Author: Bamigbala Abiodun Fehintola, BSc nursing student, Novia UAS
Supervisor: Anita Wikberg, RN, RM, PhD, Senior Lecturer, Novia UAS

Abstract

The brain drain is driven by globalization, and this is because the mobility of people including skilled health workers has become easier. Health care professionals migrate from their home countries to other high-income developed countries because of the push factor that motivates them towards leaving their home country and the pull factor which attracts them to move and start their career in a host country. This article further examines the concept of brain drain of health workers in developing countries, reasons and causes of brain drain , the effects of brain drain of health professional in low-income nations and it then proposes solution and suggested strategies that may help limit brain drain occurrence in developing countries and seek that the developed countries put in place a unilateral measure that reduces the recruitment of health workers from places already experiencing shortage of these skilled professionals.

Introduction

Brain drain is the movement of people who are professional in their field, especially health workers, to move from their home country to a host country. Brain drain has become a major concern as it widens the gap in health inequalities. There are instances where brain drain is internal, and this is when there are fewer health workers in the rural areas, because people want to work in the urban centers. This article refers to the brain drain of health workers when cross-border migration occurs. The health workers include doctors, nurses, laboratory technicians, pharmacists, midwives, and other major areas of the health profession. International migration of skilled workers first became a public health issue in the 1940s when health workers migrated from Europe to the United States and United Kingdom (Misau et al. 2010). According to the United Nation Conference on Trade and Development (UNCTAD), in the least developed countries of the world, one in five university educated professionals leaves for employment in other countries. In contrast, the estimate of workers who migrate as skilled workers in developed nations is one in twenty-five. At one point, the brain drain rate was estimated at 18.4 percent for the least developed countries (LDC) which is highly above the 10 percent rate for developing countries and, six out of the forty -eight least developed countries do have more skilled citizens living in a host country than their home country (UNCTAD, 2012).

The health care sector in the developing countries is in chaos as the population number is high and the migration of the skilled health workers disrupt the capacity of the states to deliver good health care services for its citizens especially in areas that are affected by global diseases. According to the report from the World Health Organization, it states that over 800 million people spend no less than 10 percent of their household budget on health expenses and about 100 million people may not have access to healthcare or be able to afford it, especially when health practitioners are not available due to shortage because brain drain of health care personnel benefit the developed countries at the detriment of the LDC
(WHO, 2017). The paper examines the challenges of brain drain of health workers in developing countries.

Reasons and causes of brain drain

Some countries, for example the Philippines, use globalization to their advantage on both technical and political level. This country intentionally trains health workers and sends them abroad to boost their economy financially through the benefits of remittance of funds and this should be considered as a purposeful drive by the state and not brain drain. In most cases, there is unplanned migration of health workers considered as brain drain driven by push and pull factors. The push factors that motivate health workers to migrate to the high-income countries are based on financial reasons, poor working conditions burdened by; corruption, limited resources and lack of equipment, and limited career opportunities and growth. The pull factor that causes brain drain includes high salary and bonuses, improved quality of life, better career, and recruitment opportunities (Cometto, Tulenko & Krech. 2013). It is vital to understand the reason behind the brain drain of health workers and below the effect of brain drain on the economy is discussed.

The effect of brain drains

One of the effects of brain drain is that highly skilled professionals who moved to the host country do not pay taxes to their home country and these impact the country in a negative way. In most of the developing countries, education is partially or totally subsidized by the state and most of the people who immigrate may not pay their debt before leaving the country. The result of this is that the government is likely to reinforce its fiscal cost into other disciplines such as finances, law and so on rather than educate those who want to qualify as health professionals (Docquier & Marfouk, 2007).

Beside the state's perspectives on funding of education, the country gradually loses its bright minds and there is a reduced generation of excellent ideas and the loss of entrepreneurial talents (Dodani & LaPorte, 2005), it undermines the capacity to deal with health crises especially in the face of global disease burden areas and decreases the adoption of modern technologies (Docquier & Marfouk, 2007). The low-income countries experience a shortage of skilled personnel in the health sector, while the country loses its investment in education as the host country becomes the benefactor (Misau et al. 2010). Another aspect is that the non-payment of tax to the home country has an adverse effect on the provision of public infrastructure and amenities as most of these projects are funded using money paid through taxes.

The effect of brain drain increases technological gap between the leading countries and the underdeveloped countries due to more human capital and collaboration among bright minds in the advanced states compared to the less developed countries. Therefore, there is more technological advancement (Docquier & Marfouk, 2007). With the effect of brain drain, there are solutions and suggested strategies proposed for the different countries.

