sBMJ | Poor countries need to tackle the brain drain

Poor countries need to tackle the brain drain

By Roger Dobson, Abergavenny

With the United Kingdom needing 10 000 more doctors, and with more than 7000 nurses from the Philippines alone currently registered in the United Kingdom, compared with just 52 in 1999, a new report says that the countries providing the workers, as well as those that hire them, need to look for solutions.

"Source countries must work on improving staff attraction and retention. Recipient countries should also try to get their own houses in order so they are not a permanent drain on health professionals from the South," says a study in Health Policy (2004;70:1-10).

In research funded by the UK's Department for International Development, the authors looked at Ghana, a net exporter of health workers; South Africa, an importer and exporter; and England, a net importer.

The authors, Peter Bundred from the department of primary care, Liverpool University, Tim Martineau from the Liverpool School of Tropical Medicine, and Karola Decker from the University of Hamburg, say that the effects on source countries of losing health workers can be serious.

"The Centre for Spinal Injuries in Boxburg, near Johannesburg, South Africa was the referral centre for the whole region. On the same day in 2000 the two anaesthetists were recruited by a Canadian institution opening a new Spinal Injuries Unit. A consequence of the loss of these two key staff was the temporary closure of the centre," says the report.

The authors report that India has lost up to $5bn (£2.7bn; a4.1bn) in investment in training of doctors since 1951 and that Ghana has lost around $60m.

The authors say a "carousel" movement of doctors exists. The Canadian provinces of Alberta and Saskatchewan, for example, have been recruiting actively in South Africa for GPs to work in remote rural areas. At the same time South Africa has been recruiting internationally to fill rural posts.

The report says that many African doctors also migrate within the continent, mostly to southern African states where salaries are often higher: for instance, $1242 a month in South Africa, compared with $50 in Sierra Leone.

It suggests that some of the demand in developed countries is due to the pyramidal structure of the workforce: a large number of junior and intermediate level doctors supporting a small number of consultants. "The structure works if foreign medical graduates contribute to the mid- and lower level posts in hospitals. In the UK foreign medical graduates trained outside the European Economic Area make up 65% of the staff grades compared with 17% of consultants," the report says.

It says that, to allow proper monitoring, accurate data on the numbers of migrating health professionals are needed.

"The negative impact on health services... 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."

studentBMJ 2004;12:309-348 SeptemberISSN 0966-6494

Responses published this month

Articles	Responses
NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)	Laxmi Vilas Ghimire (August 31, 2004) Read this response

NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)	Bernard Maybury (September 13, 2004) Read this response

NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)	Prof (Dr) Jogenananda PramanikMD (September 24, 2004) Read this response

NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)	Karen Milford (September 27, 2004) Read this response

	NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)
	Laxmi Vilas Ghimire (August 31 2004) medical student, TUTH,Kathmandu vilas_laxmi@iom.edu.np
	editor-thanks to the sBMJ for highlighting the problem that the poor countries are facing.every one related with this field and the government officials know that the problem of brain drain is increasing at unprecedented rate these days.the health minister of nepal on 26th NMSS(Nepal medidical Student society)day this year confessed that the government has not been able to control the brain drain as it has not been able to provide enough facilities and resources the profesionals want. being a medical student i am very aware of this problem and i have identified following causes as important cuases for the brain drain: the foreign land,esp Europe and USA have been the 'green pastures' for the medical doctors as payment in homeland is negligible in comparision to the payment in those countries. there are not very good institutions to continue post graduate studies in the poor countries.moreover there are not varities of specialising subjects for one to pursue in his interest . people of the poor contries still have the perception'white men wise'so any degree taken from the developed land would be counted high and better in comparision to the one taken in their homeland and the international recognition and belief they can impart if they take higher education from the developed world.

	NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)
	Bernard Maybury (September 13, 2004) Year 13, Winchester College b_maybury@wincoll.ac.uk
	If the UK really is in need of 10000 more doctors, surely adjusting the quotas for admissions of students to medical schools would be a more responsible solution than recruiting doctors from developing countries.

	NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)
	Prof (Dr) Jogenananda PramanikMD (September 24, 2004) Dept of Biochemistry & Genetics, International American University,College of Medicine,Vieux Fort,St.Lucia pramanik_dr2000@yahoo.co.uk
	Brain drain is an age old global problem.In recent years,this issue has been politicised extensively. In the name of brain drain, most of the developing countries are introducing various restrictions on health professionals and shamelessly detaining them from achieving desired goals in their life.Genuine aspiring candidates are facing unlimited restrictions, while many others with lower educational backgrounds are enjoying easy access to western world with the help of their relatives staying there to sponsor. Since there is high demand of health professionals in western countries,several private limited corporations have come forward to establish private medical colleges in developing countries like India,Nepal,St.Lucia.These medical schools are offering free seats to the respective state Government Education Ministry to sponsor eligible candidates.At present about eight medical colleges are funtioning in Nepal while many more are likely to crop up in near future.There should be many more export quality medical colleges in all the developing countries and respective Governments should encourage such efforts from the NGOs in general. It is not true that brain drain is limited to health sectors only.It is much more visible among the computer and information technology area.Since health sector is a sensitive area-people take it as a unpardonable offense to allow doctors to find jobs abroad. Due to such unwise restrictions and discriminations towards health sector man power,in recent years,young generation is getting more attracted to computer and information technology area and getting jobs in western countries with fabulous pay packages at ease. In nutshell,this international problem of brain drain should be solve at the global level and health professionals of the poor countries should not not suffer due to isolated and sporadic political deicisions.They should get enough opportunities to exhibit their capabilities. References Brain drain to be halted? Don't mash the brains! Prof(Dr)Jogenananda Pramanik.MD, Visiting Professor & Academic Co-ordinator,Foreign medical students' programme.Xinxiang Medical College,Xinxiang City,Henan Province,P.R.China-453003.and Tanu Pramanik,Medical Sociologist,Kolkata,India. http://bmj.bmjjournals.com/cgi/eletters/327/7420/930-b#39043 News: Offshore medical schools:India daily:30th July 2004.

	NEWS Poor countries need to tackle the brain drain Roger Dobson (September 2004)
	Karen Milford (September 27, 2004) MBChB IV, Pretoria, South Africa karenm1202@yahoo.co.uk
	I am a fourth year student at the University of Pretoria in South Africa. I was very interested to read your article on the so-called brain drain in from poorer countries: here in South Africa we sometimes refer to the recruitment of South African health professionals by countries such as the UK and Canda as poaching. What needs to be borne in mind when looking at the South African situation is the increasing pressure placed on new doctors to serve the country, while often putting themselves at a huge disadvantage. The year before I entered medical school a new law saw passed, requiring newly qualified doctors to spend a year doing community service, often in highly remote, dangerous, understaffed and underequipped areas of the country. This to me was acceptable, as upon entering medical school it was truly my intention to serve the community anyway. I was less impressed when halfway through my studies a new law was passed that said I now needed to do an extra year as a house doctor before entering my community serviceyear, increasing the total time before I could really make any independant decisions about my career to nine years. On top of this, new dispensing laws have made it virtually impossible for practitioners to make a profit from dispensing, and it also seems now that soon the government will be able to dictate to us where we may or may not practice, regardless of our needs and wishes. Add to this the terrible conditions and relatively pitiful pay available to doctors throughout most of the country - would you also rather not move to the UK, where you can earn a decent living, while at the same time providing the best possible care to your patients? I don't want to leave South Africa, but if legislation and conditions make it too difficult for me to have a good quality of life here, I will.