Global Trends by Martin Khor

Monday 10 April 2006

Medical brain drain hits poor nations

Last Friday, the World Health Organisation warned of the “deadly impact” of a shortage of medical personnel in developing countries.  Ironically, poor countries are subsidising rich countries by sending them thousands of doctors and nurses.     


Developing countries are facing a critical shortage of health workers because so many of their doctors and nurses are leaving for the green pastures of the rich countries.

Raising the alarm bell, the World Health Organisation says the world is short of 4.3 million medical personnel and this has a “deadly impact” on the countries’ ability to fight diseases or respond to new challenges like avian flu.

The migration of doctors and nurses is a “perverse subsidy”, says the WHO, provided by poor to rich countries. The equivalent of 23% of doctors trained in sub-Saharan Africa are working in the rich countries.  As much as 37% of South African doctors are in rich countries.

The shortage of health workers was picked as the theme for this year’s World Health Report, released by the WHO last Friday.

South-East Asia has the greatest shortage of health workers in absolute terms, and Africa the worst affected in relative terms.

The brain drain figures are quite staggering.   "There are more nurses from Malawi in Manchester than in Malawi, and more Ethiopian doctors in Chicago than Ethiopia," according to European Parliament member Gladys Kinnock, quoted in an IPS agency report.

Last year, Kenya lost 2,998 graduate nurses to other countries - mostly to the United States and Britain. In Canada, New Zealand, the United Kingdom and the United States, a quarter or more of all physicians had been imported from other countries.

The US, which has more than half of all the world's nurses, will need a further 800,000 by 2012 and will buy in nurses from abroad, according to an article in The Independent.

It doesn’t help when the rich countries embark on a deliberate policy or even campaign to poach medical personnel from poor countries. Last month, the European Union justice commissioner Franco Frattini outlined proposals for recruiting highly educated professionals, including a “green card” for researchers, engineers and doctors.

"I am concerned by Frattini's proposals," Kinnock said, calling on European leaders not to poach health workers from the world's poorest countries.

The WHO report recognises that migration of health workers generates billions of dollars in remittances.

But when doctors and nurses leave, the countries that financed their education lose a return on their investment and end up unwillingly providing the wealthy countries with a kind of "perverse subsidy", says the WHO.

South African medical schools report that a third to a half of their graduates emigrate to the developed world every year, according to Danielle Grondin, of the International Organisation for Migration, quoted in IRIN agency.

"There are recruiting agencies that are very unethical - we have seen cases where recruiters go in to an African country and recruit 100 percent of a graduating class.”

What can be done about the brain drain?  The subsidy paid by government to train a doctor or nurse can be calculated, and this amount should be repaid to the government if there is medical migration.

The cost can be paid by the country to which the person is migrating, as it would be gaining from the transfer of “human capital” which had been trained at great cost by the country of origin.

A 2005 report by Save the Children and Medact estimated that Britain had saved £65m in training costs for doctors and £38m for nurses it had taken from Ghana alone since 1999. 

Britain could compensate Ghana for the cost of training the doctors and nurses whose services it now enjoys. This makes ethical and even business sense, as it is cheaper to train someone in a poor country than in a rich country, so the rich country itself gains even though it has to pay.

But rich countries will not readily agree, as they have been getting the “human capital” for free all these years.

There can also be codes of conduct on recruitment by the rich countries.  Britain introduced an employment code for NHS trusts six years ago which bans international recruitment from countries with the worst shortages. But hospitals in the NHS and private sectors have found ways round it.

Another measure could be to stop the medical personnel from leaving, or ask them to pay back the cost (or some of it) of their training.

But this is a difficult issue. It is hard to reconcile the extremes of "poaching practices by rich countries" and respecting the choice of the individual to pursue a better way of life, as Grondin pointed out.

The WHO suggests that governments take measures to encourage doctors and nurses to stay, for example by improving pay and working conditions.