The difficulty of finding a doctor in emerging markets

By Doctorly, 5 April 2026

In sub-Saharan Africa, South Asia, and Latin America, seeing a doctor when you are unwell can mean a journey of several hours, an overnight wait, and no guarantee a physician will be there at all. This article examines why the global doctor shortage falls hardest on emerging markets, from the brain drain that strips trained physicians away to the urban-rural divide within countries, and asks what technology can and cannot do to fill the gap.

Across sub-Saharan Africa, South Asia, and much of Latin America, one of the most routine acts in daily life, seeing a doctor when you are unwell, is anything but routine. For hundreds of millions of people, it involves a journey of several hours, an overnight wait, and at the end of it all, no guarantee that a physician will be there. The global shortage of doctors is not evenly distributed. It is concentrated precisely where populations are largest, poorest, and most vulnerable to disease.

The scale of the problem

An estimated 6.4 million physicians are needed to meet goals for universal health coverage, with 132 countries facing shortages as of 2019 [1]. But averages conceal the real extremes. Sub-Saharan Africa carries 24 percent of the world's disease burden while employing only 3 percent of its health workers. As of 2017, the doctor-to-patient ratio across the region stood at roughly two doctors per 10,000 people, compared to 3.3 physicians per 1,000 people in high-income countries [2]. That is a gap of more than fifteen to one.

India, often cited as a country with a large and growing medical workforce, tells a similar story once you look past the cities. India reports one doctor per 1,456 people on average, well below the WHO's recommended ratio of 1 to 1,000, and rural regions are far more underserved than that national figure suggests [3]. In practice, access to a physician in a rural Indian village and access to a physician in South Delhi exist in entirely different realities.

The brain drain that never stops

Training doctors in low- and middle-income countries is expensive, slow, and increasingly futile when the graduates leave. More than 70 percent of African medical providers have migrated, and they now constitute up to one-fifth of physicians practicing in developed countries [2]. Nigeria illustrates this with particular sharpness. A 15-year cohort study found that nearly half of Nigerian medical graduates had emigrated within 15 years of qualification, leaving the country with approximately 3.8 doctors per 10,000 people, meaning fewer than one doctor for every 2,600 people [4].

The countries doing the recruiting are not apologetic about it. The United Kingdom, United States, Canada, and Australia have long relied on internationally trained physicians to staff their own health systems. Between 2005 and 2015, there was over a 70 percent increase in the number of Africa-trained physicians who entered the US workforce [5]. The cost of that arrangement is invisible to the receiving country but devastating to the one left behind. Source countries spend hundreds of millions of dollars educating doctors who ultimately extend healthcare to wealthier populations on the other side of the world.

Governments have tried to stop the flow. Nigeria's legislature proposed a bill in 2023 that would have withheld a doctor's full license for five years after graduation if they planned to emigrate. The public, including health professionals, broadly opposed it on the grounds that it failed to address the core causes of migration and raised serious human rights concerns [2]. The instinct behind it was understandable. The approach was not. You cannot legislate loyalty when the reasons for leaving, low pay, collapsing infrastructure, no equipment, personal safety, remain entirely intact.

The urban-rural split inside emerging markets

The shortage is not distributed evenly even within a single country. Doctors, like most skilled professionals, gravitate toward cities. In South Africa, patients in rural areas walk long distances to seek medical services because doctors migrate from rural to urban areas, which offer better working conditions and available resources. Public health facilities face the additional problem of physicians leaving the public sector for private practice entirely [6]. For improved pay and working conditions, the physicians who remain in low-income countries often transition to urban private practices, decreasing access to care for poor, rural communities and further amplifying the health disparities within these nations [5]. This creates a layered crisis. Even a country with a functioning capital city medical sector may have provinces and districts that effectively have no physician at all. In rural areas of northern Nigeria affected by insecurity, the ratio can be as low as one doctor per 20,000 people [2].

