Introduction

As a country develops, it invests in its own systems to ensure that in the future, they are equipped as needed to run on their own. However, the reality is that the products of these investments benefit wealthy nations. In essence, brain drain is an issue that is costing source countries a considerable number of their capable population. The effects of the same are detrimental to these source countries, and they are facing the difficulties of sustaining large populations of people with few healthcare providers. By examining the definition of the term "brain drain" and its impact, it is evident that brain drain negatively affects source countries, from their economy to education and other social institutions.

The Definition of Brain-Drain

Brain drain is defined as the migration of educated health professionals in search of more sustainable living (Richards, 2003). Sustainable living can be from the point of view of better working conditions, seeking political stability, and even access to advanced technology. Regardless of the motivating factors, brain drain results in many healthcare professionals migrating to developed countries. This phenomenon has been ongoing for decades. As early as the 1940s, there were records of masses of professionals moving to developed countries. The wave was predominantly among European and Asian countries whose professionals were mostly moving to the United States and Australia  (Najib et al., 2019). Reports show that these two were the destinations for doctors, nurses, engineers, and other professionals. To tackle the problem, organizations and governmental leaders have attempted to develop policies and offer solutions so developing countries can retain their health professionals. However, as more and more people choose to work abroad, it is clear that the available solutions are insignificant to tackle the problem.

Developing and developed countries vary greatly. There are certain aspects that a country has to acquire in order to be categorized as developed (Likupe, 2013). Countries such as the USA and Canada and many European countries are classified as developed countries status due to their livelihood and institute systems. Developed countries have high-class technology and well-established healthcare organization and are also motivated by stable political scenes and support from their government regarding the economy and general running of things.

On the contrary, developing countries are plagued with issues such as political instability and a lack of economic opportunities, such as unemployment due to saturated labor markets (Likupe, 2013). Ultimately, doctors and nurses seek better employment opportunities elsewhere. Over the years, the brain drain of healthcare professionals has become a more prominent issue (Hashish & Ashour, 2020). These continuous phenomena only prove that the imposed solutions are failing. Even with the various policies put in place to reduce brain drain, more and more healthcare professionals from developing nations are migrating to the UK, Europe, and other developed countries (Jenkins, 2016).

Brain-Drain as a Phenomenon in Developing Countries

As briefly touched, it is clear that developing countries are the source of numerous health professionals for developed countries. In 2001, a Manila-based newspaper report showed that 13,536 nurses from the Philippines migrated to developed countries, even though only 4780 nurses graduated that year (Richards, 2003). This showed that the number of nurses from previously graduated classes who chose to look for greener pastures elsewhere was vast in numbers. These high levels of brain drain have been a phenomenon for decades, such that professionals and, most notably, health care professionals from Africa, the Middle East, and more developing parts of the world seek employment outside their home countries.

In most of these developing countries, some policies promote the migration of health professionals. For instance, the Cuban government has a foreign policy involving healthcare professionals. They are awarded the right to migrate to whichever country they desire. As a result, in 2004, 18,425 Cuban nurses worked outside their country (Mortensen, 2008). This is a huge increase compared to the total of 3,350 nurses who migrated from the country between the 1960s and 2000. The number is only expected to rise as such foreign policies allow their professionals to pursue the working conditions they want. The attitude that pushes this migration of professionals is the view that health professionals could be a legitimate export business. Preceding the needs of their people, countries such as the Philippines, India, and China seek to produce nurses in vast numbers. This increased nurse education can also be seen in the Philippines, where over 460 nursing schools produce over 20,000 nurses annually (Negin, 2008). These nursing schools in developing countries have been funded by private organizations seeking to employ trained nurses.

Reasons why Health Care Professionals Migrate to Developed Countries

To understand why nurses and doctors flee their own countries, starting with the working conditions in their home countries is helpful. Sub-Saharan Africa has about 11% of the world's population. On top of that, they experience about 25% of the world's illnesses (Chiamaka & Chimereze, 2020) and only have about 3% of healthcare professionals worldwide. Countries across Africa and also in other developing nations have high populations as well as high disease prevalence. In contrast, North and South Americas have about 14% of the world's population but only 10%  of the world's illnesses (Noland et al., 2008). Despite the low number of diseases, they have 37% of the world's healthcare professionals, predominantly nurses and doctors. Across Africa, the numbers are consistent with low numbers of nurses and doctors and huge populations. Take Malawi, situated in the south of Africa; for one, the ratio of health care professional to the number of population is about 19 doctors and 283 nurses and midwives per 1,000,000 Malawi population (Bickton & Lillie, 2019).

