Like so many children who grow up wanting to be a doctor, Tariku Hussen (MD) had his heart set on the medical profession from a young age. He had good grades and encouragement from his aunt who had supported him through school. But the decision to become a doctor took a lot of consideration. He knew that he would have to commit the next seven years of his life to school, which generates minimal pay only during the graduating class.

It was a difficult choice to make but one he ended up making with resolve; hoping that once he was finished with his studies, things would fall into place.

In a country where there is only one physician for every 10,000 people, according to a report by the United Nations Development Programme (UNDP), employment for a doctor seemed as good as guaranteed.

However, as graduation loomed closer, Tariku understood that his chances of finding a job were not as secure as he had once imagined.

"I knew this was coming before I graduated," said Tariku, who had served as president of the Ethiopian Medical Association at Gonder University. "We were having dialogues with the Ministry of Health at the time to resolve similar issues for our seniors who were having difficulty [securing jobs]."

He says he was not prepared for how bleak it really was.

"It wasn't that there weren't enough job posts," he said. "It was that there were no posts at all. It was demoralising to realise I wouldn't get a job after all this time."

So he volunteered to work at Eka Kotebe General Hospital for three months. His time there proved valuable as he met senior doctors who helped him get a job.

"It was difficult to find myself without a source of income after all those years," he said, "and to find out I wouldn't be able to get a job because of a language barrier and other issues was heartbreaking."

"As a doctor, you take care of an enemy's wounds," he said. "That is the moral obligation we have, but somehow I couldn't find a job, because I wasn't from a particular place in the country."

Though Tariku may have found work now, his earlier predicament is still the reality for hundreds more across the country. Last year, graduates found themselves at the height of the problem. A letter addressed to the Health Ministry regarding the rising joblessness of doctors amassed over 450 signatures in less than a week's time last August.

The practitioners have been out of work since graduation — for some, unemployment has lasted nearly a year. The problem has affected doctors from all parts of the country, with over half hailing from Amhara Regional State.

The hiring process has been difficult for many as most jobs require an additional language to be able to serve in that state, according to Gedefa Kindu (MD), who had been one of the coordinators seeking a response from the government. Applying for a job in private health institutions also comes with its own challenges, as private institutions demand experience.

For many years prior, graduating medical students were assigned to posts in different parts of the country by the Health Ministry. The centralised delegation was done based on the needs and capacity of the regional states. In 2019, this system changed and doctors were directed to look for job posts from regional health bureaus instead.

"This was why there were more doctors looking for jobs in Amhara Regional State," Gedefa said. "In some cases we encountered, being from the region itself was required."

There were also doctors who had received job offers by Tigray Regional State but had opted to decline. The current political impasse between the Regional State and the federal government had created a sense of unease among the graduates, and they had chosen to return to their hometowns.

But without a unified job post portal, it was difficult to know which posts were available.

"We don't know if any regional states have any open posts if it's not out in public," said Gedefa.

Stories of alleged bribes to secure posts, rigged entrance examinations, and unspecified criteria for job posts that led to an arbitrary selection became rife.

Tariku Belachew, deputy head at the Amhara Regional Health Bureau, cited budgetary constraints as its main limitation.

The region of 22 million inhabitants had tacked on an additional 162 million Br to the 300 million Br that was allocated to salaries of health professionals last year. Even so, it was only able to take in half of the 600-plus doctors that had applied for the posts.

"The demand and the resources available for hiring more doctors aren't balanced," said Tariku. "This is becoming an increasingly difficult problem, which didn't exist a few years ago. "

The deputy director attributes this to the differences between the rate of health institutions being built and the rate of professionals matriculating from schools. The region currently has 81 functional hospitals with seven more under construction.

"As per the population, we need 210 hospitals," he said. "But there is no shortage of doctors within the health facilities available in the region."

The region is conducting an assessment to evaluate the structural needs of the health facilities and the professionals needed within.

Currently, 50,000 health professionals, from health extension workers to specialised doctors, are operating in the Regional State. It has 862 health centres in which the Bureau is pushing for doctors to get hired, but budgetary restraints are also visible here.

"We're trying to get the weredaadministrations to allocate a greater share of their budgets to this," he said.

Discussions on medical employment and budgetary constraints were taking place before the onset of the COVID-19 pandemic. Joint meetings involving the Jobs Creation Commission, the Ministry of Health, 15 members of the Ethiopian Medical Students Association, as well as the Centre for International Reproductive Health Training, had started, but efforts were put on hold once the pandemic appeared in March.

When Prime Minister Abiy Ahmed (PhD) called on retired and in-training medical professionals for national duty two weeks after the onset of the pandemic, it had seemed that the country might find itself in desperate need of health professionals.

By July, nearly 23,000 health professionals had been committed to the cause in isolation and quarantine centres. Overall, the pandemic had created new job opportunities for 4,000 health professionals including recently graduated doctors. They were called into work on a contractual basis, with terms ranging from three to six months, subject to renewal if the need so dictated.

This relief, however, is proving to be short-lived.

COVID-19 quarantine and isolation centres are closing up following government policy changes geared toward isolation and self-care at home. A number of doctors have already been told that their services are no longer needed. With just a few days remaining on their contract, some are awaiting renewal, while others have already started looking for other options.

Kaleab Ashebir (MD) has applied for a teaching post, a general practitioner post at a private hospital, and the annual residency programme for graduates in the hope that one will stick.

"We've been told that they'll redeploy us, but I'm looking at other alternatives in case that doesn't work out," he said.