Out-Migration/Brain Drain

West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration.

Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration. [from abstract]

There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries. [from abstract]

This report presents global data on the distribution of pharmacists, continuing professional development systems, and migration of pharmacists. [author’s description]

As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates in the US, and compared their characteristics to those of US medical graduates and other international medical graduates. [abstract]

This study uses a new database of health worker emigration from Africa to test whether exogenous decreases in emigration raise the number of domestic health professionals, increase the mass availability of basic primary care, or improve a range of public health outcomes.

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It outlines FBO health services in Kenya and sources of and financial support for them. It also discusses the exodus of health workers from church health facilities, the reasons behind this migration and how this problem is being addressed.

TURP was commissioned to investigate the extent of nurse emigration and to suggest why this is happening. This report draws out the findings of the research conducted by TURP, and also uses information from newspaper reports. [introduction]

The effective provision of health services in poor countries is severely hampered by lack of staff. A frequently cited reason for staff shortages is brain drain or moving to greener pastures. Although international migration of health personnel has been occurring since before the 1970s, this has been further facilitated by the recent globalisatioIl of markets and the development offree trade agreements. A summary of an international review was done, to place the South African situation within the international context, and understand the various factors that influence migration. [from executiv

The report provides evidence of inadequate ratios of personnel to population for key skilled health personnel, and a maldistribution of personnel along three different axes, between: public and private heath sectors, urban and rural areas and tertiary and primary levels of the health system. It describes the exodus of healthcare workers from areas of poverty and low socio-economic development, to more highly developed areas. [from executive summary]

The international mobility of health workers is nothing new. In recent years, however, migration of health workers — from highly skilled physicians to those in lesser skilled positions, from the developing world to wealthier destinations — has increased. Moreover, the countries with the most alarming outflows include those sub-Saharan African nations suffering acutely from the HIV/AIDS epidemic and dwindling numbers of health workers. Controversy surrounds the proper role of policy interventions in the global labor market of health care professionals.

As many as 30% of doctors working for the National Health System of the United Kingdom of Great Britain and Northern Ireland have obtained their primary qualifications from a country outside the European Union. Factors driving this migration of doctors to the UK is not fully understood and merit continuing exploration. Our objective was to obtain training and employment profile of UK doctors who obtained their primary medical qualification outside the European Union (non-European doctors) and to assess self-reported reasons for their migration. [from abstract]

The crisis of human resources for health that is affecting low-income countries and especially sub-Saharan Africa has been attributed, at least in part, to increasing rates of migration of qualified health staff to high-income countries. We describe the conditions in four Organisation for Economic Cooperation and Development health labour markets that have led to increasing rates of immigration. [from summary]

The African continent is facing 25% of the world’s morbidity rate with only 3% of its healthcare personnel. This is the result of years of neglect and underinvestment by African governments and the international community, plus harsh IMF restraints on nations’ budgetary expeditures. [author’s descripton]

Many countries around the world are now facing a huge brain drain of highly skilled professionals to well-paid jobs in developed countries. One of the worst affected sectors is healthcare, an area in which developing countries are struggling to keep professionals at home and encourage others to return. [auhor’s description]

This article discusses the issue the brain drain of doctors to more developed countries and Ghana’s efforts to supply an adequate health workforce in the face of this problem.

This commentary examines the significance of international links as a major contributor to growth of the nursing workforce in the UK, and also highlights more recent indicators of a rapid decline in international nurses registering in the UK. [from introduction]

The migration of health professionals trained in Africa to developed nations has compromised health systems in the African region. The financial losses from the investment in training due to the migration from the developing nations are hardly known. Developing countries are losing significant amounts of money through lost investment of health care professionals who emigrate. There is need to quantify the amount of remittances that developing nations get in return from those who migrate. [from abstract]

This report calls for provincial governments to take a closer look at the way they hire doctors, nurses and other health professionals from developing countries. Canada has always relied on newcomers to help deal with shortages in this field, but increasingly these professionals are coming from developing countries, especially from Africa and Asia, which have staffing shortages and critical health problems of their own.

The loss of human resources through migration of professional health staff to developed countries usually results in a loss of capacity of the health systems in developing countries to deliver health care equitably. Migration of health workers also undermines the ability of countries to meet global, regional and national commitments…

The Royal College of Nursing commissioned this report into the employment policy and practice implications of the rapid growth in the number of internationally recruited nurses working in the UK. [from summary]

This document highlights the potential advantages and perils of career moves and migration for nurses, describes some of the main nurse migration trends and establishes a list of critical questions as an ethical framework for nurse recruitment. [adapted from author]

The medical brain drain has been described as rich countries looting doctors and nurses from developing countries undermining their health systems and public health. However this brain-drain might also be seen as a success in the training and export of health professionals and the benefits this provides. This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world, Malawi. [author’s description]

This presentation was part of a USAID Mini-University session in October 2007. It gives an outline of healthcare worker issues and shortages, including worker density by region, and a breakdown of the reasons for the HRH crisis in Africa. The presentation also presents solutions to address the problem.


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This paper focuses on nurses who have migrated and are registered/licensed/authorized to practice, post-adaptation/orientation, and are working as a nurse in a given country. The term international nurse is used for nurses who have been educated abroad and have either been recruited or have chosen to migrate.

The shortage of health workers with the right expertise and experience has reached crisis levels in many developing countries. The ability of health services to deliver care depends on the knowledge, skills and motivation of health workers. Without enough skilled staff in the right place at the right time health systems cannot function effectively and populations are left without the treatment and support they need. [author’s description]

London is more reliant than other parts of England on the international recruitment of health professionals. This raises several questions. How can employers support and develop such a diverse workforce? How can they retain hard-won international health care staff in the face of increasing international competition? And is it ethical to recruit workers from developing countries experiencing their own shortages? This research summary profiles the capital’s international health care workforce for the first time, with case studies detailing the experiences of three London NHS trusts.

The main objectives of this paper are to report on the country and demographic profile, motivations, experiences and career plans of recently recruited international nurses working in London, and to give a detailed insight into why they have come to the UK, and what are their future intentions. In order to put these findings in context, the paper also outlines the overall trends in numbers of nurses coming to the UK, and examines the policy context in which international recruitment activity has been conducted. [from introduction]

There is growing interest in the migration of doctors from Africa to developed nations. Little attention has been made in understanding the flow of doctors into African countries. The objective of this article is to describe the nationality, country of primary qualification as a doctor and specialties of doctors registered in Malawi in 2003. [from abstract]

This paper discusses human capital outflow from Africa from a developmental perspective. The focus is on the high skill content of African emigration to industrial countries, its impact on development in the region, and the challenges faced by institutions of higher learning to help the region deal with this problem. This paper further takes up the issue of African brain drain in the context of relevant changes taking place globally: globalization, movement towards a knowledge-based economy, and global demographic trends. [adapted from author]