groups » Trial Management » 'Health Workforce Brain Drain' - new article in PLoS. Does this affect you?

A new article in PLoS Medicine discusses the problem of the migration of health workers from low and low-middle income countries to high income countries. The authors say: 'migration of health professionals is unplanned for and represents a “brain drain” for source countries, a result of enormous wage differences and poor working conditions, including lack of support, adequate infrastructure, and career development opportunities, in LMICs.'

The authors argue for the need for a series of evidence-based solutions, and make suggestions for things that can be done by both lower and high income countries to turn this situation around, including:

- placing greater emphasis on non-wage retention strategies, including improving working and living conditions [20];
- diversifying the skills mix to harness the potential of non-physician clinicians [21] and community health workers [22]; the credentials awarded to these cadres are typically recognized only in their own country, making them less vulnerable to international migration;
- circular migration, i.e., promoting a triangular flow of talent and skills by encouraging some migrant health workers to return to their home country [23].

For more information, follow the link to the full PLoS article.

What do you think? Is this a problem you see in your setting? What do you think are viable solutions to this problem?


  • fatimatasako Fatimata Ba 3 Oct 2013

    Many Subsaharan Countries are experiencing worse cases. For instance, Today's economic crisis in Mali among many countries is favoring the brain brain. Many health workers travel today for a better living condition for them and families. I believed that Host countries play an important role in brain drain. Hosts Countries such as USA and UK are facing low physician-to-patient ratio because of the rapid population grow. Therefore, these countries will offer anything to maintain foreign health workers to increase access to healthcare. No host Country has to be blamed for, because they invested in the education of these foreign health professional. In my perspective, prioritizing international fellowship or internship programs to allow these workers to serve both the sources and hosts countries could minimize the impact of the brain drain.

  • stevefrench Steve French 3 Oct 2013

    There are countries that "over produce" their health professionals such as nurses. Take Philippines as an example, underemployment is quite high in the population, and Nurses there end up working in other sectors. We cannot really stop people from moving if they see opportunities, unless you give them better pay where they are. About 11 million Filipinos work abroad and they send money to their families back home. Last year, the remitance reached more than 20 billion USD, and the effect of this diaspora kept the Philippine economy afloat, in fact one of the best performing emerging markets in the world, amidst US and European economic crisis. On the other hand, putting food in the table is a higher priority than health in many settings. In the Philippines, unless the gov't closes it's boarder, we cannot really stop skilled workers form leaving the country. One program example that the Philippines did, as far as I can remember, was "bingding the scholars" after the completetion of their education. A goverment scholar is "quarantined", meaning he/she must work for the state/country for at least 5 years before he/she can employ elsewhere.
    If you want to learn more about migration of skilled workers, learn from Philippine experience. Their group is called Overseas Filipino Workers (OFW's).
    You will know a lot of good and bad sides of it. :)

  • draisah Dr Adamu Isah 2 Oct 2013

    you have raised a very relevant topic which I consider as a cornerstone in all public health services, especially in developing countries. In my view, whatever interventions we do to improve health sector will be meaningless if we do not have the right workforce.

    In my country, Nigeria, a national daily newspaper reported last week that only one-third of all doctors trained since Nigeria in independence are currently available to provide services - the remaining two-thirds have moved out of the country. That is why it is common to find only one or two doctors managing a general hospital in many states in Nigeria. In some case, you find none!

    What worries me most is that, no one really has any sustainable solution to this problem. Most Governments and NGO's are doing window-dressing. In my humble opinion, we need to embrace the concept of task-shifting and decentralization of services. I see no reason why an experienced midwife or theater nurse should not be allowed to conduct emergency Cesarean Section, simply because they do not have the qualifications of a medical doctor.

    It pains me to admit that discussions on task-shifting have become a taboo in the eyes of many doctors and even policy makers. Yet, they do not have any effective solution to that poor village women that profusely bleeds during labor, or suffers eclamptic fits or spent three days in labor. How can we achieve the MGDs in such situations?

    We must think outside the box. Our medical schools are not capable of provide adequate medical doctors. Even if they do, the do Doctors would not stay in the villages!

  • I very much agree with you. The main problem is no twith the developing countries but the developed. If they could have an embargo on professions migrating to their counties,it would help in the brain drain.
    Developed countries are the beneficiaries of the brain drain.
    Can the the developed countries repay what the ripped from these countries during colonial error, buy doing so we would stop these vice.

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