Perceptions of Medical Brain Drain among Young Doctors in Kenya: A Cross-Sectional Study

Author(s) Paul Yonga1, Henry Muchiri2, Were Onyino3
Affiliation(s) 1Clinical Services, Ministry of Health, Nairobi, Kenya, 2Clinical services, Ministry of Health, Nairobi, Kenya, 3Clinical Services, International Committee of Red Cross, Nairobi, Kenya.
Country - ies of focus Kenya
Relevant to the conference tracks Health Workforce
Summary The objective of this study was to determine the perceptions of medical brain drain among young doctors in Kenya. A descriptive cross-sectional study was carried out between March and May 2012 among young doctors aged 50 years and below in all the seven provinces of Kenya using multi-stage sampling, and the research instruments were semi-structured self-administered questionnaires. 288 doctors were interviewed and data entry and analysis was done using Epi-data and SPSS version 17 respectively. 91.5% were not satisfied with their remuneration and 85.9% have thought, or are thinking of seeking for employment outside Kenya. This is a worrying trend which should be swiftly addressed.
Background The movement of trained health personnel out of developing countries is one of the most numerous health crises facing the African continent, inclusive of Kenya. This phenomenon of “medical brain drain” has been described as rich countries “looting” doctors and other health professionals from developing countries. Emigration results from a combination of push factors (in source countries) and pull factors (in recipient countries), and several authors have addressed the push-pull theory of migration.This phenomenon has exacerbated the already weak national, provincial, and district health systems in Kenya, thus proving a serious challenge for the realization of the United Nations Millennium Development Goals (MDGs).
Objectives The major objective of this study was to examine the perceptions on medical brain drain among young doctors in Kenya. The specific objectives were to determine the level of satisfaction as far as remuneration and support in the work environment is concerned, to discover the common reasons for wanting to work outside Kenya and to determine factors that can help in stemming the tide of medical brain drain in Kenya.
Methodology This was a descriptive cross-sectional study carried out between March and May 2012 in Kenya among young doctors, which is defined as doctors aged 50 years and below. Until recently, the government health facilities in Kenya where doctors could be accessed were national, provincial, and district hospitals. After the promulgation of the new Kenyan Constitution in 2010, the health structure has been divided into county health systems where there are now 47 counties and each county will have at least one major county hospital staffed with doctors. However, due to the incomplete implementation of the new system, the study was carried out as per the former structure, where the seven provinces in Kenya were used as study sites.
A sample size of 1,571 doctors who met the age cut-off criteria was arrived at using the Kish and Leslie formula. A multi-stage sampling method was employed in sample selection whereby in stage I all the seven provinces in Kenya, that is, Rift-Valley, Western, Central, Nyanza, Coast, North-Eastern, and Nairobi provinces, were used as strata for the study. In stage II, the government provincial and district hospitals within each province, as well as private hospitals including health-provider non-governmental organizations (NGOs) within each province, were included. In stage III, in each facility, the doctors aged 50 years and below were selected and systematic random sampling used to arrive at the sample size of 1,571.
Data collection instruments were semi-structured, self-administered pre-tested questionnaires that were divided into three sections. Study variables included satisfaction with remuneration, if the doctor ever thought of, or is currently thinking of practicing outside Kenya and if yes the reasons why, and finally possible solutions that can help stem the medical brain stem tide in Kenya.
Of the 1,571 questionnaires distributed 288 were duly filled and returned to the primary author and co-authors. After data cleaning and validation, entry was done using Epidata software and analysis was done using PASW (SPSS) version 17.
Results 91.5% (n=260) of the doctors interviewed were not satisfied with their current remuneration. 85.9% (n=244) have ever thought of, or are currently thinking of seeking for employment outside Kenya, of which 43.7% (n=124) cited poor economic returns as the major reason for wanting to relocate. 73.3% (n=208) were generally dissatisfied with the work support they receive in their working environment, of which 45.1% (n=128) on a scale of 1 to 4 were very dissatisfied. 77.5% (n=220) of the young doctors advocated for better remuneration, 71.8% (n=204) advocated for more funding for health services, and 38.0% (n=108) advocated for more involvement in policy making changes as some of the top solutions that would help in stemming the tide of medical brain drain among young doctors in Kenya.
Conclusion Human resources is a key element that makes organizational or national goals attainable. The state of a nation’s health sector is strategic to growth and development. Thus, with the majority of young doctors practicing in government health facilities, their views and opinions are vital in addressing medical brain drain and should be involved in key health policy-making decisions that will strengthen the health system through adequate funding to avert this challenge. Otherwise, at the moment, without any concrete solutions and lack of political will, Kenyans should surely be worried as they will be disadvantaged further in a society already in dire need of health care reform and quality health care.

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