Abstract
A growing challenge of globalization is the migration of many healthcare trainees to richer nations when they complete their education. This loss of intellectual capital compromises the ability of low-income countries to provide adequate health care. Despite recognition of this loss most African nations keep no track of those they train. Effective investment in health care demands retention of this resource; the ability to direct healthcare providers where needed; understanding of local factors driving migration, choices regarding postgraduate training abroad, and future practice preference. Self-administered questionnaires were distributed to a random sample of 200 Uganda College of Health Sciences students for anonymous completion; 141/200 (70.5%) were completed; 84% of respondents intended to pursue postgraduate studies abroad; 63% to migrate within five years of graduation; 57% to work in urban areas. While partly due to global trends and awareness of international opportunities, this negative trend of migration and shunning rural practice is also influenced by sociopolitical and educational elements within Uganda. One option (adopted elsewhere) is mandatory practice in government community health centers for a period following graduation. But the ethics, consequences, and implications of current international migratory trends need to be addressed locally and by the global medical education community.
Highlights
While the WHO Millennium Declaration (2000) [10] sets out governments’ responsibilities and defines specific targets, universal access to appropriate health care remains a dream for nations like Uganda
Self-administered questionnaires were distributed to a random sample of 200 Uganda College of Health Sciences students for anonymous completion; 141/200 (70.5%) were completed; 84% of respondents intended to pursue postgraduate studies abroad; 63% to migrate within five years of graduation; 57% to work in urban areas
Discuss options to provide a sustainable supply of health care providers across the healthcare system of resource-constrained countries such as Uganda, and call for changes in medical education and public policy that could be put in place to address international migration by graduates from health education programs
Summary
While the WHO Millennium Declaration (2000) [10] sets out governments’ responsibilities and defines specific targets, universal access to appropriate health care remains a dream for nations like Uganda. Because of recognition that the urban-based medical schools effectively had been training for urban practice, the training of health care professionals is organized in such a way that interdisciplinary cohorts of trainees spend at least 5 weeks every academic year living and working in a community With these changes in educational delivery and new emphasis on community-based learning we studied what the future plans of students at MakCHS (medicine, dentistry, nursing, and pharmacy) were with regard to: where they would seek to pursue postgraduate training (at home or abroad), where they intended to work (urban or rural practice), the proportion who planned to migrate from Uganda within the 5, 10, or 15 years, and whether their origin from a rural or urban area influenced their decisions.
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