Zijlstra Ed E, Broadhead Robert L
College of Medicine, PO Box 360, Blantyre, Republic of Malawi.
Hum Resour Health. 2007 Apr 13;5:10. doi: 10.1186/1478-4491-5-10.
Malawi has a critical human resources problem particularly in the health sector. There is a severe shortage of doctors; there are only few medical specialists. The College of Medicine (COM) is the only medical school and was founded in 1991. For senior staff it heavily depends on expatriates. In 2004 the COM started its own postgraduate training programme (Master of Medicine) in the clinical specialties.
We explore to what extent a brain drain took place among the COM graduates by investigating their professional development and geographical distribution. Using current experience with the postgraduate programme, we estimate at what point all senior academic positions in the clinical departments could be filled by Malawians. We demonstrate the need for expatriate staff for its most senior academic positions in the interim period and how this can be phased out. Lastly we reflect on measures that may influence the retention of Malawian doctors.
Since the start of the COM 254 students have graduated with an average of 17 students per year. Most (60%) are working in Malawi. Of those working abroad, 60% are in various postgraduate training programmes. In 2015, adequate numbers of Malawi senior academics should be available to fill most senior positions in the clinical departments, taking into account a 65% increase in staff to cope with increasing numbers of students.
There seems to be no significant brain drain among graduates of the COM. The postgraduate programme is in place to train graduates to become senior academic staff. In the interim, the COM depends heavily upon expatriate input for its most senior academic positions. This will be necessary at least until 2015 when sufficient numbers of well trained and experienced Malawian specialists may be expected to be available. Improved pay structure and career development perspectives will be essential to consolidate the trend that most doctors will remain in the country.
马拉维面临严重的人力资源问题，尤其是在卫生部门。医生严重短缺，医学专家寥寥无几。医学院（COM）是该国唯一的医学院，成立于1991年。高级职员严重依赖外籍人员。2004年，医学院启动了自己的临床专业研究生培训项目（医学硕士）。
通过调查COM毕业生的职业发展和地理分布，我们探讨了人才流失的程度。根据研究生项目的当前经验，我们估计临床科室所有高级学术职位何时能由马拉维人填补。我们证明了在此过渡期间临床科室最高学术职位对外籍人员的需求，以及如何逐步淘汰他们。最后，我们思考了可能影响马拉维医生留任的措施。
自COM成立以来，已有254名学生毕业，平均每年17名。大多数（60%）在马拉维工作。在国外工作的人中，60%参加了各种研究生培训项目。考虑到为应对学生人数增加而增加65%的员工，到2015年，应该有足够数量的马拉维高级学者来填补临床科室的大多数高级职位。
COM的毕业生似乎没有出现严重的人才流失。研究生项目旨在培养毕业生成为高级学术人员。在此过渡期间，COM在最高学术职位上严重依赖外籍人员的投入。至少在2015年之前这将是必要的，届时预计将有足够数量训练有素且经验丰富的马拉维专家。改善薪酬结构和职业发展前景对于巩固大多数医生留在国内的趋势至关重要。
