title: The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis.
abstract: OBJECTIVE
  To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States.
  
  
  METHODS
  Human capital cost analysis using publicly accessible data.
  
  
  METHODS
  Sub-Saharan African countries.
  
  
  METHODS
  Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries.
  
  
  METHODS
  The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors.
  
  
  RESULTS
  In the nine source countries the estimated government subsidised cost of a doctor's education ranged from $21,000 (£13,000; €15,000) in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m).
  
  
  CONCLUSIONS
  Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their health systems.
authors: Faculty of Health Sciences, University of Ottawa, Canada. Edward.mills@uottawa.ca
authors: Edward J
authors: EJ
authors: Mills
authors: Steve
authors: S
authors: Kanters
authors: Amy
authors: A
authors: Hagopian
authors: Nick
authors: N
authors: Bansback
authors: Jean
authors: J
authors: Nachega
authors: Mark
authors: M
authors: Alberton
authors: Christopher G
authors: CG
authors: Au-Yeung
authors: Andy
authors: A
authors: Mtambo
authors: Ivy L
authors: IL
authors: Bourgeault
authors: Samuel
authors: S
authors: Luboga
authors: Robert S
authors: RS
authors: Hogg
authors: Nathan
authors: N
authors: Ford
mesh_terms: D017954:Africa South of the Sahara; D003365:Costs and Cost Analysis; D003906:Developing Countries / Q000191:economics*; D004503:Education, Medical, Graduate / Q000191:economics*; D004641:Emigration and Immigration; D006801:Humans; D010820:Physicians / Q000191:economics* / Q000600:supply & distribution*