Wealthy countries’ gains maintain the brain drain in the health sector

A steady flow of health personnel, including nurses, doctors, physiotherapists, pharmacists and researchers, migrates from developing countries to North America, Japan and Europe. Researchers from Belgium’s Institute for Tropical Medicine examine the underlying causes of this ‘brain drain’ and discuss strategies to reduce its negative impact.

International migration flows from the most deprived regions within developing countries to middle income nations and from there to high income countries. As a result, many health systems in Africa are suffering enormously. Positive and negative effects include:

• a sharp decrease of the availability and quality of health services, particularly in rural areas and the public sector
• lost investment in the education and training of health professionals
• fiscal losses from emigration of higher-level taxpayers
• foreign exchange sent to home countries, partially offsetting losses
• creation of long-term professional networks and improved training.

Both ‘push’ and ‘pull’ factors contribute to this migration pattern. Push factors that discourage health workers in low income countries directly include inadequate working conditions, lack of continuing education and professional development. Indirect factors are political instability, civil strife, insecurity, poor housing, inadequate social services and educational facilities for children.

In the higher income countries, the increasing demand for health care is fuelled by demographic trends, advances in medical practice and technology, and increasing public expectations. This demand is, however, not matched by increases in the domestic health workforce inflow and retention. Recruitment of professionals from developing countries constitutes a major pull factor.

The researchers discuss the merits of various strategies to stem the brain drain. In poorer ‘exporting’ countries, these could include:

• general development goals, such as economic growth, political stability, democracy, good governance and respect for human rights
• reasonable salaries and improved benefits for health personnel working in remote areas, adequate working conditions and clear-cut merit-based career structures
• selection of candidates for medical education who are likely to stay in their country and work where they are most needed
• permanent or temporary repatriation of migrants workers through induced or voluntary schemes
• barriers to professional migration, including bonding of trained health workers.

But developed countries should also bear considerable responsibility for correcting health workforce imbalances. They could compensate less-developed countries for the health workers they attract. Administration costs of such a scheme would, however, be high and this does not tackle the root causes of migration.

More importantly, wealthier countries must enhance the attractiveness and retention capacity of the health professions within their own health systems. Strategies include:

• improving the image of health care jobs
• providing better careers information
• improving working conditions
• upgrading financial and other incentives
• developing flexible employment arrangements including career breaks and part-time posts
• offering good retirement packages
• organisational changes to encourage participative decision-making and to create environments that enable professional practice.

Ethically, individual freedom of movement and the personal right to pursue self-fulfilment and better living conditions are called upon by some to justify the brain drain. Their arguments are accompanied by the linguistic shift from ‘brain drain’ to ‘professional mobility’.

In reality and for the foreseeable future, the current strategies result in skimming off the precious human capital of low-income countries. This type of professional mobility remains a brain drain that suits the rich countries but further reduces the chances of socioeconomic development in the South.

Source(s):
‘Health workforce imbalances in times of globalization: brain drain or professional mobility?’, International Journal of Health Planning and Management 18: S89-S101, by B. Marchal and G. Kegels, 2003
HINARI subscribers can access the full-text article here. Full document.

Funded by: Belgian Directorate General for Development Cooperation; Medicus Mundi Internationalis

id21 Research Highlight: 28 April 2004

Further Information:
Bruno Marchal
Department of Public Health
Institute of Tropical Medicine
Nationalestraat 155
B-2000 Antwerp
Belgium

Contact the contributor: bmarchal@itg.be

Institute of Tropical Medicine, Antwerp

Other related links:
'Migration and asylum policies in crisis: time for a rethink?'

'Skilling up in a globalising world: Africa’s training challenge'

'Where has all the education gone? Tracing the employment outcomes of African school-leavers and graduates'

'All in the mind? The emigration of South Africa’s young professionals' >

See id21's collection of links relevant to health systems and economics.