Physician Emigration from Sub-Saharan Africa to the United States: Analysis of the 2011 AMA Physician Masterfile

Tankwanchi, Akhenaten Siankam; Özden, Çağlar; Vermund, Sten H.

doi:10.1371/journal.pmed.1001513

Cited by 92 publications

(85 citation statements)

References 57 publications

(61 reference statements)

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“…Our experience reflects the realities of severe limitations in one of the world's most resource-constrained nations (34). In this context, health worker shortages and weak health systems threaten to undermine the MISAU's ability to attain key health goals (35). Lessons learned during this initial year of implementation will foster continuous strengthening of the health systems in these ten districts.…”

Section: Discussionmentioning

confidence: 83%

Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambézia Province, Mozambique

Edwards

Moisés²,

Nzaramba³

et al. 2015

Int J Health Policy Manag

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Background: Avante Zambézia is an initiative of a Non-Governmental Organization (NGO), Friends in Global Health, LLC (FGH) and the Vanderbilt Institute for Global Health (VIGH) to provide technical assistance to the Mozambican Ministry of Health (MoH) in rural Zambézia Province. Avante Zambézia developed a district level Health Management Mentorship (HMM) program to strengthen health systems in ten of Zambézia's 17 districts. Our objective was to preliminarily analyze changes in four domains of health system capacity after the HMM's first year: accounting, Human Resources (HRs), Monitoring and Evaluation (M&E), and transportation management. Methods: Quantitative metrics were developed in each domain. During district visits for weeklong, on-site mentoring, the health management mentoring teams documented each indicator as a success ratio percentage. We analyzed data using linear regressions of each indicator's mean success ratio across all districts submitting a report over time. Results: Of the four domains, district performance in the accounting domain was the strongest and most sustained. Linear regressions of mean monthly compliance for HR objectives indicated improvement in three of six mean success ratios. The M&E capacity domain showed the least overall improvement. The one indicator analyzed for transportation management suggested progress. Conclusion: Our outcome evaluation demonstrates improvement in health system performance during a HMM initiative. Evaluating which elements of our mentoring program are succeeding in strengthening district level health systems is vital in preparing to transition fiscal and managerial responsibility to local authorities. Implications for policy makers• Health worker shortages and weak health systems threaten to undermine the ability to attain key health goals. • A strategy to deploy teams of mentors to build capacity by equipping district health managers with skills in planning, priority setting, and problem solving across eight target health management domains was implemented with some early success. • Mutual trust stemming from an open and collaborative relationship with provincial and district health authorities was key to program success. •In following best practice guidelines in global health by involving local stakeholders, our interventions were designed to target areas of joint priority and need, which encourages both relevance and sustainability of the program. This is particularly important as President's Emergency Plan for AIDS Relief (PEPFAR) seeks to fully transition authority to local entities, though we recognize that such a process can have precarious consequences if done too quickly or too cheaply. Implications for publicA health management mentoring initiative was implemented as part of a larger President's Emergency Plan for AIDS Relief-funded (PEPFARfunded) HIV care and treatment scale-up program, based on assumptions that improvements in overall system performance will eventually result in better clinical outcomes for patients. Our result...

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Section: Discussionmentioning

confidence: 83%

Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambézia Province, Mozambique

Edwards

Moisés²,

Nzaramba³

et al. 2015

Int J Health Policy Manag

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“…We believe, but cannot prove, that formal research training, with U.S. institutional linkages, will incentivize LMIC clinical scientists to remain in their home countries, and represent a concrete effort to build expertise and opportunities that may curtail the long-standing "brain drain" to high-income nations. [14][15][16] In this manner, the successor Fogarty Global Health Fellows and Scholars Program continues to equip U.S. and LMIC Fellows and Scholars 8 for effectiveness in global health research, and they are likely to contribute similarly to global health research productivity and institutional capacity. Disclaimer: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.…”

Section: Discussionmentioning

confidence: 99%

Impact of Global Health Research Training on Scholarly Productivity: The Fogarty International Clinical Research Scholars and Fellows Program

Heimburger¹,

Carothers²,

Blevins³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. In the Fogarty International Clinical Research Scholars and Fellows (FICRS-F) Program, 536 U.S. and international doctoral and postdoctoral health profession students and trainees completed 1-year research training at research centers in low-and middle-income countries. To evaluate the Program's impact, we analyzed data gathered prospectively during the Program, from PubMed, and from a representative survey of alumni. Of 100 randomly selected respondents, 94 returned the survey. Reflecting the sources of funding, human immunodeficiency virus/acquired immunodeficiency syndrome was the focus of 47% of the projects, but research in noncommunicable diseases (NCDs) and dual infection/NCD-related topics increased over time. Among the first 1,617 alumni publications, output was associated positively with being an international versus U.S. trainee, a postdoctoral Fellow versus predoctoral Scholar, and accumulation of more years post-training (all P < 0.001). Fellows were first author on a higher proportion of their articles than were Scholars (P < 0.001), and U.S. trainees were more often first author than international trainees (P = 0.04). Survey respondents had submitted 117 grant applications, and 79 (67.5%) had been funded. The FICRS-F Program yielded substantial research productivity in the early post-training years. Research outputs and impact will increase over time as alumni careers mature and they gain research independence and assume leadership positions.

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“…We believe that training LMIC scientists in situ may encourage talent to stay at home, rather than migrate to high-income countries. [22][23][24][25] Nearly two-thirds of the U.S. alumni had already returned to the LMIC research site after completion of the FICRS-F Program. This has laid a solid foundation for international, interdisciplinary collaboration in future global health research.…”

Section: Resultsmentioning

confidence: 99%

Impact of Global Health Research Training on Career Trajectories: The Fogarty International Clinical Research Scholars and Fellows Program

Heimburger¹,

Carothers²,

Blevins³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. From 2004 to 2012, the Fogarty International Clinical Research Scholars/Fellows Program (FICRS-F) provided 1-year research training opportunities for U.S. and international doctoral "Scholars" and postdoctoral "Fellows" at low-and middle-income country (LMIC) centers. We collected data prospectively and then surveyed a representative sample of 100 alumni (94% response), assessing Program impacts on their careers and collaborations. Frequently, collaborations continued beyond the formal training period with U.S.-(63%) and site-based mentors (66%). U.S. Fellows reported the highest post-training focus on research (88 on a 100-point scale), and the highest Program impact on competitiveness for career or training positions and choices of post-training topics and institutions (95 points). Interest in global health research increased markedly during the training period, especially for LMIC trainees, and was sustained post-training. LMIC alumni reported a significantly higher focus on global health and research than did U.S. alumni. Alumni reported that their mentored research training had a substantial impact on their career trajectories.

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Physician Emigration from Sub-Saharan Africa to the United States: Analysis of the 2011 AMA Physician Masterfile

Abstract: Siankam Tankwanchi and colleagues used the AMA Physician Masterfile and the WHO Global Health Workforce Statistics on physicians in sub-Saharan Africa to determine trends in physician emigration to the United States. Please see later in the article for the Editors' Summary

Cited by 92 publications

References 57 publications

Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambézia Province, Mozambique

Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambézia Province, Mozambique

Impact of Global Health Research Training on Scholarly Productivity: The Fogarty International Clinical Research Scholars and Fellows Program

Impact of Global Health Research Training on Career Trajectories: The Fogarty International Clinical Research Scholars and Fellows Program

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