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Health worker flight

Royal Victorial Teaching Hospital, a training hospital, in Banjul

The Gambian government loses up to half of its trainee health workers every year to the private sector or to jobs abroad, causing dangerous shortfalls in patient care in some government hospitals, health workers say.

Half of government-trained public health workers in Gambia – including doctors, nurses and managers – have left public hospitals and clinics over the past decade and the departure rate is rising, according to Mamat Cham, of the Gambia Department of State for Health.

The Royal Victoria Teaching hospital lost 250 nurses between 2003 and 2005 according to a Gambian Department of Education August 2008 report.

“My class had 26 students, but only two now work as government doctors,” said a public-sector doctor who asked not to be named. “All the rest work for NGOs or have left the country.”

Most leave to join private clinics or international NGOs in The Gambia or to go abroad, particularly to the United States, Australia and the United Kingdom.

The high attrition rates lead to overworked doctors and dangerous patient neglect, in some cases even death, the doctor said. “If you are left with only one doctor when you’re supposed to be three, patients will have to wait too long for care.”

Cham said shortfalls hit rural areas particularly hard. “Our rural health centres and hospitals are now left in the hands of junior nurses because the seniors and other highly skilled nurses and doctors have left.”

Why the exodus

Gambia’s health workers leave the public sector because of low salaries, poor training, a lack of career development opportunities, difficult working conditions, and a lack of equipment, according to ex-government nurse Yero Jallow, who now works in the private sector.

And they leave because they have somewhere to go. In the private sector and in developed countries there is a high demand for skilled medical workers for relatively high-paying jobs.

A government doctor can expect to earn US$ 226 in The Gambia, the unnamed doctor told IRIN, adding that at a private clinic or NGO the same person can earn “up to eight times more”. In the UK the most junior hospital doctor will earn $48,723 a year, and general practitioners can expect to eventually earn $118,000 to $178,000.

Incentives to stay

Governments of both The Gambia and the UK are taking measures to help keep Gambian health workers in their home country.

The Gambian department of health recently introduced a hardship allowance of $22.30 per month, plus additional monthly risk and on-call allowances, and a responsibility allowance for health officers in charge. It has also put in place hardship allowances for rural postings.

But the health department’s Cham said recruiting countries also need to do more by agreeing to limit recruitment numbers.

In February 2008 the UK government was the first country to pass a law limiting the number of doctors from abroad – specifically the Commonwealth – seeking postings in the National Health Service (NHS).

The legislation was passed to preserve health service jobs for British graduates and is accompanied by a push to train British medical students, with medical school places having doubled since 1997.

The UK government also enforces a code of practice for all NHS employers to prevent developing countries being targeted in international recruitment drives.

“[The code] is concerned with the protection of developing countries such as Gambia and seeks to prevent targeted recruitment from developing nations that are experiencing shortages of healthcare staff,” said an NHS spokesperson.

Among the 247,000 doctors now registered with the UK General Medical Council, 27 percent come from outside of Britain.

For now the UK is the only country to put such recruitment restrictions in place and the move might help slow Gambia’s brain drain. Still the laws affect only government jobs and those who choose to join the private health sector are as free as ever to do so.


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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