Quick question: Are there more medical schools in the United States or in all of Sub-Saharan Africa?

Given how much I go on about the dire state of health services and health human resources in Africa you would probably guess that I was asking this because the answer is the United States – I would. Well, we would both be wrong…but not by much.

According to the results of the Sub-Saharan Medical School Survey (SAMSS) there are now approximately 168 medical schools in Sub-Saharan African countries. According to Wikipedia, my source of all essential knowledge, there are 159 medical schools in the United States including 29 schools of osteopathic medicine. On a population basis, though, we can still argue that the United States produces more physicians per capita than Sub-Saharan Africa (roughly 20K for 300M pop vs. 11K for 800M pop) But Africa now has more medical schools than the USA.

Another reason why I would have selected the United States is that a few years ago when I had done a review of the topic, I seem to recall learning that there were fewer medical schools in Africa than in the United States (that review eventually turned into this). But what was known then was based on a few outdated studies from the 1970s and 1980s (i.e. pre-history). According to the findings of SAMSS, a lot has changed in the landscape of medical education in SSA and it is therefore about time that we have a new study that better reflects these changes.

Sub-Saharan Africa has actually been undergoing a little “boom” in medical education: of the 168 medical studies identified in SAMSS, 58 were established since 90s and more than half of them were established in the last decade. There is nearly 50% more medical schools today than there was just a few decades ago! Plus, almost all of the schools surveyed in SAMSS reported that they have significantly increased enrollments over the past few years. So there are more schools and existing schools are producing more graduates, overall some very good trends.

But there has also been a number of more subtle changes that I did not anticipate. I had heard a bit about the development of private medical schools in SSA, but I was not fully aware of the extent of this growth. About a third of the newly established medical schools since the 1990s were private compared to essentially zero private medical schools on the continent prior to the 1990s. Earlier this week an op-ed in the Guardian sparked off a sharp rebuttal from Michael Clemens, Senior Fellow at the Center for Global Development and NYU-Wagner Visiting Scholar, about the roles of rich countries in allowing or even fostering the migration of international medical graduates from poor countries.

At the heart of this debate is whether or not the migration of a health professional, who has received medical training that has been subsidized by its home government, represents an unfair subsidy by poor countries to rich countries and therefore such migration should be limited. Michael’s research on this topic has shown that many health professionals living abroad spend many years in their home country before migrating and on top of it send home many thousands of dollars a year in remittances which likely offset these losses. Although I tend to side more on Michael’s side on this debate – as an immigrant I believe people should have the right to migrate – I think the finding about the growth of private medical training further weakens the argument against reducing international migration – if they are paying a growing share of their own education than it also means that a smaller subsidy, if you think of it as one, is actually occurring.

Of course just generating more doctors will not solve the human resource crisis in SSA – there are many other barriers including the placement of these graduates into health systems, the distributions of the workers, on-going training, and creating the right incentives for them to work near their levels of competency – but this is a very good step in the right direction.

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20 Responses to “The expansion of medical education in sub-Saharan Africa”

  1. RT @KarenGrepin: The expansion of medical education in sub-Saharan Africa, some interesting trends: http://bit.ly/eL8xoB (blog post) #globalhealth

  2. Tom Murphy says:

    The expansion of #medical #education in sub-Saharan #Africa via @karengrepin http://awe.sm/5I07C

  3. Thank you for your article. New Internationalist did an article on the subject of brain drain some years ago that showed that remittances do not come anywhere close to offsetting what the developing country loses.

    Clemens may think otherwise but losses to whom? The people who end up with no health professionals to tend to their needs?

    Rich countries often actively recruit qualified health personnel in developing countries, at least until they have enough to supply their need. Meanwhile, regardless of how many medical schools there are in Africa, some countries have only one doctor for ever 50,000 people.

    Worse still, most of those doctors live in urban areas and most of the people live in rural areas, so the actual ratio means that most people will never see a doctor.

    As an example, 99% of Kenyan doctors are in provincial and district hospitals (7 and 132, respectively). The remaining 1% are in the 1,976 health centers and dispensaries that the majority of people have access to.

    So what is the benefit of having more medical schools than the US to Africans?

    • Joel Miller says:

      Hope Africa University (www.hopeafricauniversity.org) in Bujumbura, Burundi is one of the private medical schools you mention. They were asked by the Burundian gov’t to start a medical school to help meet the increasing need for doctors. Part of the med students’ training is taking place in rural Kibuye Hope Hospital. That, along with training in-country, will hopefully increase the odds of a doctor staying in SSA and caring for the needs of the majority rural population.

  4. On the boom in African medical education, from @KarenGrepin http://bit.ly/gMP6ZG

  5. RT @m_clem: On the boom in African medical education, from @KarenGrepin http://bit.ly/gMP6ZG

  6. John Russell says:

    RT @m_clem: On the boom in African medical education, from @KarenGrepin http://bit.ly/gMP6ZG

  7. RT @m_clem: On the boom in African medical education, from @KarenGrepin http://bit.ly/gMP6ZG

  8. Medic Mobile says:

    The Boom in African Medical Education, from @KarenGrepin http://bit.ly/gMP6ZG via @m_clem #meded #globalhealth

  9. AJ Leon says:

    RT @Medic: The Boom in African Medical Education, from @KarenGrepin http://bit.ly/gMP6ZG via @m_clem #meded #globalhealth

  10. RT @ajleon: RT @Medic: The Boom in African Medical Education, from @KarenGrepin http://bit.ly/gMP6ZG

  11. RT @Medic: The Boom in African Medical Education, from @KarenGrepin http://bit.ly/gMP6ZG via @m_clem #meded #globalhealth

  12. Shakwei says:

    168 med schools in Sub-Saharan African countries v/s 159 in the US but US producing more physicians/capita than SSA – http://bit.ly/egtKzE

  13. David Hercot says:

    Hi Karen,

    Quoting my colleague Faustin Chenge (see http://cat.inist.fr/?aModele=afficheN&cpsidt=23268619 for example), I would say that the mushrooming of private medical schools in DRC for instance is not quality insured. As a concrete indicator of this, doctors graduated from those schools are now denied the right to migrate to Southern African Countries -as practitioners at least- which was once a main career path for Congolese doctors up to the UK and USA. Hence more is not always a good news.

    • Karen Grepin says:

      David,

      I would totally agree with that. I have also heard of quality concerns in other examples – and not just in the private sector. Many public medical schools have expanded their enrollments so much that there are great fears that the students graduating are not learning as much as they were before.

      Definitely something work tracking as well.

      Karen

  14. […] countries. According to Wikipedia, my source of all essential knowledge, there are 159 …http://karengrepin.com/2011/04 .. Share and […]

  15. […] USA to Donate $130 mil. To African Medical Schools SAMJ: South African Medical Journal – SA medical schools to rescue … SAMSS | The Sub-Saharan African Medical Schools Study | The … The expansion of medical education in sub-Saharan AfricaDescription : Sub-Saharan Africa has actually been undergoing a little “boom” in medical education: of the 168 medical studies identified in SAMSS, 58 were established since 90s and more than half of them were established in the last decade. …http://karengrepin.com/2011/04 .. […]

  16. Dave Algoso says:

    The expansion of medical education in sub-Saharan Africa http://goo.gl/lWjjR

  17. PDM-L says:

    More med schools in US or sub-Saharan #Africa? RT @dalgoso: The expansion of medical education in sub-Saharan Africa http://goo.gl/lWjjR

  18. The expansion of medical education in sub-Saharan Africa http://goo.gl/lWjjR

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