In consideration of these numbers and statistics, it is understandable to wonder why most nurses and doctors choose to migrate to other developed countries. It all begins with the conditions they are expected to work in. Other than external brain drain, there is also internal brain drain. Nurses studying in various schools across different countries all aim to work rather in well-developed urban regions than rural regions. A 2005 study in Ethiopia showed that 67% of its nursing students would want to work in urban settings once their training was complete (Negin, 2008). Having mentioned that, it is safe to say that the working conditions are one of the motivators for individuals choosing to work in other countries. What these doctors and nurses need is a constant supply of medical equipment to be able to care for their patients.

A considerable number of migrating professionals usually cite technological advancements as one of their contributing factors (Chiamaka & Chimereze, 2020). Developing countries are, in most cases, poorly funded and equipped technologically. On top of that, there is the issue of low wages, insufficient allowances, and political instability. Since most of these developing countries are fighting for political stability, healthcare personnel often find themselves in hostile territories. Their push to migrate is to work in areas that allow them to offer the utmost care for their patients without the fear of political unrest, inadequate supplies, and the motivation of sufficient compensation.

Developed countries such as the USA, United Kingdom, Canada, and the rest have had better health and political systems. Their economies have been well established for years, meaning they can afford to pay their nurses and doctors a better salary for their services. In addition to these favorable conditions, these developed countries actively seek out trained health professionals. They offer lucrative positions accompanied by hefty compensation salaries. Countries such as Canada openly advertise and offer permanent residency once a nurse or doctor works in the country for a given number of years (Hawkes et al., 2009). These incentives contribute to the brain drain of talented healthcare personnel and make sure these professionals do not return to their countries.

The Underlying Impact of Brain Drain on the Developing Countries

Most records in existence offer the adverse effects of brain drain in developing countries. As briefly highlighted above, it is clear that the brain drain is leaving developing countries without sufficient numbers of healthcare providers. For instance, the 2000 nurses in Malawi are few considering that they are expected to care for a population of over 12 million. Therefore, one of the most noticeable effects is the shortage of nurses and doctors in these developing countries. Correspondingly Lesotho has 0.5% doctors per 10,000 individuals. In Africa, the statistics point to 13 doctors for a 10,000 population (Hashish & Ashour, 2020). While 280 doctors per 10,000 patients in the United States (Serour, 2009). Moreover, only a small number of doctors and nurses can be found in rural settings, as most trained personnel choose to work in urban settings.

Another effect is the lack of training for future doctors and nurses. Approximately 23,000 educated Africans migrate to the USA, the United Kingdom, or other developed countries (Dovlo, 2004). The result is that the number of professionals who can train the remaining population is significantly less. Therefore, the training level will not be as high as it could be if the developing countries retained their trained personnel. On the other hand, developed countries are getting the top nurses and doctors; hence the training of their younger generations is of the highest quality. The United Arabic Emirates (UAE) is among the growing working destination for healthcare professionals. In an online survey, 26.97% of healthcare providers reported being better compensated in the UAE than in their mother countries (Mortensen, 2008). As a result, more healthcare professionals are seeking to move to the UAE, leaving their home countries short-staffed for doctors and nurses.

The third and most important effect is on developing countries' economies. Developing countries spend a considerable amount of money training their doctors and nurses. In return, the developed countries take this trained personnel, denying them the chance to contribute to their home countries' economies. In 2005, 167 doctors moved from Kenya to the United Kingdom and the United States (Misau et al., 2010). Out of these, 40% were in the United Kingdom and 56% in the United States. The cost of training a single doctor from primary to medical doctor training in Kenya is approximately $65,997 US dollars (Kirigia et al., 2006). This number, multiplied by the number of doctors migrating to other developed countries plus the interest and the amount gained over the years, is a substantial loss to the source countries. Furthermore, considering that these doctors and nurses contribute to the economy of the developed countries, they reside in only aggravates the losses.

