Out-Migration/Brain Drain

This article describes the achievements of 11 Sudanese-Canadian physicians who completed medical training and returned to Southern Sudan to practice. Few internationally educated physicians are prepared to return to a homeland as challenging as Southern Sudan; this goes against the globally entrenched flow of physicians migrating from developing to developed countries. [from introduction]

Countries in Africa are facing a public health meltdown as hundreds of public health workers succumb to the AIDS pandemic or are fleeing the region in search of better pay. As well, the healthcare infrastructure is well below the required standard with rural communities in some nations struggling to cope. [from article]

This brief considers the policy implications in Europe of the international migration of health workers and addresses the question of how the migration of health service professionals can be managed in ways that reduce any negative effects on supply. [from executive summary]

The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States reflects the mutual recognition of stakeholder interests relevant to the recruitment of foreign educated nurses. It is based on an acknowledgement of the rights of individuals to migrate, as well as an understanding that the legitimate interests and responsibilities of nurses, source countries, and employers in the destination country may conflict. It affirms that a careful balancing of those individual and collective interests offers the best course for maximizing the benefits and reducing the potential harm to all parties.

This study was conducted to identify determinants, benchmarks and indicators of the costs and benefits and distributional impact of the migration of human resources for health on health services in Kenya and to make policy proposals for intervention. [from abstract]

This paper examines health workforce and migration policies in New Zealand, with a special focus on the international recruitment of doctors and nurses. [from abstract]

Balancing medical workforce supply with demand requires good information about factors affecting retention. Overseas qualified doctors comprise 30% of the National Health Service workforce in England yet little is known about the impact of country of qualification on length of stay. We aimed to address this need. [from abstract]

The so-called brain drain is a complex phenomenon with a web of push-pull factors determining final outcomes. There are no quick fixes. Yet, those on the front lines addressing the critical personnel shortages in South Africa's public health system - especially in rural areas - have pointed to approaches that could slow the exodus and eventually turn the situation around. [from author]

This paper aims to present the existing HRH problems exemplified by migration in the light of other related issues such as the nurse medic phenomenon, foreign doctors taking up residency training, quality of nursing education, paradoxical enrollment trends in nursing and medicine and the effects of migration on health service delivery.

This issue focuses on the health workforce and contains the articles: Could health worker migration bring benefits to Malawi?; Removal of childbirth delivery fees: the impact on health workers in Ghana; Regulation of dual job-holding public sector doctors in Peru; Health worker responses to health sector reforms; and Motivating Tanzanian primary health care workers. [adapted from author]

This is a review of current multi-lateral agreements, codes of practice, bilateral agreements, regional agreements, and strategies and position statements that govern the migration of health workers from ESA (East and Southern African) countries. The main purpose of this paper is to provide an overview of the current situation in ESA. [from executive summary]

This report summarizes the results of the first year of the two-year project entitled International Recruitment of Nurses to the United States: Toward a Consensus on Ethical Standards of Practice. It examines the structure and basic practices of the U.S. based international nurse recruitment industry. The purpose of the project is to facilitate consensus among stakeholders on how to reduce the harm and increase the benefits of international nurse recruitment for source countries and for migrant nurses themselves. [from author]

The Canadian health care system is one of the places where push comes to pull in terms of attracting health care professionals from sub-Saharan Africa. The authors call this "the perverse subsidy": the costs of training these professionals are paid for by "poorer people in poorer countries." The pull to Canada is equally a push from Africa. Reflections on a pilot study on a labour mobility issue that is equally a question of conscience. [from author]

This editorial describes the widespread recruitment of health workers from sub-Saharan Africa to developed nations by recruiting agencies. The authors describe international efforts to criminalize this practice and express concern at the continued practice of recruitment.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study done to analyze health worker perceptions of renumeration and determine the factors that affect the mobility of the health workforce in Burkina Faso

This presentation was given at the First Forum on Human Resources for Health in Kampala. It outlines HRH in the eastern Mediterranean region, trends in international nurse migration, and the Lebanese context. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It outlines the micro-economics of health worker behaviour and discusses a study done to evaluate migration in Ghana.

This article discusses the challenges related to preventing the out-migration of health care workers from the developing world. Experimental policies and best practices are outlined. The authors call for new policies to be created to encourage health workers to remain at home.

This study explores the views of nursing students in Uganda to assess their views on professional practice options and their intentions to migrate to wealthier countries. The surveys show that most students would like to work outside of Uganda. The authors conclude that nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda. [adapted from author]

This study shows that graduates from higher quality institutions account for a disproportionately large share of emigrating physicians in India. Even within high-end institutions, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. The findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel. [adapted from author]

It has been shown that, internationally, medical students of rural origin are more likely to practice in a rural area after graduation, but this has not been demonstrated in South Africa before. This study aimed to investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural origin students are currently practicing in a rural area. [from abstract]

In order to highlight the driving forces determining the international allocation of medical personnel, the cases of four countries (the Philippines and South Africa as source countries, and Saudi Arabia and the United Kingdom as destination countries) are examined. The paper concludes that changes in demand generated in major destination countries determine the international allocation of medical personnel at least in the short run. [from abstract]

The migration of medical professionals as a result of the expansion of the European Union is cause for concern. But there is a significant lack of information available about this phenomenon. This study did a search of secondary databases about the presence of european doctors working abroad and a survey of professional organisations and regulators in countries of the European Union. [from abstract]

One major challenge for all countries is to establish workforce planning mechanisms that effectively meet the demands for health care and provide workforce stability. However, few nations have developed strategic plans for meeting nursing resource requirements that effectively address supply and demand. Instead, many developed countries choose to implement short term policy levers such as increased reliance on immigration, sometimes to the detriment of developing countries. This has prompted calls for developed countries to employ a model of so-called self sufficiency in addressing nursing and other health human resource shortages.

This is an exploratory descriptive study that examined migration of locally trained doctors from Ghana using graduates of the country’s first medical school as a proxy. The objectives of the study were to describe trends in the loss of medical personnel to emigration and the influence this has on human resources planning, including forecasting of staff supply and requirements. It was also to provide some information towards the development of strategies to counteract such losses. [from abstract]

The migration of health professionals from developing countries in general, and sub-Saharan African countries in particular, has become the subject of considerable theoretical and case study research attention in international migration and human resources for health (HRH) literature. This report is a review of all available literature on the costs and benefits of the migration of health workers from East and Southern African (ESA) countries to developed nations. [from executive summary]

In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health. [

The ILO Sectoral Activities Department initiated an explorative research project on health worker mobility in Europe with focus on CEE countries. The purpose of the project was to explore and document current knowledge and information available in order to establish the current status, and identify both preliminary trends as well as information gaps and the need for further action. The project contained two main components: a literature review to provide an overview on the state of the migration discussion in Europe, complemented by initial research in selected countries for obtaining country-based insight on information available.

This study aims to provide in-depth information on the migration of Filipino health workers and the repercussions this has on individual migrants, their families, their professions and the nation as a whole.

Because of its inherent complexities, the migration of health workers benefits from multidisciplinary research: solutions must be informed by a better understanding of the perspectives and underlying motivations of the many stakeholders. [author's description]