HIV pandemic, medical brain drain, and economic development in Sub-Saharan Africa
HIV pandemic, medical brain drain, and economic development in Sub-Saharan Africa
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DOI：
10.1093/wber/lhn005
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发表时间：
2008-01-01
影响因子：
2.5
通讯作者：
Docquier, Frederic
中科院分区：
文献类型：
--
作者：
Bhargava, Alok;Docquier, Frederic
1990-2004年每三年一次的国家级纵向数据用于分析影响撒哈拉以南国家医生移民的因素以及这种医学人才流失对预期寿命和艾滋病死亡人数的影响。数据是针对来自 16 个接收经济合作与发展组织 (OECD) 国家的移民非洲医生而编制的。通过将医疗人才流失变量与艾滋病毒患病率、公共卫生支出、医生工资以及经济和人口变量的最新数据合并起来，开发了一个综合纵向数据库。考虑到这些变量的相互依赖性，使用对医学人才流失率、预期寿命和艾滋病死亡人数的五次观察，在随机效应框架中估计三角方程组。较低的工资和较高的艾滋病毒感染率与撒哈拉以南非洲国家的医生人才流失到经合组织国家密切相关。在艾滋病毒感染率超过 3% 的国家，医疗人才流失率增加一倍，导致成人艾滋病死亡人数增加 20%；医疗人才流失似乎不会影响预期寿命。这些发现强调，需要改善医生的经济条件，以留住撒哈拉以南非洲的医生，特别是在抗逆转录病毒治疗变得更加广泛的情况下。
Country-level longitudinal data at three-year intervals over 1990-2004 are used to analyze the factors affecting emigration of physicians from Sub-Saharan countries and the effects of this medical brain drain on life expectancy and number of deaths due to AIDS. Data are compiled on emigrating African physicians from 16 receiving Organisation for Economic Co-operation and Development (OECD) countries. A comprehensive longitudinal database is developed by merging the medical brain drain variables with recent data on HIV prevalence rates, public health expenditures, physicians' wages, and economic and demographic variables. A triangular system of equations is estimated in a random effects framework using five time observations for medical brain drain rates, life expectancy, and number of deaths due to AIDS, taking into account the interdependence of these variables. Lower wages and higher HIV prevalence rates are strongly associated with the brain drain of physicians from Sub-Saharan African to OECD countries. In countries in which the HIV prevalence rate exceeds 3 percent, a doubling of the medical brain drain rate is associated with a 20 percent increase in adult deaths from AIDS; medical brain drain does not appear to affect life expectancy. These findings underscore the need to improve economic conditions for physicians in order to retain physicians in Sub-Saharan Africa, especially as antiretroviral treatment becomes more widely available.