The positive Effects of Brain Drain

Brain drain has been the source of many negative consequences. However, some researchers argue that, in a way, brain drain is also beneficial (Pang et al., 2002). The first positive effect is the exposure of nurses and doctors to advanced healthcare technology. Unlike developing countries, developed ones can provide their nurses and doctors with high-level technology that corresponds when treating a patient. The general conditions provided by these developed countries promote innovation and collaboration between professionals from other countries and their own.

Furthermore, brain drain does promote the development of developing countries. The Philippines, as mentioned, has received funding from private companies in developed countries that aim to produce more nurses. On the other hand, recruiting agencies in India have partnered with hospitals to train more nurses. These recruiting agencies spend between $4,000-7,000 on training a single nurse, yet they earn $47,000 when the nurse is hired by an organization in a developed country (Record & Mohiddin, 2006). Therefore, the brain drain has led to an entrepreneurial wave where agencies and nurses training schools are growing within developing countries. Even though the talent is being used elsewhere, some individuals are generating profits from it.

It has been mentioned that the source countries' economies often suffer greatly. However, the following two positive effects contribute to the source country's economic flow. On the one hand, the more the professionals are paid in their new countries, the more they are motivated to send money home (Misau et al., 2010). As a result, money remittances from the diaspora healthcare professionals play a positive role in the growth of the home economy. On the other hand, brain drain has made it easy for young ones to attain training so they could also migrate back to their countries of origin in the future.

Solutions to Brain Drain

Although the positive effects of brain drain are significant, they still do not negate their adverse effects. For decades, developed countries have been “stealing” top professionals with their provision of better opportunities. The source countries are becoming more crippled without sufficient healthcare personnel to serve their own populations. In response to these adverse effects, researchers have shown that the solution to brain drain may be the circulation of professionals worldwide. In Cuba, they have a program where their nurses and doctors are distributed across different countries. Some work in the United States, some in the United Kingdom, others in Africa, some in India, and so forth (Bach, 2008). This program is expected to train professionals in different cultures and techniques. An improvement to the program would see the nurses and doctors shift from one country of service to another after a given period. They can transfer their knowledge to other professionals and gain more skills. This circulation program would benefit developing countries because the doctors and nurses attained from one country will not solely reside in the developed country of their choice. After some time, they will find themselves in developing countries with people that need medical care. By doing so, nurses and doctors who get advanced training with updated technology can return to their home countries and offer improved care to their patients.

Another solution would be making nurses and doctors promise and commit to stay and serve in their source countries for 2-3 years after graduation in order to get admission to the programs (Bach, 2008). As it is, training doctors and nurses are in the source countries' responsibility. However, countries such as Ethiopia, the Philippines, and India have used international nursing language and curricula to teach their students (Lorenzo et al., 2007). Though this is only meant to improve their student's chances of being absorbed in developed countries, their approach is appealing. The system would only need to be changed so that nurses and doctors all over have a compatable training curriculum. Also, developed countries could offer many scholarships to students from developing countries interested in the healthcare field. After finishing their training, they can absorb some and return most students to their source countries. In that way, the developed countries' institutions will have several well-trained nurses and doctors, and so will the source countries. Doing this will increase the number of trained healthcare personnel significantly. It would result in filling employee positions within the healthcare facility. On top of that, the nurses and doctors will have sufficient amounts of training at the international level. These trained nurses and doctors would prove relevant in increasing patients' quality care, both at the rural and urban levels, in their respective developing countries.

Conclusion

Developing countries have been the victims of the brain drain for several decades now. The motivating factors that push doctors to abandon their home countries are poor working conditions, political instability, poor wages, and lack of advanced technological devices. Regardless of the motivating factors, one of the major ones is that developed countries always want to absorb more healthcare professionals. They provide them with what they want and offer them permanent citizenship alongside lucrative salaries. The effects of brain drain are primarily felt in the source countries. Their healthcare systems have to work with short-staffed doctors and nurses even though they have a higher population of illness prevalence. Although brain drain has some positive effects, the adverse effects often prevail. As a solution, developed countries could fund the training of a more significant number of nurses and doctors from developing countries. That way, they can retain a few and send a more substantial number to developing countries. Ultimately, this would increase healthcare professional presence in developing countries.

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