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One country’s experience. Ethiopia, an ancient culture in the Horn of Africa (East Africa) is a country with 80 million people, the majority of whom live on less than $2 USD per day. As of 2006, the prevalence of HIV/AIDs was estimated at about 6 % of the population, a prevalence rate that is less than one fourth of prevalence rates found in many sub-Saharan African countries. And yet, life expectancy remains under 50 years of age for both men and women. When one looks below the surface to find root causes, one discovers that Ethiopians die young, primarily from preventable or easily curable health conditions that simply no longer exist in the developed world.

As of 2008, there were 2000 qualified physicians residing in the country to treat 80 million people, or a ratio of 40,000 individuals for each physician. There are seven board-certified psychiatrists, three oncologists, two infectious disease specialists, and one gastroenterologist. Even though the Ethiopian government has opened several new medical schools to produce more doctors, and are training as many nurses as possible, most newly-trained physicians continue to leave Ethiopia to practice in other countries. Furthermore, of the 2000 physicians in country, almost 1000 (half) are now working for NGOs, with many of them at desk jobs that have removed them from patient care. The situation in Ethiopia is not unique; one can see this pattern replicated throughout the developing world.

Reasons to leave home and/or patient care. Why do trained physicians simply leave their countries or go to work for local NGOS? Recent surveys of physicians from several developing countries have identified three reasons. The first and most common is the desire to receive more advanced clinical training that is simply not available in country. Unfortunately, once gone, many are reluctant to return. The second reason given is the inability to earn a living wage, one large enough to support a family. This is especially true if a physician or other trained healthcare worker is placed in the public sector, even when the government provides extra pay to work in remote areas. At the local level, income differentials between what foreign NGOs are able to pay and what physicians and nurses are paid by public sector hospitals and clinics is often the reason clinicians leave patient care. The last reason cited by the physicians is the current state of many of their own countries’ healthcare facilities. Due to scarce resources for essential supplies and equipment, these facilities are often unable to meet even the most basic standards for clinical operations. In Ethiopia, the government is working vigorously to address these monumental challenges. Meanwhile, physicians continue to leave the country or the bedside. 

“Never doubt that a small group of committed people can change the world. In fact, it is the only thing that ever has.”
Margaret Mead

The Callaway Group contribution. In developing countries, the Callaway Group focuses its effort in three areas we believe address some of the root problems we have identified. The first is our collaboration with well-respected, accredited educational institutions of higher learning to create practical leadership and management development programs delivered in the local setting. Our students are working healthcare professionals and others in management positions in Ministries of Health or healthcare providers working directly with patients. Given the shortage of qualified professionals in all fields in most developing countries, overworked clinicians must not only provide healthcare but also, simultaneously, manage the organizations where they work.  Our academic collaborating partners are always indigenous to the countries where we work; others are internationally oriented graduate schools with relevant expertise.

Our second area of focus is helping to design healthcare delivery systems that can overcome, to some degree, the serious shortage of skilled healthcare professionals. Using contemporary technological innovations and continuum of care models that recognize the reality of resource-constrained environments, we help clarify what is the most appropriate level of healthcare needed in different healthcare facilities. We then work to find creative ways to connect relevant clinical expertise to healthcare providers on the ground, irrespective of where that expertise resides.

Our third area of focus is our collaboration with healthcare professionals throughout the globe who are also dedicated to increasing knowledge transfer to developing countries. We use information technology and international educational conferences to make connections across continents. One recent initiative is illustrative of our approach. The Callaway Group was one of four organizing sponsors that planned and produced our first continuing medical education conference (CME). It took place in Ethiopia in April 2008, to an overflow crowd of healthcare professionals hungry to improve their clinical understanding. (click here to see the CME program) The entire conference, Ethiopia’s First International Continuing Medical Education Conference: 21st Century Healthcare in Resource Constrained Settings, was videotaped professionally and is being professionally edited. We will soon have a website where anyone can download the outstanding presentations of our clinical experts from diverse medical fields and countries. We are finalizing a mechanism to make these DVDs available to a broader audience. Our local collaborating partner was the Ethiopian Medical Association. This is our commitment to sustainability.

In our next issue of CG INSIGHTS, we will expand on what we’re learning about Effective Knowledge Transfer in Resource Constrained Settings. We will also share our insight about the characteristics of Healthcare Delivery Systems That Work.

Until the next time, thank you for taking time to think about our perspective on this very important topic. We hope we have given you thoughts to ponder. Let us know what you think.  

M M Callaway
Chicago, IL, USA
May 12, 2008

Future topics will include: The Characteristics of Successful Strategic Partnerships, The Global Challenge of 21st Century Leadership, How Effective Leaders Find their Voice, The Seven Aspirations of Effective Leadership.

To receive announcements about our future INSIGHTS, go to Contact and sign up for our ‘Periodic CG INSIGHTS Announcement.’

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US News and World Report Cover Story: "Medical Tourism" (www.usnews.com)

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