The fate and career destinations of doctors who qualified at Uganda's Makerere Medical School in 1984: retrospective cohort study
http://www.100md.com
《英国医生杂志》
1 Pharmacy Programme, School of Health Sciences, University of the North, Private Bag X1106, Sovenga 0727, Republic of South Africa yoswad@unorth.ac.za
Introduction
The high death rate (30%) of young doctors within 20 years of graduation is a cause for concern. The profile of presumed causes of death highlights the impact of HIV/AIDS on countries that have a high prevalance of HIV, such as Uganda. The declining deaths—seven between 1984 and 1989, compared with three between 2000 and 2004—may partly point to the effective AIDS prevention campaigns for which Uganda has become renowned. That only 30% of the surviving 1984 graduates work outside Uganda is encouraging and suggests that the brain drain is not as massive in Uganda as it is in other African countries. In Ghana, for example, more than 60% of a cohort of doctors graduating between 1986 and 1995 had left the country within 10 years of graduation.4 Death has been a bigger brain drain than emigration among the 1984 Ugandan graduates.
Given the high proportion of health professionals working in the private sector in many countries,5 it is interesting that only 10% of the Ugandan graduates work in Uganda in the public sector work primarily in private practice. This may be due partly to the fact that many Uganda based doctors in public employment are able to do part time private practice as well. The low numbers of these graduates in academia reflects the worldwide unpopularity of academic medicine.
What is already known on this topic
Little information exists on the career path and fate of African doctors
What this study adds
Thirty per cent of doctors who graduated from Makerere, Uganda, in 1984 have died (most as a result of AIDS related causes), and most surviving doctors
This study did not establish the reasons for the choices made, lacked documentary proof of cause of death, and obtained little information on the social lives of the graduates. Nevertheless, these findings should serve as a springboard for a detailed study on the career choices and paths (and reasons) of Makerere trained doctors and on the implications of such choices for the Ugandan health system.
Editorial by Ncayiyana
This article was posted on bmj.com on 5 August 2004: http://bmj.com/cgi/doi/10.1136/bmj.38134.524387.AE
I thank all those colleagues who provided me with information in the discussions, telephone interviews, and via email, particularly Drs I Ndifuna, F Mulwanyi, J Omagino, G Murindwa, J Amandua, A Khayinza, S Omoding, KK Owor, C Kyambadde, I Oluoch, D Bukenya, H Ndobo, S Kabanda, and C Mugero. I also thank N Sewankambo and the staff of the Academic Registrar's Office, Makerere University, for the graduation list. Irene Modipa and the BMJ reviewers made valuable comments on an earlier version of this manuscript.
Contributors: YMD is the sole contributor.
Funding: None.
Competing interests: YMD is one of the Makerere graduates of 1984.
Ethical approval: Not required.
References
Weiner R, Mitchell G, Price M. Wits medical graduates: where are they now? S Afr J Sci 1998;94: 59-63.
Lambert TW, Goldacre MJ, Edwards C, Parkhouse J. Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983. BMJ 1996;313: 19-24.
Woodward CA, Ferrier BM. Career development of McMaster University medical graduates and its implications for Canadian medical manpower. CMAJ 1982;127: 477-80.
Dovlo D. The brain drain and retention of health professionals in Africa . www.worldbank.org/afr/teia/conf_0903/dela_dovlo.pdf (accessed 1 June 2004).
Padarath A, Chamberlain C, McCoy D, Ntuli A, Rowson M, Loewenson R. Health personnel in southern Africa: confronting maldistribution and brain drain. (EQUINET discussion paper No 3, 2003). www.equinetafrica.org/bibl/discussion.php (accessed 1 June 2004).(Yoswa M Dambisya, senior )
Introduction
The high death rate (30%) of young doctors within 20 years of graduation is a cause for concern. The profile of presumed causes of death highlights the impact of HIV/AIDS on countries that have a high prevalance of HIV, such as Uganda. The declining deaths—seven between 1984 and 1989, compared with three between 2000 and 2004—may partly point to the effective AIDS prevention campaigns for which Uganda has become renowned. That only 30% of the surviving 1984 graduates work outside Uganda is encouraging and suggests that the brain drain is not as massive in Uganda as it is in other African countries. In Ghana, for example, more than 60% of a cohort of doctors graduating between 1986 and 1995 had left the country within 10 years of graduation.4 Death has been a bigger brain drain than emigration among the 1984 Ugandan graduates.
Given the high proportion of health professionals working in the private sector in many countries,5 it is interesting that only 10% of the Ugandan graduates work in Uganda in the public sector work primarily in private practice. This may be due partly to the fact that many Uganda based doctors in public employment are able to do part time private practice as well. The low numbers of these graduates in academia reflects the worldwide unpopularity of academic medicine.
What is already known on this topic
Little information exists on the career path and fate of African doctors
What this study adds
Thirty per cent of doctors who graduated from Makerere, Uganda, in 1984 have died (most as a result of AIDS related causes), and most surviving doctors
This study did not establish the reasons for the choices made, lacked documentary proof of cause of death, and obtained little information on the social lives of the graduates. Nevertheless, these findings should serve as a springboard for a detailed study on the career choices and paths (and reasons) of Makerere trained doctors and on the implications of such choices for the Ugandan health system.
Editorial by Ncayiyana
This article was posted on bmj.com on 5 August 2004: http://bmj.com/cgi/doi/10.1136/bmj.38134.524387.AE
I thank all those colleagues who provided me with information in the discussions, telephone interviews, and via email, particularly Drs I Ndifuna, F Mulwanyi, J Omagino, G Murindwa, J Amandua, A Khayinza, S Omoding, KK Owor, C Kyambadde, I Oluoch, D Bukenya, H Ndobo, S Kabanda, and C Mugero. I also thank N Sewankambo and the staff of the Academic Registrar's Office, Makerere University, for the graduation list. Irene Modipa and the BMJ reviewers made valuable comments on an earlier version of this manuscript.
Contributors: YMD is the sole contributor.
Funding: None.
Competing interests: YMD is one of the Makerere graduates of 1984.
Ethical approval: Not required.
References
Weiner R, Mitchell G, Price M. Wits medical graduates: where are they now? S Afr J Sci 1998;94: 59-63.
Lambert TW, Goldacre MJ, Edwards C, Parkhouse J. Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983. BMJ 1996;313: 19-24.
Woodward CA, Ferrier BM. Career development of McMaster University medical graduates and its implications for Canadian medical manpower. CMAJ 1982;127: 477-80.
Dovlo D. The brain drain and retention of health professionals in Africa . www.worldbank.org/afr/teia/conf_0903/dela_dovlo.pdf (accessed 1 June 2004).
Padarath A, Chamberlain C, McCoy D, Ntuli A, Rowson M, Loewenson R. Health personnel in southern Africa: confronting maldistribution and brain drain. (EQUINET discussion paper No 3, 2003). www.equinetafrica.org/bibl/discussion.php (accessed 1 June 2004).(Yoswa M Dambisya, senior )