What this looks like in practice

The numbers translate into something very human. A child with a high fever in a rural district hospital in Malawi, Zimbabwe, or rural Bangladesh may be seen by a nurse or a clinical officer, trained and capable people doing their best, but not by a physician. Malawi has had around 100 doctors and 2,000 nurses to serve a population of 12 million people [7]. In that environment, hospital beds overflow, staff cannot keep pace with the flow of patients, and waiting is not an inconvenience but a life-threatening delay.

Women bear a disproportionate share of this. In low-resource countries, only 57 percent of women give birth with a skilled attendant present, and about 35 percent of pregnant women have no contact with health personnel before delivery [8]. The consequences show up directly in maternal mortality figures that remain many times higher than those in rich countries, not because the medicine is different, but because there is no one there to deliver it.

The structural forces that sustain the shortage

Several forces keep this problem entrenched. Medical training takes the better part of a decade, meaning that any policy reform today does not produce results for ten years. Medical schools in many low-income countries have limited capacity, and expanding them requires investment in faculty, facilities, and clinical training environments that are themselves under strain. The private sector, where it exists, absorbs physicians away from public hospitals. And the salaries on offer from institutions in London or Toronto dwarf what any government in West Africa or South Asia can realistically match.

There are also subtler dynamics. Physicians who want to specialise in cardiology, neurology, or oncology often find the training simply does not exist at home. Pursuing it means leaving, and leaving often means not coming back. Doctors who want to specialise are particularly prone to move, seeing in Europe or North America opportunities to develop their skills and gain international recognition that their home countries cannot provide [9].

Technology as a partial answer

The search for solutions has increasingly turned to telemedicine and AI-assisted diagnostics, and there are genuine success stories worth examining. India's eSanjeevani platform is the most ambitious example. Launched in 2019 and built on a hub-and-spoke model, it connects community health officers at rural wellness centres with doctors at district and regional hospitals for video consultations, allowing patients in underserved areas to access a physician without travelling [10]. As of 2025, the platform has delivered over 276 million consultations across all of India's states and union territories [11], a scale that would have seemed implausible a decade ago. In Rwanda, Babyl (now rebranded as Babylon Health Rwanda) took a similar approach through a smartphone app that connects patients directly to doctors for text and video consultations, targeting a population where the alternative is often a multi-hour journey to the nearest clinic. In South Africa, HelloDoctor operates a comparable direct-to-phone consultation model.

These are not trivial achievements. For a patient with a chronic condition needing a medication review, or a mother worried about a child's persistent cough, a video call with a doctor is vastly better than no consultation at all. The eSanjeevani data show that over 56 percent of patients using the platform are women [12], a meaningful result in a context where mobility constraints and household responsibilities often prevent women from making long trips to health facilities.

The limits, however, are equally instructive. Research on eSanjeevani acknowledges that teleconsultation uptake remains shaped by digital infrastructure, smartphone ownership, and internet connectivity, factors that are still limited in rural and low-income communities [10]. A study in rural Karnataka found that awareness of the platform in one village stood at just 2.2 percent, and none of the participants surveyed had used it in the previous year [13]. Separately, analysts have identified problems with eSanjeevani's design in practice, including inadequate training of health workers leading to ineffective consultations, outdated technological support, and an absence of feedback loops between patients, referring workers, and hub doctors [11]. The consultation itself may happen, but whether the patient can actually obtain the prescribed medicine, reach a specialist if referred, or receive a follow-up assessment remains an open question in much of rural India.

The situation in sub-Saharan Africa is starker. A review of telemedicine services identified a small number of active platforms, including Hudibia in Nigeria and Bima in Ghana, but noted that data on their actual uptake is limited [14]. Most operate at a fraction of the scale needed to make a meaningful dent in a region where the infrastructure for digital health, reliable power, broadband connectivity, device ownership, remains thin outside major cities.

The fundamental constraint is this: telemedicine can extend the reach of a consultation, but it cannot perform an examination, deliver a baby, set a broken bone, or diagnose a condition that requires laboratory tests the patient cannot access. It works best as a complement to a functioning primary care system, channelling patients efficiently toward in-person care when they need it. In settings where that in-person care barely exists, telemedicine risks becoming a way of appearing to address a problem without solving it.

