The brain drain of doctors is not a problem

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This piece may be very provocative. It is intended to stimulate debate.

When was the last time you heard that a minister of state in Ghana had quit his job for greener pastures abroad? To the best of my knowledge, this has never happened. Ever wondered why? Of course, the answer is obvious. These ministers are paid well (salary, official perks, fringe benefits, etc). In contrast, it is common to hear that Ghanaian medical doctors are leaving in droves for greener pastures elsewhere. Some have described the behavior of the doctors as unpatriotic. But are they? Consider the following thought experiment: let?s pay doctors what we pay our ministers (salary, official perks, fringe benefits, etc). Will the doctors leave? No. Now let?s pay the ministers what we pay our doctors, will they leave? And if they did, will the same politicians describe the behavior of their colleagues as unpatriotic?

If we can make our ministers happy, then we can also make our doctors in the public sector happy because they are all paid from government coffers. Of course, why doctors? Why not engineers and lawyers who work in the public sector? Well, we cannot make everyone happy and if we are particularly concerned about the brain drain of doctors, then we should set our priorities right!! As a nation, we should set our priorities right, and stop complaining about the brain drain. This is not socialism because I have not advocated any policies for the private sector. The crux of the matter is the following: GIVEN that we have a public health sector, how should we think about improving incentives; in this case, halting the exodus of doctors in the public sector.

In Singapore, ministers? salaries are automatically pegged to the average incomes of the top few professions. This is about 70% to 80% of what their equivalents are earning in the private sector, a formula based on an average of six professions. We should not necessarily copy Singapore?s policy but they are acting according to what they value. At least, there is a comparison of the salaries of ministers and the average salary in the top six professions. So it is not a crazy idea to compare the salaries and other forms of remuneration of our doctors and ministers. Will this comparison be a taboo in Ghana? If not, can it be done in clear and transparent manner?

We should not continue appealing to the sense of patriotism of these doctors when it is clear that this has not worked and will not work. By paying our 88 ministers of state much more than we are paying our doctors in the public sector, we have revealed our relative valuations of these two jobs. Then when the doctors leave, our politicians and the whole nation must live with the stark reality.

If we pay our doctors well and retain them in the country that will improve the health sector. And if we are happy with the quality of health care in the public sector, the government will find it much easier to increase tax rates, widen the tax base, and reduce tax evasion.

If government officials bemoan the brain drain, especially the brain drain of doctors, are they really willing to sacrifice to solve the problem? I mean take a cut in their official perks, salary, fringe benefits, and transfer these resources to our doctors? Does that feel like a pay cut or a tax increase? You bet it does. But in the interest of public service and your love for mother Ghana, what?s the big deal with a little pay cut, if that will halt the exodus of our doctors in the public sector? My point is not that ministers should not be well paid. My point is if we care about the exodus of doctors, then we should think harder about some of these glaring anomalies.

That we can halt the exodus of doctors by paying them well is an old argument. In this piece, I have argued that not only should we pay doctors well but also we are capable of doing so. If you doubt it, look at our ministers of state.

So the next time someone claims that the brain drain of doctors in Ghana is a problem, please ask him/her why there is no brain drain of government ministers.