Out-Migration/Brain Drain

Workers tend to go where the working conditions are best. Income is an important motivation for migration, but not the only one. Other reasons include better working conditions, more job satisfaction, career opportunities and the quality of management and governance. Political instability, war, and the threat of violence in the workplace also are strong drivers in many countries. [author’s description]

Many articles on the loss of health professionals in sub-Saharan Africa highlight migration to higher paying jobs in wealthier countries as a major cause of the shortage of health professionals. In fact, emigration is not the greatest drain on the supply of health professionals in some countries severely affected by AIDS. Death is depleting the ranks of health professionals more rapidly than recruitment abroad. [author’s description]

This paper challenges the decision by the Government of Uganda to export health workers to developed countries. It argues that while the Ugandan National Health Policy emphasises strengthening the numbers of health personnel in order to be able to provide a minimum health care package and to redress the imbalances in distribution of skilled staff, it is totally contradictory to start exporting the few personnel available.

This report presents a review of issues in the regional policy context that are of relevance to the retention of human resources for the health sector (HRH) within the region, based on a rapid appraisal in selected countries and at regional level. This work specifically focussed on the actions needed to stem the flow of international migration by encouraging the retention of health staff within countries. A particular concern raised across countries is staff retention in the public and rural services that preferentially serve the poorest populations. Importantly, policy documents and national

The consequences of health professional mobility have become a prominent public policy concern. This paper considers trends in mobility amongst doctors and nurses and the consequences for health systems. Policy responses are shifting from a reactive agenda that focuses on stemming migration towards a more active agenda of managed migration that benefits source and destination countries. Improved working conditions and effective human resource practice are required to encourage retention of health professionals in both source and destination countries. [abstract]

The Department of Health in South Africa has attempted to address the shortage of rural doctors by introducing various interventions, including an increase in salaries, introduction of scarce skills and rural allowances, the deployment of foreign doctors, and upgrading of clinics and hospitals. Despite these, the maldistribution of doctors working in South Africa has not improved significantly. The main objectives of this study were to identify interventions as proposed by doctors in the rural Limpopo province of South Africa and to develop recommendations based on these. [from introduction]

Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. [author’s description]

This presentation was part of the Health in Foreign Policy Forum 2006. It covers the face of the human resource for health crisis in Zambia, the migration of health professionals, the impact on health service delivery, current initiatives, country-level solutions, challenges to implementing the HRH strategic plan and options to mitigate the HR crisis in developing countries and the global level. [adapted from author]

This presentation was given at the second annual AAMC Physician Workforce Research Conference, “2020 Vision: Focusing on the Future.” It discusses out migration and brain drain from sub-Saharan Africa and gives an overview of the issues related to this problem, particularly in respect to a project done in Uganda.

Note: This resource is no longer available online

The migration of doctors and nurses from Africa to rich countries has raised fears of an African medical brain drain. But empirical research on the issue has been hampered by lack of data. How many doctors and nurses have left Africa? Which countries did they leave? Where have they settled? As part of a larger study of the consequences of the international migration of African health professionals, we compiled a database of the cumulative bilateral net flows of African-born physicians and nurses to the nine most important destination countries. It is the first database of net bilateral migration flows specific to a skilled profession collected systematically for a large number of developing countries.

This paper examines various aspects of the nursing and midwifery workforce in Africa, looking at education and supply systems; recruitment, retention and motivation and career systems. It further investigates attrition from migration and HIV/AIDS, as well as other factors and makes some recommendations on how to move forward using examples of experiences from countries. These experiences, albeit on a small scale, show promise of good results after being scaled up. [author’s description]

Human resources become increasingly relevant in this context. Health human resource (HHR) is currently experiencing a three-fold problem, which encompasses old issues, together with the effects of reform, and the consequences of globalisation. This includes the workforce crisis in nursing which, facing all kinds of difficulties, requires complex in-depth analysis, synergies and alliances in order to ensure quality nursing services.

This report focuses primarily on the policy implications of the international migration of nurses, and highlights recent trends. International recruitment and migration of nurses has been a growing feature of the global health agenda since the late 1990s. Nurses have always taken the opportunity to move across national borders in pursuit of new opportunities and better career prospects, but in the last few years nurse migration appears to have grown significantly, with the potential to undermine attempts to achieve health system improvement in some developing countries.

Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? [author’s description]

Intended to complement Working Together for Health: The World Health Report 2006, these policy briefs are intended to assist those who make and carry out health policy worldwide. The briefs address the following, Strengthening information and research on the health workforce: strategies for action; Investing in education for expanded capacity and lifelong learning; Making the most of the existing health workforce; Addressing the complex challenges of health worker migration; Bridging between health workers in separate public health programs; and Financing health workforce development. After describing an issue, the briefs propose ways to address it, many of which have been drawn from experience in countries. [author’s description]

The study aimed to establish the magnitude of migration of health professionals, its causes and to document the associated impacts on service delivery. [author’s description]

This paper reviews the situation and trend in human resources for health and its priority problems in Thailand. It also highlights the issue of the inequitable distribution of doctors. Through several brainstorming sessions among stakeholders, it summarizes a package of recommendations for the future continuous and sustainable knowledge-based human resources for health development. [from abstract]

This article addresses some human resource problems amongst which migration of human capital to resourceful settings is detailed as a priority problem. Several factors have contributed to dissatisfaction and human resources, especially those with higher skills and qualifications, migrating towards more resourceful settings, both overseas and within the country. [from abstract]

The nurse program for foreign countries in Indonesia has been carried out since 1996. In the beginning, this program attempted to solve the false ‘surplus’ problem of nurses in Indonesia. Recently, however, the MOH has developed serious concerns with this program. There have been several efforts to promote the nurse program for foreign countries starting with the improvement of education, recruitment and other mechanisms related to nurses for foreign countries. Some achievements, strengths, weaknesses, potentials and threats are discussed in this paper.

The loss of skilled personnel to rich countries is a major concern for many developing countries today. However, large numbers of people from developing countries are also being trained overseas and, of those trained at home, many cannot be absorbed productively into their economies of origin. At the same time, the association between the presence or absence of health personnel and the health status of a population is seen as simplistic and a range of other factors are addressed. This Briefing examines the case for a two-tiered health training system, one for global markets and the other for local markets.

The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.

The Royal College of Nursing (RCN) commissioned this report into the experiences of internationally recruited nurses (IRNs) working in the UK. The study explores the motivations and experiences of IRNs in order to understand why overseas nurses come to work in the UK, what experiences they undergo and whether they plan to stay in the UK, return to their countries of origin or go to another country to work after a short period. [from executive summary]

With globalisation trends, the emigration of highly skilled persons from developing countries has significantly increased. The implication of this movement of skilled labour (termed as “the brain drain”) has emerged as an important issue of international debate in recent years. The objective of the paper is to look at different possible policy responses which can minimize its adverse effects, and which can promote the sharing of gains between source and host countries. The paper focuses on three policy approaches: retention, return and circulation of skills. It argues that the best strategy to deal with the problem of loss of skilled labour is one based on the concept of circulation of skills, which yields mutual benefits for both sending and host countries.

This publication provides an overview of some of the key challenges for policy-makers in addressing the linkages between migration, health and human rights.The first section explains why we are addressing the issue of migration and health and what is meant by doing this through a human rights framework. It then explores some of the terminology used. The second section links the reasons why people migrate with the health and human rights implications of moving on the populations left behind. The third section considers the health implications for those on the move both in the context of public health as well as in relation to the health of the individual.

The study found that about half of the deliveries in Malawi are not assisted by a skilled attendant. It seems that there is a severe and long standing problem with retaining midwives. Therefore, close monitoring of the retention problem is advisable. The research found that the two main forms of losses are that the midwives die or they go abroad. Possible ways of mitigating the loss through emigration could be to continue efforts in enforcing codes of practice on international recruitment in recipient countries.

The numbers of health professionals joining the brain drain has reached a peak in recent years in apparent response to huge demands emanating from the developed countries. The brain drain of professionals, combined with the health crisis, threatens the entire development process in Africa. The crisis in health intensifies with the advent of the HIV/AIDS crisis. The loss of health workers simply serves to worsen a dire situation.

The brain-drain may not be stoppable, but it may be manageable. There is a great deal more that developed countries should be doing to support collapsing health systems in poorer countries and improving incentives for health staff to stay. [From author]

A human rights framework provides a formal and explicit way to examine the different social, political and economic problems that both give rise to, and result from, international migration, in particular inequality. It also allows clear and explicit articulation of where the obligation to do something about these human rights impacts lies under international human rights law, together with migration of health workers; and ensures that any improvements in the right to health are achieved without any express limitation of any other rights, including freedom of movement and rights in work.

This paper should be read in association with its companion paper on migration and human rights (Bueno de Mesquita and Gordon 2005). Our aims are conceptual and agenda-setting. In essence, we argue that current policy responses to migration of health professionals from low income developing countries underestimate the pressures and misidentify the reasons for rising migration, overestimate the impact of recruitment policies on migration flows while ignoring unintended side effects, and mis specify the ethical dilemmas involved.

This report is the result of a two-year project. The aim of the project was to examine the crucial issue of nursing shortages and identify priority areas for intervention. Five priority areas of intervention for ICN and nursing were identified: Macroeconomic and health sector funding policies; Workforce policy and planning, including regulation; Positive practice environments and organisational performance; Recruitment and retention, addressing in-country maldistribution, and out-migration; and Nursing leadership.