Modeling solutions to Tanzania's physician workforce challenge - PubMed (original) (raw)

Modeling solutions to Tanzania's physician workforce challenge

Alex J Goodell et al. Glob Health Action. 2016.

Abstract

Background: There is a great need for physicians in Tanzania. In 2012, there were approximately 0.31 physicians per 10,000 individuals nationwide, with a lower ratio in the rural areas, where the majority of the population resides. In response, universities across Tanzania have greatly increased the enrollment of medical students. Yet evidence suggests high attrition of medical graduates to other professions and emigration from rural areas where they are most needed.

Objective: To estimate the future number of physicians practicing in Tanzania and the potential impact of interventions to improve retention, we built a model that tracks medical students from enrollment through clinical practice, from 1990 to 2025.

Design: We designed a Markov process with 92 potential states capturing the movement of 25,000 medical students and physicians from medical training through employment. Work possibilities included clinical practice (divided into rural or urban, public or private), non-clinical work, and emigration. We populated and calibrated the model using a national 2005/2006 physician mapping survey, as well as graduation records, graduate tracking surveys, and other available data.

Results: The model projects massive losses to clinical practice between 2016 and 2025, especially in rural areas. Approximately 56% of all medical school students enrolled between 2011 and 2020 will not be practicing medicine in Tanzania in 2025. Even with these losses, the model forecasts an increase in the physician-to-population ratio to 1.4 per 10,000 by 2025. Increasing the absorption of recent graduates into the public sector and/or developing a rural training track would ameliorate physician attrition in the most underserved areas.

Conclusions: Tanzania is making significant investments in the training of physicians. Without linking these doctors to employment and ensuring their retention, the majority of this investment in medical education will be jeopardized.

Keywords: Tanzania; doctor shortage; modeling; workforce.

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Figures

Fig. 1

Fig. 1

Pathways through medical education and graduate employment in Tanzania.

Fig. 2

Fig. 2

Projected density of clinically active physicians in urban areas, rural areas, and overall, 2009–2025, with and without attrition in 2015 graduates onward.

Fig. 3

Fig. 3

(a) Projected density of clinically active physicians and those lost to clinical practice, 2009–2025; (b) projected density of clinically active physicians in rural areas and those lost to rural clinical practice, 2009–2025.

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