Donor countries may unintentionally become major beneficiaries of their own aid: the case of postgraduate specialist training at the Fiji School of Medicine

Introduction: The small island nations of the Pacific, like most developing countries, suffer from a shortage of specialist doctors. Postgraduate specialist training was established in Fiji in the late 1990s, supported by aid from the Australian goverment (AusAID). Anecdotal evidence suggests that los to migration of graduates from the Fiji postgraduate programs has been substantial. Methods: By January 2005, 120 trainees, 65 from Fiji and 55 from other Pacific Island nations had been trained to a one-year Diploma level or above. Data on these enrolees are analysed by gender, race, highest qualification awarded, and current working location. Results: 64.6% and 65.5% of Fiji and regional enrolees respectively had left training with a Diploma, while the remainder were studying for or had been awarded a specialist Masters (MMed) degree. Of the 58 Fiji and 45 regional graduates no longer in training, 39.7% and 82.2% respectively were employed in the public sectors, and 37.9% and 9.4% respectively were believed to have migrated permanently to a developed country, particularly Australia and New Zealand. By January 2005, more Fiji graduates lived in developed countries (25) than were working in the public sectors in Fiji (23). Discussion: Australian aid has historically made an important contribution to medical education in Fiji and the Pacific. However, this study suggests that in spite of good intentions, donor nations such as Australia can inadvertently become major beneficiaries of their own aid, to the detriment of the countries they are trying to assist. Therefore attention should be given to try to prevent this from occurring. Australia needs to address its own doctor shortages and adhere to ethical recruitment standards. Fiji needs to determine and address the reasons for dissatisfaction of doctors working in the public sectors.