Brain drain is defined as the migration of health personnel in search of the better standard of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. This migration of health professionals for better opportunities, both within countries and across international borders, is of growing concern worldwide because of its impact on health systems in developing countries. Why do talented people leave their countries and go abroad? What are the consequences of such migrations especially on the educational sector? What policies can be adopted to stem such movements from developing countries to developed countries?
This article seeks to raise questions, identify key issues and provide solutions which would enable immigrant health professionals to share their knowledge, skills and innovative capacities and thereby enhancing the economic development of their countries.
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INTRODUCTION
Brain drain is the migration of skilled human resources for trade, education, etc.1 Trained health professionals are needed in every part of the world. However, better standards of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in the developed countries attract talent from less developed areas. The majority of migration is from developing to developed countries. This is of growing concern worldwide because of its impact on the health systems in developing countries. These countries have invested in the education and training of young health professionals. This translates into a loss of considerable resources when these people migrate, with the direct benefit accruing to the recipient states who have not forked out the cost of educating them. The intellectuals of any country are some of the most expensive resources because of their training in terms of material cost and time, and most importantly, because of lost opportunity.
In 2000 almost 175 million people, or 2.9% of the world’s population, were living outside their country of birth for more than a year. Of these, about 65 million were economically active.2 This form of migration has in the past involved many health professionals3: nurses and physicians have sought employment abroad for many reasons including high unemployment in their home country.
International migration first emerged as a major public health concern in the 1940s when many European professionals emigrated to the UK and USA.4 In the 1970s, the World Health Organization (WHO) published a detailed 40-country study on the magnitude and flow of the health professionals.5 According to this report, close to 90% of all migrating physicians, were moving to just five countries: Australia, Canada, Germany, UK and USA.5
In 1972, about 6% of the world’s physicians (140 000) were located outside their countries of origin. Over three-quarters were found in only three countries: in order of magnitude, the USA, UK and Canada.6 The main donor countries reflected colonial and linguistic ties, with a dominance of Asian countries: India, Pakistan and Sri Lanka. By linking the number of physicians per 10 000 population to gross domestic product (GDP) per capita, the countries that produced more physicians than they had the capacity to absorb were identified7 as Egypt, India, Pakistan, Philippines and South Korea. However, the lack of reliable data and the difficulties of defining whether a migrant is ‘permanent’ or ‘temporary’ still exist.
One may claim that this migration from developing countries is both useful and unavoidable. There are definite advantages—enabling the migrant to spend time in other countries—but at the same time, the very low emigration rate of professionals from USA or UK may be as disturbing a sign as the high rates of immigration to these countries.
Young, well-educated, healthy individuals are most likely to migrate, especially in pursuit of higher education and economic improvement.8,9 The distinction between ‘push’ and ‘pull’ factors has been recognized.10 Continuing disparities in working conditions between richer and poorer countries offer a greater ‘pull’ towards the more developed countries. The role of governments and recruitment agencies in systematically encouraging the migration of health professionals increases the pull.10 Migrant health professionals are faced with a combination of economic, social and psychological factors, and family choices11, and reflect the ‘push–pull’ nature of the choices underpinning these ‘journeys of hope’. De-motivating working conditions, coupled with low salaries, are set against the likelihood of prosperity for themselves and their families, work in well-equipped hospitals, and the opportunity for professional development.12
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