Practising globally: regional challenges
Dr Margaret Mungherera, President, World Medical Association
Sir Sabaratnam Arulkumaran, President, British Medical Association
Professor Teerachai Chantarojanasiri, Vice President, Thailand Medical Association
Doctors feeling hard pressed by the seemingly endless demand for their services should spare a thought for World Medical Association President, Dr Margaret Mungherera.
In her native Uganda, Dr Mungherera is one of just 36 trained psychiatrists, serving a population of 36 million people. To even begin to meet the need for their specialist knowledge and skills, Dr Mungherera and her colleagues focus much of their effort on training, research and supervision, amplifying their reach by instructing health workers.
It is a similar story across Africa and, indeed, much of the developing world, where millions – through lack of money and human resources – have access to only the most rudimentary of health services.
In a number of African countries, Dr Mungherera said, governments were beginning to take steps toward the creation of national health systems, but such work was still in its infancy, and faced many significant barriers, among them a shortage of doctors and other health workers, a lack of hospitals and other infrastructure, and the cost of medicines and other treatments.
One of the most pressing problems is the lack of trained doctors.
Dr Mungherera said Africa’s medical workforce was very young – 90 per cent of doctors were less than 10 years out of medical school.
Added to this inexperience was problem, shared by countries such as Australia, of encouraging them to practise where the need was greatest.
“The biggest problem in Africa is that 95 per cent of the population live in rural areas, but just 5 per cent of doctors work in rural areas,” she said.
In an attempt to address this problem, several governments have resorted to bonding medical students with obligations to practice in rural areas upon graduation, but Dr Mungherera said this was not only a violation of the right of people to practice where they want, it had the effect of discouraging people who might have undertaken medical training.
In addition to internal migration from the country to the city, African doctors often migrated overseas, lured by much better pay and conditions then they could expect in their home country.
Added to this brain drain, many of those who remained in their home country moved out of clinical practice into non-clinical jobs, including working for international organisations which, again, offered better money than might be had in public or private practice.
Dr Mungherera said the WMO and medical groups within Africa were working on innovative ways to harness the skills and knowledge of doctors who have chosen to work abroad.
She said the WMO was working on a scheme to encourage expat African doctors visiting home to give lectures, conduct ward rounds, undertake research or even donate a month of their time to local clinical practice.
In addition, 20 national African medical associations were in talks about harmonising their qualifications to make it easier for doctors to migrate to other countries within the continent, as a way to retain their skills within the region.
Though Thailand’s 23 medical schools train far more doctors – 2500 a year – than most Africa countries, Vice President of the Thailand Medical Association, Professor Teerachai Chantarojanasiri, said his country had a similar problem with access to care, particularly in rural areas.
“Although we are producing 2500 doctors a year, it is still not enough,” he said. “Access to health care has improved but demand and supply is not equal.”
As in Australia and Africa, most doctors graduates to the cities and larger towns, leaving a gap in care for the large proportion of Thais who continue to life in rural areas.
Professor Chantarojanasiri said the country relied on an army of 20,000 health volunteers in rural villages and communities to provide primary care.
Medical students whose training is paid for by the Government are obliged to work in the public health system for three years upon graduation, and students from well-off families often paid to train overseas, particularly the United States, in order to avoid this obligation, Professor Chantarojanasiri said.
British Medical Association President, Sir Sabaratnam Arulkumaran, said that Britain, like Australia, faced the challenge of an ageing population, which raised the prospect of increasing national health bill as the number of people who required complex care for an extended period during their latter years of life expanded.
“The problem at the moment is the increasing proportion of people over 65 years,” he said. “The birth rate is 2.1 and the replacement level is 2.6, and although we are prolonging life expectancy, we need to increase healthy life expectancy.”