Mouhamed Ndiaye, a family case manager at African Services Committee, is beginning his residency in psychiatry in the Bronx.

The Brain Drain and Africa's Healthcare Worker Crisis

Carolyn Dieckman

These statistics paint a grim picture for the health of the more than 600 million people who call sub-Saharan Africa home. To meet their people's most essential health needs, experts estimate that Africa needs at least 1 million new healthcare workers. The impact of the brain drain that draws essential talent out of Africa to high-paying jobs in the West, is even starker in countries that bear the greatest burden of the HIV/AIDS epidemic, where shortages are creating critical bottlenecks to scaling up the AIDS response and achieving universal access to AIDS treatment by 2010.

Over the last year, a broad coalition of doctors, AIDS advocates, health service organizations, and leaders in health policy has formed around the healthcare worker crisis in Africa. African Services is part of this coalition that is led by HealthGAP and is calling on the U.S. and other wealthy nations to lead a global health workforce initiative in the most AIDS impacted countries.

At African Services, HIV/AIDS programs in both New York City and Ethiopia, rely on the unique skills of African healthcare workers to provide care and support to their communities. We know first-hand their capacity to provide lifesaving care on both sides of the divide.

Mouhamed Ndiaye, a family case manager at African Services, knows both the frustration and satisfaction that healthcare workers in Africa face. Before coming to the U.S. in 2001, he spent 11 years training and working as a doctor in West Africa. His experience growing up in a small town in Senegal motivated him to begin a career in medicine. He remembers as a child seeing the local nurse--the area's most qualified health worker--overwhelmed by more than 100 patients each day seeking his service.

At age 19, Mouhamed began eight years of training at the Cheikh Anta Diop University medical school in Dakar, returning home to volunteer during school breaks. He speaks highly of his schooling, and says he and other students from across Africa received very thorough training in Dakar. But after beginning to practice medicine, Mouhamed found he wasn't able to use all he learned. In some cases, the equipment was unavailable; in others, the patient could not afford the services. Death from malaria was a daily affair, he says. Though the standard treatment, a multi-day course of medication, costs just $2, many of his patients were unable to afford it.

After working for three years as the chief of internal medicine at a regional hospital and as a physician in the private sector, Mouhamed decided to leave Senegal. He wanted to see the world and receive further medical training. He estimates as many as 30 percent of the doctors he graduated with are now working abroad in France, the United States and elsewhere. The campaign for a U.S.-led initiative to expand the global health workforce addresses these supply- and demand-side forces to reduce the brain drain and improve health systems performance.

The strategy includes expanding U.S. healthcare worker training opportunities, discouraging active recruitment from poor nations and working with developing and developed countries on migration, recruitment and wage policies that mutually benefit source and destination countries. The Initiative, priced at $8 billion for five years, also calls for a substantial community health worker program for the most AIDS-impacted countries to train, compensate and deploy community members as healthcare providers, including women and people living with HIV, to provide basic care, treatment and prevention as an integral part of the primary health system.

After settling in New York City, Mouhamed began working at African Services as a medical interpreter escorting African patients to doctor's visits and using his language skills to serve as a patient advocate. He also began studying for the U.S medical licensing exam and then undertook the long process of securing one of the few residencies available to foreign doctors. Next month, Mouhamed begins a residency in psychiatry at Metropolitan Hospital in the Bronx. With this opportunity, he will become one of the few Wolof-speaking psychiatrists and an invaluable resource in any African community he chooses to practice in, where psychiatry has been a neglected area of care. Mouhamed says he plans to eventually return to Senegal. African Services Committee wishes him the best of luck.

For information and to endorse the Global Health Workforce Initiative, go to: www.healthgap.org.