Brain Drain in Ethiopia’s Health Sector: Perceptions of and experiences with medical brain drain among Ethiopian health workers

Abstract

The global migration of health workers, also known as medical brain drain, exacerbates human resources for health (HRH) shortages in the countries of origin. These shortages disproportionally affect low- and middle-income countries due to the uneven distribution of health workers across the world. This is recognised as a major development challenge in these countries. The negative effects of brain drain are made worse by internal migration, which affects the distribution of health workers within countries and consequently access to health services for parts of the population. Ethiopia is one such country that struggles with the retention of its health workers at all levels of the health system. This thesis explores how brain drain impacts the health workers that remain – and consequently also the health system – which has been given marginal attention in the literature in general. Through qualitative interviews with Ethiopian health workers, I illustrate what it is like to work in the Ethiopian health system, and I ask how health workers perceive and experience the effects of brain drain and attrition in the public health system in Jimma specifically and Ethiopia in general. I consult policy documents to look at the policy responses to brain drain and problems of retention, and through reviewing the literature I put this in the historical political context of Ethiopia. With this, I show that the current form of the Ethiopian health system, including the shortcoming and HRH problems, can be located in this context. I find that the low-resource setting that the health workers operate within pushes many away, and in combination with low salaries many consequently choose to seek out other employment opportunities – either abroad or in Ethiopia. Having access to private practice opportunities, therefore, becomes an important factor for their retention. Furthermore, I also found that Jimma may struggle more with retention than similar places elsewhere in Ethiopia. Respondents said that this largely is due to infrastructural underdevelopment, which is also why health workers leave rural areas for urban areas in general. I argue that to create an effective policy for the retention of health workers, the health workers perceptions of and experiences with brain drain and working in the health system need to be examined in detail, and retention policies and strategies need to be informed by what pushes and pulls people away and by what makes them stay.