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Addis Ababa – In Ethiopia, the situation of unemployed doctors has recently become a major topic of public conversation. Doctors have been expressing their frustration and the difficulties they are experiencing trying to find a job. The unemployment of newly graduated doctors is unheard of in Ethiopia.
Ethiopia has one of the most severe medical shortages in sub-Saharan Africa. Recent studies show that Ethiopia has 2.5 doctors per 100,000 inhabitants below the number recommended by the World Health Organization (WHO), which is a minimum of 10 doctors per 100,000 in low-income countries. Ethiopia is also fighting a global pandemic like any other country in the world.
In an attempt to address the shortage of doctors, Ethiopia’s Federal Ministry of Health (FMoH) and Federal Ministry of Education (FMoE) initiated what is called a “flood” or “rapid expansion” policy. This policy was designed to combine speed, volume and quality of human resource development. He demanded that existing public medical schools in Ethiopia expand their enrollment from three to four times. Studies found that medical schools have increased the enrollment required by this policy. A study published in 2015 shows that 11,291 medical students are in training.
The FMoH was in charge of deploying graduates across the country upon completion of the training. This practice was stopped after doctors went on strike demanding some changes. Dr Brook Genene, a graduate of Tikur Anbessa Hospital School of Medicine, told Addis Standard that “some demands from the strike related to improved working hours and pay were answered.” Adding: “Other than that, nothing has changed,” he explained. “Many of the pressing issues, such as health insurance for healthcare professionals, better working conditions, risk payments and, most importantly, unemployment are issues that have yet to be resolved.”
Dr. Firew Asrat, a general practitioner (GP) graduated from Hawassa University in 2020, stated that one of the demands of the strike was to lift the requirement of half a million (500,000) ETB to obtain a license to practice medicine . The requirement had no legal background according to Dr. Firew and is not part of the higher education cost-sharing agreement signed between medical students and the Ministry of Science and Higher Education (MoSHE).
In an effort to expand health coverage, especially in rural areas where the shortage of physicians is most severe, after completing medical school, all graduates of public medical schools are required to work in Ethiopia as general practitioners for two to four years. This is without acquiring a license and an original copy of their medical degree, Dr. Firew explained, adding that they can acquire it after completing years of service. Addis Standard’s attempts to speak to the Human Resources department of the Ministry of Health were unsuccessful.
Responding to the demands of the protest was combined with a stumbling block that left newly graduated doctors in limbo. After the strike, all graduates in the medical field were asked to seek employment for themselves. Starting in May 2019, the Ministry of Health raised its central responsibility from top to bottom of assigning doctors randomly and without specific requirements such as language.
The health offices of the municipal and regional administration have now assumed the mandate to recruit doctors. “This has opened the doors to corruption and nepotism in the hiring process.” Dr. Brook said. Their views are shared by Dr. Firew, who recalled his experience searching for a job. “I traveled to all corners of Ethiopia in search of a job. I first applied to a hospital in my hometown, but the job was given to those who could speak the local language even though we graduated from the same university.”
Dr. Firew spoke of the psychological anguish he faced as a result of unemployment. He recounted the difficulties he faced due to the massive disorder and inconsistency of practice in regional and zonal health offices, the lack of cooperation from health office officials, having to travel amid the coronavirus pandemic, and the costs Travel. He found that some hospitals hire more general practitioners than their allowed quota.
Dr. Brook said that the job guarantee was one of the things that made medical school worthwhile. But with the new practice, regional and zonal health offices are complaining about the lack of budget to pay for the hiring of new graduate doctors. Some are working temporary vacant positions at Covid-19 treatment stations. A doctor who graduated from Arba Minch University told Addis Standard that regional health offices are complaining about the lack of budget allocation to pay for overtime and other benefit payments to those who provide services at Covid-19 stations. . She expressed uncertainty and fear of becoming unemployed after the contract ends.
Contrary to the Ministry of Health’s announcement of a renewed commitment to universal health coverage, in December 2018, the health sector was ranked eighth among the largest funded sector, with 12.8 billion birr in second to last place before security and justice related allocations in the annual budget allocation for Ethiopia 2019- FY2020. The neglect of the health sector by policy makers is also noted in the fact that it is not on the list of “key development sectors” in the 10-year development plan.
Another consequence that followed the strike is that the Ministry of Health began the practice of conducting Certificate of Competence (CoC) exams for doctors to obtain their licenses. The new practice aims to “improve the quality of health care delivery and education,” according to Tewodros Abebaw, director of the Directorate for the Evaluation of Competencies and Licenses of Health Professionals of the Ministry of Health. Dr. Brook asks, “What does the internship qualification mean? Why should we take the exam after practicing medicine for one year as an intern?” Upon successful completion of the qualifying exams, students are required to complete one year of internship and are referred to as “interns” (Year 6).
Tewodros, for his part, said that the rationale behind the Certificate of Competence (CoC) exams for physicians is to ensure internationally accepted standard quality medical care. He explained that “the practice is adopted from the experience of developed countries. The exam will focus on real-life scenarios unlike the pre-internship qualification exams, so that it prepares physicians for practice.” He added that it will include a practical exam in the coming years. Whether or not the license is permissible in foreign countries depends on their policies, but the ministry believes it is internationally accepted.
The exam is also expected to correct performance inconsistency and create uniformity in the curriculum among health colleges across the country. The decision to take Certificate of Proficiency (CoC) exams for physicians was made years ago according to Tewodros, but has not been practiced until now. He admitted that no direct studies were conducted to support the decision, but the need arises after what the ministry was able to glean from the studies conducted on patient satisfaction. Finally, Tewodros explained that stakeholders such as MoSHE, policy makers and members of the Ethiopian Medical Students Association (EMSA) were involved in the decision. Addis Standard tried to contact EMSA, but was unsuccessful.
After the coronavirus outbreak, the Ministry of Health has not been able to conduct the Certificate of Competence (CoC) examination for physicians. Because of this, recently graduated doctors who have graduated but have not yet taken the exam were unable to apply for a job. To solve this problem, the Minister of the Ministry of Health, Dr. Lia Taddese, wrote a letter requesting employers to hire new medical graduates until they could obtain a license by examining the Certificate of Competence (CoC) after November 2020. Dr. Brook shared his experience of hospitals refusing to hire based on that letter and that hospitals have now made practice licenses an important hiring requirement. Subsequently, many are forced to remain inactive for months without being able to apply for a job.
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Dr. Firew said they are disappointed by both EMSA and the Ethiopian Medical Association (EPA), who were supposed to be vigilant about medical colleagues speaking on their behalf. He recalled a job creation scheme that was proposed by the Ministry of Health in January, “I feel lucky to have found a job after all the difficulties, but there are many who are still waiting for work,” he said.
In an interview with the Addis Zemen newspaper, EPA President Dr. Tegbar Gizaw said the association is doing everything it can to pressure the government to emphasize the role of the private sector in the healthcare market. He spoke about the need to consider sending deployed doctors to foreign countries as a last resort. This will not only create more jobs, but will also help ease the pressure of declining government contracting capacity. Dr. Tegbar emphasized that the most practical solution in a country with a low number of professionals is to raise the internal budget, generate employment and improve the private health sector.
More medical students are expected to graduate in the coming months and having to wait for the Certificate of Proficiency (CoC) exam with an interval of 3 months will create a larger number of unemployed physicians. The next round of the CoC exam will be held on October 21, 2020.
