Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems.

Joseph Nwadiuko,Jamie Stern,Galen E Switzer,Keyonie James

doi:10.1186/s12992-016-0165-9

Joseph Nwadiuko, Jamie Stern + Show 2 more

Open Access

https://doi.org/10.1186/s12992-016-0165-9

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Abstract

BackgroundThere is increased interest in the capacity of US immigrants to contribute to their homelands via entrepreneurship and philanthropy. However, there has been little research examining how immigrant physicians may support health systems and what factors facilitate or raise barriers to increased support.MethodsThis study used an observational design with paper questionnaire and interview components. Our sample was drawn from attendees of a 2011 conference for US Based Nigerian physicians; respondents who were not US residents, physicians, and of Nigerian birth or parentage were excluded from further analysis. Respondents were randomly selected to complete a follow-up interview with separate scripts for those having made past financial contributions or medical service trips to support Nigerian healthcare (Group A) and those who had done neither (Group B). Survey results were analyzed using Fischer exact tests and interviews were coded in pairs using thematic content analysis.ResultsSeventy-five of 156 (48 %) individuals who attended the conference met inclusion criteria and completed the survey, and 13 follow-up interviews were completed. In surveys, 65 % percent of respondents indicated a donation to an agency providing healthcare in Nigeria the previous year, 57 % indicated having gone on medical service trips in the prior 10 years and 45 % indicated it was “very likely” or “likely” that they would return to Nigeria to practice medicine. In interviews, respondents tended to favor gifts in kind and financial gifts as modes of contribution, with medical education facilities as the most popular target. Personal connections, often forged in medical school, tended to facilitate contributions. Individuals desiring to return permanently focused on their potential impact and worried about health system under-preparedness; those not desiring permanent return centered on how safety, financial security and health systems issues presented barriers.ConclusionsThis study demonstrates several mechanisms by which health systems may benefit from expatriate engagement. Greater identification of reliable local partners for diaspora, deeper collaboration with those partners and a focus on sustainable interventions might improve the quantity and impact of contributions. Ethnic medical associations have a unique role in organizing and facilitating diaspora response. Public-private partnerships may help diaspora negotiate the challenges of repatriation.

Highlights

There is increased interest in the capacity of United States (US) immigrants to contribute to their homelands via entrepreneurship and philanthropy
In 2009 a World Bank/United Nations Children’s Fund (UNICEF)/United Nations Population Fund (UNFPA) report estimated that $68.9 billion dollars needed to be invested in low and middle income countries (LMICs) health systems in order to ensure the achievement of the Millennium Development Goals (MDGs) [1]
A convenience sample of US-practicing physicians of Nigerian birth or heritage practicing in the United States were recruited at the 2011 annual convention of the Association of Nigerian Physicians in the Americas (ANPA), the largest association of Nigerian physicians practicing in the U.S Permission to recruit was obtained from ANPA

Summary

Introduction

There is increased interest in the capacity of US immigrants to contribute to their homelands via entrepreneurship and philanthropy. There has been little research examining how immigrant physicians may support health systems and what factors facilitate or raise barriers to increased support. There is a significant gap in resourcing for health systems in many low and middle income countries (LMICs). Home country health systems have suffered from the gap left by emigrated health professionals. This was most crystallized right before the recent Ebola epidemic in Liberia, where more than % of nationally trained physicians were practicing overseas as of 2004 [4], and the nation had only physicians in 2014 to care for 5 million individuals [5]. Other studies have demonstrated an increase in HIV mortality related to physician emigration [6]

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