Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 The eedN for Public Policy Initiatives to Retain Medical Doctors in Ethiopia Berhanu Bankashe Balaker Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Policy Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Berhanu Bankashe Balaker has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Paul Rutledge, Committee Chairperson, Public Policy and Administration Faculty Dr. Raj Singh, Committee Member, Public Policy and Administration Faculty Dr. Steven Matarelli, University Reviewer, Public Policy and Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract The Need for Public Policy Initiatives to Retain Medical Doctors in Ethiopia by BerhanuBalaker MPA, American University in Cairo, 1989 B Ed, Addis Ababa University, 1982 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University January 2018 Abstract Ethiopia suffers from a medical shortage or brain drain that has severely affected its already fragile health care system. The country has a very low physician-to-population ratio,whilemany in the medical community continue to leave in great numbers. Aphenomenological approach was used in this study to explore the lived experiences of medical doctors who have left Ethiopia, with contemporary migration theory serving as the conceptual framework. The central research question focused onwhy Ethiopian medical doctors leave their country and what can be done to retain them. Participants were 10 medical doctors of Ethiopian origin who live and practice medicine in the Washington, DC metropolitan area. Participantswere purposively selected, and in-depth interviews and a focus group discussion were used to collect data from them. The study followed Moustakas’ recommendations for phenomenological analysis, which representeda modification of the Stevick-Colaizzi-Keen method. The themes that emerged during data analysis have economic, political, professional, and personal dimensions. The findings includelow pay, lack of professional development, poor working conditions, the threat of political persecution, fear of contracting HIV, and inability to participate in health care decision-making. Recommendations accordingly include offering pay raises and fringe benefits, creating opportunities for professional development, improving working conditions, and limiting political interference in the health care system. Implications for positive social change include the fact that stemming the outflow of medical doctors could help save the lives of thousands of Ethiopians threatenedby preventable and curable diseases. The Need for Public Policy Initiatives to Retain Medical Doctors in Ethiopia by BerhanuBalaker MPA, American University in Cairo, 1989 B Ed, Addis Ababa University, 1982 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University January2018 Dedication I would like to dedicate my dissertation to my parents, who lived by high moral standardsand became role models forthe people in their community. They understood the value of education early on and sent their children to school even though they were not themselves educated. In anunderdeveloped countryside without electric lighting, running water, transportation services, ormedical facilities,wherehunger was pervasive, my parents cared for the sick, consoled the grieving, welcomed guests, and shared their meager resources. They were indeed the epitome of goodness. May God rest their souls in peace. Acknowledgments Embarking on a PhD journey is a tough choice. There were times I asked myself,why am I doing a PhD? However, with God’s grace and kindness, I have almost arrived at the finish line. I would like to take this opportunity to extend mysincerest thanks and appreciation to allof those who contributed in different ways to bring this work to an end. First and foremost, I would like to express my utmost gratitude to my dissertation chair, Dr. Paul Rutledge, whose intellectual heftand able leadership inspired me, especially when I doubted my ability to complete the dissertation. His thorough revision and fruitful comments were invaluable. This work would not have come to fruition without his generous support and apt guidance. It is indeed a great privilege to have worked under his supervision,and I am so grateful for his immeasurable contributions. My most sincere thanks go to Dr. Raj Singh, a member of my dissertation committee who provided me with valuable input from the inception of the dissertation. His constructive comments have qualitatively improved this dissertation, and his guidance and encouragement have helped me bring this work to a conclusion. It would have been impossible to reach this stage without his generous support and guidance. I would also like to extend my deep appreciation and gratitude to Dr. Steven A. Matarelli for his fruitful comments and guidance. His thought-provoking suggestions have significantly shaped my dissertation. I am truly fortunate to have him as my dissertation reviewer. Finally, I would like to extend my sincere thanks to my family, my son Kaleb Berhanu, my daughter SefanitBerhanu,and mywife Ashley Kedir, for their incredible support throughout the duration of my study. Table of Contents List of Tables ..................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Background ....................................................................................................................1 Problem Statement .........................................................................................................2 Purpose ...........................................................................................................................3 Research Question .........................................................................................................3 Nature of the Study ........................................................................................................4 Theoretical Framework ..................................................................................................4 Contemporary Migration Theory ....................................................................................... 4 Operational Definitions ..................................................................................................6 Significance of the Study ...............................................................................................6 Assumptions ...................................................................................................................7 Limitations .....................................................................................................................7 Scope and Delimitations ................................................................................................8 Summary ........................................................................................................................8 Chapter 2: Literature Review .............................................................................................10 Introduction ..................................................................................................................10 Literature Search Strategy ...........................................................................................12 Migration Theories .......................................................................................................13 Neoclassical Theories of Migration ............................................................................ 13 i The Household Theory of Migration .................................................................... 14 The Push-Pull Theory of Migration ...................................................................... 15 Migration Network Theory ................................................................................... 15 Globalization Theory of Migration ....................................................................... 16 Historical-Structural Theory of Migration ............................................................ 16 Medical Brain Drain in the Third World .....................................................................17 Push Factors .......................................................................................................... 19 Pull Factors ........................................................................................................... 22 The Impact of the Brain Drain on Developing Countries ............................................23