Scholarships and the Healthcare Human Resources Crisis: A case study of Soviet and Russian scholarships for medical students from Ghana | Aids | Ghana

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Scholarships for study in the former Soviet Union were offered to students in many countries in sub-Saharan Africa and across the developing world. Many of these scholarships were used to study medicine, and the health workforces of many sub-Saharan African countries now contain a significant number of Soviet-trained doctors
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  OXFAM CASE STUDY DECEMBER 2014 www.oxfam.org  Korle Bu teaching hospital, Accra, Ghana (2010). Photo: Abbie Trayler-Smith/Panos SCHOLARSHIPS AND THE HEALTHCARE HUMAN RESOURCES CRISIS  A case study of Soviet and Russian scholarships for medical students from Ghana Scholarships for study in the former Soviet Union were offered to students in many countries in sub-Saharan Africa and across the developing world. Many of these scholarships were used to study medicine, and the health workforces of many sub-Saharan African countries now contain a significant number of Soviet-trained doctors  –  though they remain critically understaffed. The Russian programme, previously reduced, is now expanding again. Using Ghana as a case study, this report aims to establish just what impact these programmes have had on healthcare systems and how they can be improved to benefit recipient countries.  2 1 INTRODUCTION Russia is recognized as a ‘re - emerging donor’ with increasing participation in international aid, having ceased to be an aid recipient a decade ago. Total official development assistance (ODA) allocated by Russia to low-income countries increased from $100m in 2004 to $785.02m in 2009, 1  and increasing emphasis is being placed on bilateral schemes; the OECD has reported that in 2013 Russian ODA rose by 26.4 per cent due to an increase in bilateral aid. 2  This has led to increased capacity for Rossotrudnichestvo (Roscooperation), the Russian government’s cultural mission and humanitarian cooperation agency, which administers these programmes. In this context, it was announced in October 2013 that the number of government-funded university places in Russia offered to foreign students  –  a significant component of aid provided first by the Soviet Union and later Russia 3    –  would be increased from 10,000 per year to 15,000. 4   Russia’s moves to develop its aid programme coincide with decreases in bilateral aid to sub- Saharan Africa from ‘traditional donors’ of 4 per cent in 2013 5  and 7.9 per cent in 2012. 6  Educational aid to the region, a vital means of improving human resources capacity, has been decreasing too, with Canada, France, the Netherlands and the USA all reducing their educational aid budgets more than they reduced overall aid. The Netherlands had previously, in 2007, been the biggest donor to basic education. 7  In all, nine of the 15 largest donors reduced their aid to basic education in 2011. 8  By contrast, Russia and the other countries in the BRICS group have made educational aid a priority, through initiatives such as the Russian Education Aid for Development (READ) Trust Fund programme, a partnership with the World Bank which was established in 2008 and is dedicated to improving student achievement. BRICS education ministers are also cooperating with UNESCO to support progress in global education. 9  The expans ion of Russia’ s aid programme and its commitment to educational aid assume great importance in this wider context. Equally, the decision to increase the number of funded university places offered to foreign students by 50 per cent raises important questions regarding the beneficiaries of this initiative. With this context in mind, this report examines the programme of medical training at Russian universities, which is currently offered to students from Ghana and is paid for by the Russian government, and aims to evaluate this programme by determining its effectiveness for the Ghanaian setting. This scheme is part of Russia’s wider scholarship programme for international students, a successor to that of the old Soviet Union, albeit with greatly reduced numbers. Ghanaian doctors trained in the Soviet Union and Russia have had a significant impact on Ghana’s human resources for health, but this cannot be sustained since current scholarship places are too few.   3 The focus on medical scholarships reflects the importance of educational aid in improving human resources for health, a major challenge in developing healthcare in countries such as Ghana, particularly in their efforts to achieve the Millennium Development Goals (MDGs) for health. 10  This report considers current challenges facing healthcare provision in Ghana, the impact of the Soviet scholarship scheme and details of the current programme. The analysis is based on a literature review, expert interviews, a survey and series of interviews with former and current Ghanaian students in Russia and interviews with domestically trained Ghanaian doctors (for more details of the research process, see Annex 1: Methodology).  4 2 AN OVERVIEW OF SOVIET  AND RUSSIAN AID TO SUB-SAHARAN AFRICA 2.1 AID IN THE SOVIET ERA From the 1950s onwards, colonized states in Africa and Asia gradually achieved independence. Many of these states, however, remained economically dependent on their former colonial masters. The Soviet Union extended a significant amount of aid, or ‘economic cooperation’ as it was referred to by Soviet officials, to develop local industrial bases and human resources capacity in such countries, and thereby liberate them from their dependence. Between 1955 and 1991, an estimated $68bn of aid was extended by the USSR to developing countries, of which $40bn was drawn. 11  It is estimated that the Soviet Union offered over $3.5bn in aid to Sub-Saharan Africa between 1955 and 1991. 12  Soviet aid was almost exclusively bilateral, and usually came in the form of loans, trade credits or technical assistance. 13  Loans were rarely monetary as the rouble was inconvertible, so goods and services were generally used as delivery for aid and for repayment. 14  The USSR would deliver equipment or technical assistance, and the recipient country would repay in its own exports within an agreed timescale. Grants were given only occasionally. Skilled Soviet workers, such as teachers, doctors and economists, were often sent to assist in a country’s development. Bilateral treaties or Soviet-sponsored associations often offered students in developing countries the opportunity of fully funded places at Soviet universities. While it is not included in the statistics, a significant part of Soviet foreign aid to developing countries came through the Soviet scholarship scheme. The beginnings of this scheme coincided with Moscow's hosting of the 6th World Festival of Youth and Students in July 1957, when roughly 30,000 foreign youths, many of whom were African, were invited to Moscow. 15  Subsequently, it was estimated in 1984 that 45,075 sub-Saharan Africans had been educated at Soviet universities, and that 17,895 more were studying at the time. 16  Interviews conducted for this report suggest that over 100,000 Africans may have been educated in the Soviet Union overall by 1989, the majority of whom were funded by Soviet scholarships. 17  Students studied throughout the Soviet Union and were nearly fully financed, with tuition, accommodation, transport and most living
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