Elsevier

Health Policy

Volume 70, Issue 1, October 2004, Pages 1-10
Health Policy

“Brain drain” of health professionals: from rhetoric to responsible action

https://doi.org/10.1016/j.healthpol.2004.01.006Get rights and content

Abstract

The question of the “brain drain” of health professionals has re-emerged since last exposed in 1970s. This paper is based on exploratory studies in Ghana, South Africa and the UK, a literature review and subsequent tracking of contemporary events. It reviews what is currently known about professional migration in the health sector and its impact on health services in poorer countries. The relevant responsibilities at the global level and source and recipient country levels are then reviewed. It is concluded that that the situation is more complex than portrayed by some of the rhetoric and that meaningful dialogue and consideration of responsibilities is needed. In addition, better information is needed to monitor migration flows; source countries need to improve staff attraction and retention strategies; and recipient countries need to ensure that they do not become a permanent drain on health professionals from the developing countries.

Introduction

There are an estimated 35 million people working in the health sector worldwide [1]. This essential global resource is not equitably shared between countries, largely due to the extent of international migration of health professionals.

‘Brain drain’, as professional migration is sometimes called, in the health sector is not a new phenomenon. Concerns over the international movement of health workers were expressed at Edinburgh Commonwealth Medical Conference in 1965. In the 1970s the World Health Organisation was prompted to examine the global stocks and flows of doctors and nurses in what is the only study of its kind [2]. This report made little impact and migration of health professionals has gradually increased over the years [3], [4], [5]. As the large scale movement of health professionals from developing countries is now impacting on the health systems of those countries it is imperative to develop a meaningful dialogue among stakeholders in the search for urgently needed solutions.

This paper focuses on the responsibilities of importing or ‘recipient’ countries and exporting or ‘source’ countries as well as responsibilities at a global level. The implications for appropriate policies are addressed. The paper draws on an exploratory study carried out in three countries: Ghana (a net exporter); South Africa (an importer and exporter); and England (a net importer). The aim of the research was to find out what was known about the extent of migration and its impact and the kind of policies being used to influence flows by source and recipient countries. Key informants were selected purposively and interviewed during 1-week trips to Ghana and South Africa in late 2000 and interviews in the UK took place over a longer period in 2001 to early 2002. The informants were drawn from government, academia, senior health service managers, professional councils, students, development organisations and one recruitment agency. The semi-structured questionnaire covered the following areas: the extent of migration; the process and reasons for migration; the impact on source country health systems; and policies and strategies being used to influence migration. The findings from this study have been supplemented by a review of the literature and monitoring of relevant contemporary events.

Section snippets

Contemporary migration

Migration is possible for all health professionals who have marketable skills. Traditionally doctors and nurses have made up the bulk of migrants. More recently there has been increased movement of other health professionals such as pharmacists, physiotherapists and other professional groups involved with health care.

In the 1960s and 1970s past colonial cultural ties (including language) were very important in determining migratory patterns. For example, there was a high proportion of British

Negative impacts

‘Receiving’ countries benefit from international migration. From a national perspective savings are made in training and education costs from this form of ‘free riding’. Employers may also benefit from migrants’ flexibility of working, being more prepared to work in less desirable areas of work (for example, mental health), under less socially acceptable conditions (e.g. night shifts) and less desirable geographic regions (e.g. the rural areas of South Africa or Canada, or the inner cities of

Future prospects

There are many signs that the pull from richer countries will increase over the next 10–20 years [22]; it is estimated that a further one million nurses will be needed over the next 10 years to meet the shortfall in the US [23]. In addition to the general expansion of health care provision based on previous trends, these countries will have to cater for an increasingly ageing population. For example, in the UK it is estimated that the population aged 80 and over group will grow from 2.4 million

Policy issues

Policy makers need to work on the assumption that the international migration of health professionals will continue. There are therefore a number of key policy issues [15], [30] around protecting the interests of the health services in the poorest countries. These policy issues are considerably more pertinent given the risks to the proposed new investments in health care systems in sub-Saharan Africa [31] posed by staff shortages. These policy issues can be organised in terms of levels of

Conclusion

The negative impact on health services in certain poor countries of mass recruitment of health professionals by industrialised countries seems to be beyond dispute. Since the pressure from richer nations on the international health labour market is clearly set to increase the situation is likely to get worse.

The problem is not helped by oversimplifying the debate to one of heartless employers in the North poaching from the helpless South. A recognition of the complexity of stakeholder

Acknowledgements

The research on which this paper is based was funded by the UK’s Department for International Development through Health Sector Reform Knowledge Programme at the Liverpool School of Tropical Medicine. We would like to thank the following for their support in this endeavour: Dr Ken Sagoe, Director of Human Resources and Symon Koku, Ministry of Health, Ghana; Dr Kamy Chetty and Professor Rachel Gumbi, Department of Health, South Africa; Mr David Amos, Department of Health, England and all those

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