical practitioner goes to Africa solely as a medical provider there is no doubt they will help save lives, but until the number of faculty in these countries can be increased to adequate levels, the current pattern will continue. Sub-Saharan Africa for example has no medical schools in 11 of its countries [3]. If however a medical practitioner goes as a teacher, their impact will be multiplied. The students they teach will go onto save many more lives and even become teachers themselves [3]. This would effectively help these countries help themselves in the long run.

What is Being Done to Meet This Demand

All countries need robust health care delivery systems to provide quality and accessible services. The recognition that there is a need both to improve current services and to train the next generation of in-country leaders and educators is a seemingly obvious idea, but it has taken a while to be put into practice.1 I wanted to discuss one such initiative that is addressing this lack of local healthcare providers as a root cause for poor health. In 2010, the Peace Corps and Seed Global Health (a private organization founded by a small group of faculty at the Massachusetts General Hospital), started a new dedicated doctor and nursing program.3 The program places American health professionals alongside local medical and nursing faculty counterparts in African countries to meet the teaching needs identified at each institution. In the launch year of 2012-2013, SEED Global Health placed 30 doctors and nurses at 11 training institutions in each of its three partner countries: Malawi, Tanzania and Uganda [3]. For the 2014-2015 program, 42 clinical educators are worked at 13 sites across Malawi, Tanzania, and Uganda [3].

While targeting a root cause of the healthcare crisis, one of problems with such a program is that volunteers must go overseas for a one year period, a commitment which would be difficult for physicians. They would have to leave the responsibilities of a practice or staff behind, all while facing a significant cut in their salary. The debt repayment program (up to 30,000/year) offered by SEED global health is likely attractive for more recent graduates, but not as attractive for more experienced physicians with years of teaching experience who would be the best suited to educate residents and medical students in the low-income countries they could be serving [3].
Adapting the infrastructure in the developed countries sending physicians may be a solution to this problem. If universities for example, allowed a certain number of their staff physicians to take a sabbatical year and go abroad to teach students and medical trainees in low-income countries, that would allow additional and more experienced physicians to take part.

1. Kerry VB, Auld S and Farmer P. An International Service Corps for Health-An Unconventional Prescription for Diplomacy. N Engl J Med. 2010; 363(13):1199-201.
2. Mullan F and Kerry VB. The Global Health Service Partnership: Teaching for the World. Acad Med. 2014;89(8):1146-8.
3. http://seedglobalhealth.org/