By Ephrem Kirub, MD
Ethiopia is the second most populous country in Africa with dire need of physicians. According to World Bank data, in 2018, there were 0.0769 physicians per 1000 people in Ethiopia. This number is significantly lower than the WHO’s recommendation of doctor to population ratio of at least 1:1000. This is mainly because of limited number of physicians who graduate every year.
To make matters worse, many physicians go abroad every year. According to a world bank 2011 report, 26% of Ethiopian physicians are practicing abroad. Although recent data is unavailable, I have personally witnessed more than 50 colleagues and senior physicians leaving abroad in the past two years. But, What is the reason? Why do so many physicians leave? Well, there are plenty of reasons.
Firstly, physicians in Ethiopia are one of the lowest-paid in the world. A family physician makes $250 per month, while a specialist physician makes $300. Don’t get me wrong. I will not compare it with a physician salary in the U.S, Canada, or even neighboring Kenya, which pays its doctors around $1500 per month.
I know Ethiopia is poor. However, what’s disappointing the most is that professionals in Ethiopian Banks, Telecommunication, Airlines, and other government sectors are salaried more than twice that of physicians. In addition, housing benefits, health insurance, and loan services provided to these professionals are unavailable to health professionals in Ethiopia. With current inflation, physicians are barely making ends meet.
“…the government has failed to protect physicians in the past few years and let the media incessantly disrespect them with unfounded malpractice accusations“
Secondly, the working conditions are not worth the sacrifice physicians make. Becoming a physician takes much effort. Only high achiever students join medical schools and make it to the end to become licensed physicians. After 19 years of education, physicians are sent to under-equipped and understaffed healthcare facilities. Trust me; you don’t want to be a physician in a facility with no laboratory examinations to reach a proper diagnosis or medications/procedures to treat the patients. Your six and half years of medical education go down the drain and give way to a guessing game. The result is poor satisfaction on the physician’s end and harm to the patient.
Lastly, the government has failed to protect physicians in the past few years and let the media incessantly disrespect them with unfounded malpractice accusations. This ongoing accusation creates distrust between physicians and patients. There have been incidents where physicians were attacked because of the media rhetoric that fueled violent tendencies of patients frustrated by the healthcare system. Stories like these push physicians to leave Ethiopia and find a better place where they are valued and respected.
However, minimizing the problem is not a lost cause. There are solutions to curb the impending migration. The return of service agreement has not worked and will not work. We need a new approach!
First, the Federal Ministry of Health and the Federal Ministry of Education must create a platform for genuine discussions with physicians. Directly engaging them will allow in addressing the burning issues first. The healthcare system needs reform, and valuable change ideas could emerge from these discussions. Moreover, involving physicians in such reform activities will empower them and create a sense of ownership, which is currently lacking.
Secondly, the government needs to develop a payment model that satisfies the physicians but does not hurt the country financially. The government can benchmark best practices from countries with similar socioeconomic status as Ethiopia.
The government need to allocate budget for health insurance for physicians. Similarly, the Ministry of Health could negotiate with sister university hospitals in various countries to provide coverage for medical care abroad. The government could also solve the housing problem by providing funding and mortgage services, similar to other government sectors.
Another essential step is that the government must keep the media in check. The Ethiopian Media Authority must provide journalists with guidelines and directions on how to deal with medical malpractices. Journalists must be trained to seek substantiated information and produce unbiased report.
Mistakes happen, I won’t deny them. But, as Alexander Pope said, “To Err is Human.” What matters most is appropriately investigating and preventing mistakes from occurring again. This way, physicians will learn from their mistakes while, at the same time, patients are kept safe from harm in the future.
Lastly, physicians are an essential part of society. They sacrifice a lot, and they need recognition. In the past three years alone, they risked their lives fighting the COVID pandemic away from their families and loved ones. Many died of COVID-19, some still suffer from the disabling long-term sequelae of COVID-19 infection, and even more are burned out from the mental and physical strain of the pandemic. A simple, genuine “Thank you” from the community goes a long way.
In conclusion, physicians in Ethiopia are frustrated, and the issue needs due attention. The government must improve working conditions, provide better fringe benefits, and proper recognition. On the other hand, physicians need to be proactive in identifying and mitigating problems in the healthcare system and become part of the solution. Otherwise, Ethiopia will soon become a physician desert.