Monday, April 15, 2024

Brain Drain and Its Impact on The Gambia’s Health Sector

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By Alieu Jallow and Sheikh Manneh

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The “brain drain complexity continues to cause human capacity deficits in many developing countries, including The Gambia.

This exodus of human capital often has a big impact on developing nations and thus often leaves a pickle that is demanding to fill since there may not be as many people with similar skills to fill that void.

This phenomenon causes a shortage of human resources, which is particularly evident in the health sector. The Gambia has a high attrition rate and a slow production of new professionals, which results in heavy dependence on external aid to finance development projects in the health sector.

Although there are no recent figures on migration from official Gambian bodies, the available data from 2017 estimates that 140,000 Gambians were living outside of the country. Irregular migration to Europe, also known as the ‘backway,’ has heavily contributed to this number.

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According to the Organisation for Economic Cooperation and Development, the emigration rate of highly educated individuals increased by almost 40% from 2000 to 2010. These figures suggest that the country is severely affected by brain drain. The Gambia is ranked 5th (out of 21) in Africa and 15th (out of 144) in the world in terms of the emigration rate of highly educated individuals.

Although there is no recent data on skilled emigrant workers, it is unlikely that the trends in Gambian outflow of professionals have changed.

Shortfall at the referral hospital

Over the years, several health professionals have abandoned government employment for lucrative offers outside The Gambia or in the national non-governmental sector.

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For The Gambia’s only tertiary referral hospital, Edward Francis Small Teaching Hospital in Banjul, the situation has never been this bad. It is the largest hospital in the country.

In 2019, the Nurses’ Association of the Hospital held a press conference lamenting the condition of the hospital, low pay and poor working conditions.

Also in 2022, different cadres of health professionals, including midwives and public health practitioners, held strikes across the different over unpaid allowances.

Consequently, the nurses are leaving en mass.  In the last three months, according to the hospital’s spokesperson, Kebba Sanyang, about 30 nurses resigned from their positions in the hospital.

A number of them travelled out of the country while others joined the private establishments.

Lamin M. Sanyang, a former Senior Program Officer for the Non-Communicable Diseases (NCD) Prevention Unit under the Ministry of Health and Social Welfare, said working as a public health officer in The Gambia comes with a lot of challenges. Chief among these challenges is poor wages and lack of professional development opportunities.

Due to challenges like this, Sanyang left for greener pastures in the United States of America. He currently lives and works in Virginia as a safety manager on a 3.8 billion road project.

“The biggest motivation for leaving is remuneration,” Mr Sanyang affirmed.  “Health workers in The Gambia receive one of the worst remuneration packages in the subregion and we all have families to take care of.”

Assan Ceesay is also a trained healthcare personnel who used to work as a nurse at Basse Health Centre, about 400km away from Banjul. In Basse, the temperature is usually higher than the national average, but even the health centre there barely has constant electricity although it is the only main health centre in that region of The Gambia.

In the midst heat, in November 2022, Assan got an offer to work with the National Health Services (NHS) in the United Kingdom.  He left The Gambia and now works at Tarnside and Glossop Integrated Care Foundation Trust in the Greater Manchester Region.

Mr Ceesay said he left The Gambia to attain financial independence and professional growth.

“When I got the offer, I thought about it and I knew that with this offer, I can do a lot for myself, my family and in return for The Gambia,” said Ceesay.

Assan decried the cumbersome workload and working hours thus offering two to three hours of overtime out of “passion and love for the patients”.

He further highlighted that he was literally doing the work of a doctor with three assistants at the paediatric ward and was only going home with less D10,000 as a Grade 8 staffer of The Gambia Government Integrated Pay Scale.

Despite the pay increase which took his monthly salary to D15,000, Mr Ceesay said his entire yearly salary in The Gambia is equivalent to his one-month salary in the UK.

“When I pick up an extra day shift, what they will pay me for a single day is more than my monthly salary in The Gambia,” he further affirmed.

Some of the health professionals who left the Gambia for better pay and working conditions abroad said there is a need for The Gambia government to significantly increase pay, create opportunities for professional growth and inculcate nationalism ideas.

One such person is Kitabu Jammeh, a doctor.

“Providing adequate remuneration to balance the cost of living and professional growth is key to maintaining professionals,” he said.

“When greener pastures present, one may grab the opportunity, but I can confidently say that I am one doctor who is and has contributed his bit to medical service in The Gambia”.

Trend to continue

The principal Public Relations Officer at the Edward Francis Small Teaching Hospital, Kebba Sanneh, many health professionals that are leaving the country are doing so because of the economic benefits outside.

“They know when they use their expertise in other parts of the world, they stand to benefit more,” he said.  “So, unless we increase the basic needs of doctors and other health professionals, the trend will continue.”

According to the World Salaries Index 2023, a physician working in The Gambia typically earns around D480,600 per year, and this can range from the lowest average annual salary of about D225,300 to the highest annual average salary of D756,700.

Below is a table analysis of the earnings of a physician in The Gambia.

Earning level/rank Annual earning (Dalasi) Monthly earning (Dalasi)
Highest paid D756,700 GMD D63,058 GMD
Average D480,600 D40,050
Lowest D225,300 D18,775

These estimates include allowances such as housing and transportation.

In neighbouring Senegal, according to Salary Explorer, the average earning for a physician is CFA808,000, equivalent to about D81,159, with the highest earning estimated at CFA1390,000 which is equivalent to D139,619.

In the US, the average salary for a medical professional is $42,587 per year, according to…(who).  This is equivalent to D2,555,220 annual salary, which is equal to D212,935 per month.

Despite the positive impact of migration on The Gambia’s economy in terms of remittances sent home by those in the diaspora, The Gambia continues to suffer with most of its health professionals leaving for jobs abroad.

In a publication in The Gambia, Omar Kebbeh said The Gambian government’s inability to restore economic stability has resulted in increased emigration among all segments of the population, in particular nurses and doctors.

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