Be responsible! The international recruitment of health professionals

Since the 1960s, the ‘brain drain’, or the mass migration of health professionals from low income to developed countries, has taken place with little action to monitor or control the flows from many of the countries involved. Improved policies cannot be effectively implemented without better knowledge of migration flows. Policies must be put in place at national and international levels.

Although knowledge of the scale of the‘brain drain’ of health professionals from poor to rich countries is limited,it is evident that this phenomenon has accelerated since the 1970s due to the developmentof trade agreements and the increased mobility of services and people. Thismigration flows have consequences for all the countries concerned.

Rich countries receiving health workerswould appear to benefit in the short term because of the savings they are ableto make in training and education costs of highly specialised staff. However,an over-reliance on foreign workers might stifle the development of a domesticsupply. On the other hand, poor countries are being depleted of human resourcesthat are essential for the long-term survival of their health systems.  With the future scale of these unequalmigratory flows set to increase, it is necessary to find urgent solutions. Researchcarried out by the Liverpool School of Tropical Medicine took account of existingknowledge on the topic and identified a number of policy issues for managingthe problem.

‘Source’ countries also have to accept their ownresponsibilities as employers by improving strategies for attracting andretaining staff. For example, Namibia offers competitive salaries as well assubsidised housing and car ownership schemes to entice health professionals tostay. Where this is not possible, like in Mozambique, health professionalsmight consider staying in their own countries when they are given greatersocial status and professional respect.

At the level of ‘recipient’ countries, much can be done toimprove the situation. Besides managing the development of their own workforcebetter, they could share the development of human resource strategies withsource countries. This would help source countries retain more of their staffand better manage the levels of professional migration.

In sum, the massmigration of health workers from poor countries is having a negative effect onpoorly resourced health systems. However, it argues that for solutions to work,all stakeholders need to work together and ensure they meet their responsibilitiesincluding:

• better knowledge and monitoring of migrationflows
• international dialogue leading to agreements onethical codes of practice on international recruitment
• improved policies forthe attraction and retention of staff in ‘source’ countries.