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72 Carlo Resti, Yohannes Tadessewith service needs and objective realities in terms of the training of high levelprofessionals. In particular, there is a serious problem in terms of the deploymentof physicians within the public sector, especially to rural areas.Practice regulation is almost non-existent, particularly for those within theprivate sector.Attrition and Brain Drain due to migration abroadThe problem of brain drain in African countries is multi-dimensional. Onesuggested typology of this problem is to see it as “soft” and “hard” braindrain 5 . Loss of knowledge due to unavailability of health research results tohealth practitioners in Africa because many African researchers prefer to publishin northern journals can be considered as “soft brain drain”, while physicalmovement of health personnel from developing countries to northerncountries can be counted as “hard brain drain”.Among the “push” factors contributing to brain drain are: low salaries andbenefits, fear of occupational infections where HIV/AIDS and other infectiousdiseases are rife, lack of well equipped physical infrastructure, drugs, suppliesand good health management system, inadequate research possibilitiesand lack of opportunity to keep up-to-date with information in their field.In addition to the factors that are pushing health professionals out of thecountry, conditions in and practices of high-income countries (“pull” factors)encourage them and contribute to their ability to work abroad.Brain drain is a relatively recent phenomenon in the Ethiopian health sectorworkforce. Prior to 1974, Ethiopia’s skilled professionals neither emigratednor decided to stay on in the countries of their training in search of betterworking conditions and for fear of political persecutions. With the advent ofan increasing number of push factors, however, this trend has changed overthe past couple of decades. About 50% of Ethiopians who went abroad andcompleted their studies did not return home during the past 10-15 years. Forinstance, between 1980 and 1991 only 5,777 students out of a total of22,700 returned home 6 .5 Muula A. Is there any solution to the “Brain Drain” of health professionals and knowledgefrom Africa? Croat Med J 2005 46(1): 21-29.6 Mengesha Y and Kebede Y. Brain Drain. In Berhane Y, Haile Mariam D, Kloos H. TheEpidemiology and Ecology of Health and Diseases in Ethiopia. SHAMA Books andEthiopian Public Health Association, Addis Ababa, Ethiopia (1 st edition 2006).
5. Human resources for health (HRH): a crucial element for achieving international MDGs. 73Table 3 – Brain Drain of Health Professionals (Mengesha and Kebede, 2006)Year Institution Field Persons Non- % lossof Study leaving returnees1968/69- MOH Medical 2013 423 211995/96 and AAU sciences1980 - 2001 AAU MF All disciplines 121 85 70Attrition due to migration out of public sectorPharmacists and druggists seem to have been proportionally more affected byinternal migration from public to private sector. There is a huge shortage ofpharmacists in the public sector institutions. For instance, from a total ofabout 500 pharmacists, only 24% were working in the public sector. Eventhough there are attempts to replace pharmacy technicians in places that usedto be staffed by pharmacists, even the number of technicians within the publicsector is not still adequate with the result that nurses, health assistants aswell as other junior staff are getting assigned in these positions.Health workers who migrated internally continue to serve the country’s population,even though those with higher socio-economic status and usually urbanresidents. On the other hand, there also seem to be inefficiencies due toinappropriate and underutilization of highly trained health workers by theprivate sector institutions as well as vertical health programs.As shown in table 4, there seems to be an increasing trend in the attrition ofphysicians from the public sector.Table 4 – Trends in the Proportion of Physicians within the Public sectorYear Total number of Number of physicians Attrition per yearregistered physicians working with MOH1997 1,634 1,483 151 (10.2%)1998 1,743 1,415 328 (23.2%)1999 1,617 1,283 334 (26.0%)2000 1,434 1,263 171 (13.5%)2001 1,424 1,366 58 (4.2%)2002 2,374 1,888 486 (20.4%)2003 2,663 2,032 631 (23.7%)2005 2,063 1,527 536 (26%)
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