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 But what was known then was based on a few outdated studies from the 1970s and 1980s (i.e. pre-history).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.Share on Facebook