Solution and suggested strategies to curb brain drain of health workers

There are no outright ways to discourage the developed countries from poaching health workers from the developing countries. It is a complex issue and countries are affected to varying degrees. The focus must be on both the pull and push factors for migrating, because if the nations focus solely on the pull factor, there may occur a diversion of attention from important policy options to solve the problem of brain drain. A workable solution requires the intentional cooperation of all countries with the aim of solving the shortage of health workers in developed countries without damaging the health system in the developing countries. A three-way approach can be offered to the issue of brain drain. firstly, measures should be taken by the developing countries on their own, secondly, a unilateral measure adopted by the developed countries and thirdly, sets of international code of practice to regulate the ethics of cross-border recruitment should be developed (Ahmad, 2004). Furthermore, elements of suggested strategies are discussed.

National strategies suggested for developing countries

These countries may evaluate and determine the economic, political, and social reasons that make citizens decide to migrate, then reform various programs available to improve knowledge, skills, and attitudes towards national development. For example, educational institutes may introduce skill conversion for those who have background knowledge in health care services, passion for the discipline and the country. They then get trained and equipped to serve the country. In doing this, the countries should be careful of making substandard health personnel, but the focus should be on solving pressing national needs. It is, however, important to include both local and rural communities in the selection process to study health and offer them scholarships because these people tend to have a level of responsibility and obligation to their communities rather than a foreign country. With this, the government may also divert resources into incentive packages to encourage rural practice, improve working conditions in health institutions and enter into bilateral agreements with the developing countries, such that compensations can be gotten for the loss of skilled health workers. (Ahmad, 2004).

National strategies suggested for developed countries

The developed countries may endeavor to train more health professionals. Countries such as Canada, the United Kingdom and Australia have taken further steps in training more nursing and medical students especially in the rural areas and the provision of financial incentives for these students. A unilateral measure is crucial for these countries to reduce recruitment of health workers especially in the countries where there is a clear shortage and limit advertisement of job openings in such countries. Establish and implement a national code of conduct for ethical recruitment, such that there is control and measure that restrict recruitment of health workers from nations that are experiencing lack already. Non-extendable visas can also be issued especially towards skill acquisitions for the advantage of the developed country. The developed countries may compensate the source countries through bilateral agreements such as the expansion of infrastructure, communication and technology, improved access to library information, finances and the access to research grants targeted at developed countries. There may also be a program with the exchange of health professionals to the developing countries to train the local health workers, so there is no wide gap felt from those who migrated. (Ahmad, 2004)

Suggested international agreements between countries

The measures stated above can work effectively if strict international rules are made to govern the recruitment of health workers. With this, the development and formulation of international code requires the attention and cooperation of all major layers; the developed countries, developing countries, WHO and international labor organizations including the representatives of the health profession. For example, the code of practice adopted by the commonwealth for the international recruitment of health workers embodied objectives such as 1) link skilled worker international migration to health policy goals of different countries, 2) recognize countries from which recruitment is safe, 3) cross-border movement of health workers is regulated in the developed countries such that it does not affect the health care system of the developing country 4) the right of the recruits should be protected in the host country, 5) appropriate guideline for bilateral agreement should be established and the principle of fairness is applied. (Ahmad, 2004).

Conclusion

The migration of highly skilled workers from the developing countries is currently a continuous issue and the government should consider the reasons for skilled health worker migration and tackle these problems. Although the governments of the developing countries can create policies that restraints health workers from migrating. That is, having to work for the source country for a considerable number of years before migrating. However, imposing a lot of restrictions on international migration is also detrimental for development and collaboration between different countries.

To reduce the effect of brain-drain, both developing and developed countries may come to agreement on how best to solve the issue of brain drain. The developed countries can set up a unilateral measure or policy about not recruiting health workers in countries that are heavily affected by diseases and have a significant shortage of health workers. The developing nations may also focus on sorting out the issues that aid migration such as, low salaries, poor working conditions, safety of workers and so on, to encourage health workers to stay in their home country to work and contribute to the development.

Reference

• Ahmad, Omar B. (2004). Brain drain: the flight of human capital. Bulletin of the World Health Organization, 82, 797-798.
• Cometto, G., Tulenko, K., Muula, A. S., & Krech, R. (2013). Health workforce brain drain: from denouncing the challenge to solving the problem. PLoS medicine, 10(9), e1001514. https://doi.org/10.1371/journal.pmed.1001514
• Dodani, S., & LaPorte, R. E. (2005). Brain drain from developing countries: how can brain drain be converted into wisdom gain?. Journal of the Royal Society of Medicine, 98(11), 487–491. https://doi.org/10.1258/jrsm.98.11.487
• Docquier, F., Lohest, O., & Marfouk, A. (2007). Brain drain in developing countries. The World Bank Economic Review, 21(2), 193-218.
• Misau, Y. A., Al-Sadat, N., & Gerei, A. B. (2010). Brain-drain and health care delivery in developing countries. Journal of public health in Africa, 1(1), e6. https://doi.org/10.4081/jphia.2010.e6
• UNCTAD, (2012). The Least Developed Countries Report. Harnessing remittances and diaspora knowledge to build productive capacities. Url: https://unctad.org/system/files/official-document/ldc2012_en.pdf
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