A problem that compounds itself

Doctor shortages do not stay static. They feed on themselves. When a health system is understaffed, the doctors who remain work longer hours under worse conditions, burn out faster, and are more likely to leave. Patients who cannot access care wait too long, arrive at hospitals sicker, are harder to treat, and die more often. The system's reputation declines, trust erodes, and people who can afford it seek care privately or abroad, withdrawing resources from the public system further.

Brain drain worsens patient-to-doctor ratios, lengthens wait times, reduces treatment outcomes, and increases mortality, undermining the performance of tertiary healthcare institutions while deepening social and economic inequities [4].

This is the essential paradox facing emerging market health systems: the places most in need of physicians are the least able to retain them, and the consequences of that failure make the environment even less hospitable for those who remain.

What needs to change

There is no single fix. Raising physician salaries in public sector roles closes part of the gap but requires fiscal capacity many governments do not have. Expanding medical school places matters, but only if the graduates have somewhere viable to work afterward. Mandatory rural service programs, used with varying success in Thailand, Brazil, and South Africa, distribute the existing workforce more equitably but create resentment and poor morale if the conditions in rural posts remain intolerable.

The international dimension is equally unresolved. Rich countries that recruit from low-income health systems effectively impose a hidden tax on those systems. The WHO's voluntary code of practice on international recruitment, adopted in 2010, encourages destination countries to avoid actively recruiting from countries facing critical shortages, but it is non-binding and widely ignored in practice.

In the meantime, millions of people in emerging markets continue to navigate a system in which the question is not which doctor to see, but whether there will be one to see at all.

References

[1] Across globe, 6.4 million physicians needed in 132 countries facing shortages. Medical Economics, 2024. https://www.medicaleconomics.com/view/across-globe-6-4-million-physicians-needed-in-132-countries-facing-shortage

[2] Navigating brain drain: understanding public discourse on legislation to retain medical professionals in Nigeria. Globalization and Health, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11566287/

[3] Bridging the gap: Addressing the doctor shortage in Asia. Wolters Kluwer, 2025. https://www.wolterskluwer.com/en/expert-insights/the-doctor-shortage-across-asia-pacific-a-growing-crisis

[4] Nigeria's Medical Exodus: Urgent Reforms to Retain Doctors. PMC, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12596899/

[5] Down the brain drain: a rapid review exploring physician emigration from West Africa. PMC, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10294534/

[6] Brain drain in South Africa is affecting health care. South African Family Practice, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10839150/

[7] Brain-drain and health care delivery in developing countries. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5345397/

[8] Healthcare workers and the brain drain. International Journal of Gynecology and Obstetrics, 2009. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1016/j.ijgo.2009.03.035

[9] Brain drain in Africa's health-care sector. Development and Cooperation, 2023. https://www.dandc.eu/en/article/medical-professionals-are-emigrating-africa-because-catastrophic-conditions-health-care

[10] Adoption and utilization of India's eSanjeevani national telemedicine service. Oxford Open Digital Health, 2025. https://academic.oup.com/oodh/article/doi/10.1093/oodh/oqaf025/8276784

[11] Reimagining India's National Telemedicine Service to improve access to care. PMC, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11422547/

[12] eSanjeevani, health ministry's telemedicine service, completes 10 million consultations. Gaon Connection. https://en.gaonconnection.com/esanjeevani-health-telemedicine-rural-women-covid19-pandemic-doctors-ayushman-bharat/

[13] Telemedicine Awareness and the Preferred Digital Healthcare Tools: A Community-based Cross-sectional Study from Rural Karnataka, India. PMC, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10795884/

[14] Lessons Learned From Over 20 Years of Telemedicine Services in India: Scoping Review of Telemedicine Services Initiated From 2000 to 2023. Journal of Medical Internet Research, 2025. https://www.jmir.org/2025/1/e63984