Out-Migration/Brain Drain

Shortages of skilled health workers occur in most countries in the world, and most significantly in countries where education levels are relatively high. Migration has tended to be at some cost to relatively poor countries where the costs of production are considerable and losses are not compensated. The costs of global mobility are thus unevenly borne by the poorer source countries and the benefits are concentrated in the recipient countries. Since migration cannot be ended, and source countries have only limited scope for substantial policy change that will improve the number and status of health workers in the home countries, the onus has increasingly shifted towards the role of recipient countries in ensuring that, if migration is to continue, then it be more equitable and that there be adequate compensation for losses incurred in source countries.

The appealing, modern websites of the private agencies specializing in the recruitment of health care professionals for Western markets invite the loggers-on to explore a myriad of opportunities. So fierce is the competition to secure scarce health care professionals that private recruitment agencies stage promotional events and aggressive recruitment campaigns in supplying countries, tripping over each other to attract suitable candidates. How did the shortages of health care professionals become so acute, and how did international migration come to be viewed as one of the solutions to the problem?

The number of health workers employed is an indicator of a country’s ability to meet the health care needs of its people, especially the poorest and most vulnerable. Resource-constrained countries committed to the Millennium Development Goals are facing up to the reality that shortages and uneven distribution of health workers threaten their capacity to tackle the HIV/AIDS pandemic, as well as the resurgence of tuberculosis and malaria. Worker shortages are linked to three factors: 1) decreasing student enrollment in health training institutions, 2) delays or freezes in the hiring of qualified professionals and 3) high turnover among those already employed.

In recent months, the debate over foreign workers in the UK has become more heated. While the government argues that more foreign workers will raise growth, protectionists insist that foreign workers are robbing British citizens of jobs. A different question is also asked: how can Africa develop if the brightest and best are leaving? The debate runs a serious risk of trivialising what is a complex set of issues. [from author]

African public health care systems suffer from significant brain drain of its health care professionals and knowledge as health workers migrate to wealthier countries. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain).

The synthesis report addresses the issues of the impact of high skilled emigration on developing countries, and the policy mixes and options available to both receiving and sending countries to harness its benefits. The study argues that the feedback or indirect effects of skilled migration can often outweigh any initial negative impacts on developing countries. The challenge is to maximize these benefits through appropriate policies relating to encouraging return migration, retention of manpower, tapping diaspora networks, and productive utilization of remittances.

This issue of the Bulletin of the World Health Organization addresses the issue of the migration of health professionals. It includes articles about the genteral topic, specific measurements and evaluations of the problem and strategies to address the brain drain.

Migration and remittances are of considerable importance in the small Pacific island states. There has been a significant migration of skilled health workers in recent decades to metropolitan fringe states, including Australia and New Zealand. This paper reports the findings of a re-analysis of a survey of Samoan and Tongan migrants in Australia where the sample is split between nurse households and others.

In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and Development (OECD) countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. [from abstract]

The aim of the code of practice is to promote high standards of practice in the international recruitment and employment of healthcare professionals. [author’s description]

This paper seeks to provide a compelling evidence base to reveal the factors that lead to high turnover and to promote tested responses to retain health workers. The literature researched is presented to support country-level action. [abstract]

This study aims at analysing the impact of international service trade on the health care system, particularly in terms of human resources for health (HRH), using Thailand as a case study. [from abstract]

This study provides an overview of existing information on the migration of health workers, with an emphasis on related social and labour issues. It considers trends in migration, the working conditions of migrants, migration policies and recruitment practices, and the impact of international standards and trade agreements on conditions of migrant health workers. The study also outlines policies and practices associated with more socially acceptable forms of managed migration. It focuses on nurses and doctors, who have been in the forefront of current debate about health worker migration. [author’s description]

Many countries are using the strategy of international recruitment to make up for shortages of health professionals. This is often to the detriment of health systems in the poorest parts of the world. Codes of practice on ethical international recruitment or similar instruments are beginning to be introduced at both national and international levels to protect the health systems of vulnerable countries. This study was designed to review the potential impact of existing instruments. [from executive summary]

Health services in the UK are benefiting from the collapse of health services in some of the poorest countries of the world due to the widespread and increasing migration of health professionals. Children in these countries are unable to obtain the most basic health services and many die as a consequence. Research summarised in this briefing reveals that current UK policy in this area is ineffective in tackling this inequality. Using Ghana as a case study, it sets out a range of practical suggestions for how the UK Government should respond. [From author]

The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.

The author argues that the migration of physicians and other trained health professionals undermines the ability of developing countries to meet agreed Millennium Development Goals and creates untenable health conditions for the poorer sections of their populations.

The Code develops a consensus approach to dealing with the problem of international recruitment of health workers, while remaining sensitive to the needs of recipient countries and the migratory rights of individual health professionals. The Code covers issues of transparency, fairness, mutuality of benefits, compensation/reparation/restitution, selection procedures, and registration. [Description from author]

This paper illustrates that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers.

Whilst the issue of international migration of health workers is sometimes presented as a one-way linear ‘brain drain,’ the dynamics of international mobility, migration and recruitment of health workers are complex.

The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed. [from abstract]

This report examines trends and policy issues relating to international mobility of nurses. The increase in knowledge worker migration, which is partly a result of industrialized countries trying to solve skill shortages by recruiting from developing countries, is a key component of current international migration patterns. [author’s description]

Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries—especially within Africa—the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows. [from abstract]

Billions of dollars have been invested in efforts to prevent the spread of HIV and other diseases in the world’s poorest countries. Yet at the same time, qualified health workers are leaving the same areas to work in the world’s richest countries. This article provides a brief overview of this issue. [author’s description]

The causes of brain drain are complex and interrelated, involving social, political, and economic factors. The necessary responses will therefore be varied and cover an array of areas. Drawing on growing interest and scholarship, Physicians for Human Rights (PHR) proposes this plan of action for addressing brain drain and the unequal distribution of health personnel within countries, recommending actions by high-income countries, African governments, WHO, international financial institutions, private businesses, and others. [author’s description]

This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States.

There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians. With the use of World Health Organization data, this article presents an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration. [from abstract]

Most statistics on the migration of health-care workers are neither complete nor fully comparable, and they are often underused, limited, because they often give only a broad description of the phenomena, and are not as timely as required. This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources, and other challenges that need to be met to obtain good evidence on the migration of health workers. This paper also proposes methods to improve the collection, analysis, sharing, and use of statistics on the migration of health workers.

Ghana’s health sector has lost many health care workers, including those migrating to other countries. Strategies aimed at keeping personnel have had varied results. This article briefly reviews these strategies. [adapted from author]

Building health research expertise in developing countries often requires personnel to receive training beyond national borders. For research funding agencies that sponsor this type of training, a major goal is to ensure that trainees return to their country of origin: attaining this objective requires the use of proactive strategies. This paper describes the strategies employed to discourage brain drain by the principle investigators of five of the longest-funded AIDS International Training and Research Program. [from abstract]