Out-Migration/Brain Drain

This paper reviews the situation and trend in human resources for health and its priority problems in Thailand. It also highlights the issue of the inequitable distribution of doctors. Through several brainstorming sessions among stakeholders, it summarizes a package of recommendations for the future continuous and sustainable knowledge-based human resources for health development. [from abstract]

The causes of brain drain are complex and interrelated, involving social, political, and economic factors. The necessary responses will therefore be varied and cover an array of areas. Drawing on growing interest and scholarship, Physicians for Human Rights (PHR) proposes this plan of action for addressing brain drain and the unequal distribution of health personnel within countries, recommending actions by high-income countries, African governments, WHO, international financial institutions, private businesses, and others. [author's description]

The African continent is facing 25% of the world’s morbidity rate with only 3% of its healthcare personnel. This is the result of years of neglect and underinvestment by African governments and the international community, plus harsh IMF restraints on nations’ budgetary expeditures. [author's descripton]

The numbers of health professionals joining the brain drain has reached a peak in recent years in apparent response to huge demands emanating from the developed countries. The brain drain of professionals, combined with the health crisis, threatens the entire development process in Africa. The crisis in health intensifies with the advent of the HIV/AIDS crisis. The loss of health workers simply serves to worsen a dire situation. The health and education sectors need to cooperate intensively to devise means of gaining some utility from the health professionals they produce before they leave for greener pastures.

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. [from introduction]

The authors outline the crisis in Africa's health workforce, why it matters, and the causes and solutions to the crisis including: HIV/AIDS, under-investment, and unmet healthworker needs. The presentation discusses the brain drain and the causes of health workforce migration. It also provides recommendations and solutions to the problem and a brief description of the current responses.

The brain-drain may not be stoppable, but it may be manageable. There is a great deal more that developed countries should be doing to support collapsing health systems in poorer countries and improving incentives for health staff to stay. [From author]

The issues surrounding nursing shortages and global nurse migration are inextricably linked. The shortage of practicing nurses worldwide has led to aggressive recruiting by healthcare employers in the United States, the United Kingdom, and other countries. Foreign-educated healthcare professionals represent more than a quarter of the medical and nursing workforces of Australia, Canada, the United Kingdom, and the United States. [author's description]

This video clip is 6 minutes and 58 seconds and provides information on the training and retention of health workers in Cape Verde. The majority of the training is done abroad due to poor medical educational facilities in country, and the video communicates the policies and programs Cape Verde has used to ensure trained doctors return to the country as well as how they ensure deployment of doctors to rural areas.

The appealing, modern websites of the private agencies specializing in the recruitment of health care professionals for Western markets invite the loggers-on to explore a myriad of opportunities. So fierce is the competition to secure scarce health care professionals that private recruitment agencies stage promotional events and aggressive recruitment campaigns in supplying countries, tripping over each other to attract suitable candidates. How did the shortages of health care professionals become so acute, and how did international migration come to be viewed as one of the solutions to the problem?

This document highlights the potential advantages and perils of career moves and migration for nurses, describes some of the main nurse migration trends and establishes a list of critical questions as an ethical framework for nurse recruitment. [adapted from author]

This presentation was part of the "Call to Action: Ensuring Global Human Resources for Health" conference. It discusses international migration of health workers, the ethical dimensions, immigration bans, barriers to integration of migrating health workers, and areas for intervention.

The aim of the Code of Practice is to promote high standards of practice in the international recruitment and employment of healthcare professionals. This is underpinned by the principle that any international recruitment of healthcare professionals should not prejudice the healthcare systems of developing countries. Therefore a key component of the Code of Practice is to preclude the active recruitment of healthcare professionals from developing countries, unless there exists a government-to-government agreement to support recruitment activities. The Code of Practice also acknowledges the reality that the international movement of healthcare professionals is a long established practice that will continue.

Malawi has a critical human resources problem particularly in the health sector. The College of Medicine (COM)is the only medical school. For senior staff it heavily depends on expatriates. We explore to what extent a brain drain took place among the COM graduates by investigating their professional development and geographical distribution.

This Briefing has two parts: Comment on the World Health Report 2006; and Overview of the multi-partner initiative: 'HR-HR' Improving Human Resources for Better Health Research in Africa.

The Code develops a consensus approach to dealing with the problem of international recruitment of health workers, while remaining sensitive to the needs of recipient countries and the migratory rights of individual health professionals. The Code covers issues of transparency, fairness, mutuality of benefits, compensation/reparation/restitution, selection procedures, and registration. [Description from author]

Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. [author's description]

The African Region continues to experience loss of a sizeable number of highly skilled health professionals (physicians, nurses, dentists and pharmacists) to Australia, North America and European Union. Past attempts to estimate cost of migration were limited to education cost only and did not include the lost returns from investment. The objective of this study was to estimate the social cost of emigration of doctors and nurses from the African Region to the developed countries. [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]

The story of the international nurse in the U.S. workforce is generally one of perserverance - not only in obtaining a visa and a state license, but in adjusting to living and working in the United States. [author's description]

Most statistics on the migration of health-care workers are neither complete nor fully comparable, and they are often underused, limited, because they often give only a broad description of the phenomena, and are not as timely as required. This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources, and other challenges that need to be met to obtain good evidence on the migration of health workers. This paper also proposes methods to improve the collection, analysis, sharing, and use of statistics on the migration of health workers.

The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed. [from abstract]

Many countries around the world are now facing a huge brain drain of highly skilled professionals to well-paid jobs in developed countries. One of the worst affected sectors is healthcare, an area in which developing countries are struggling to keep professionals at home and encourage others to return. [auhor's description]

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]

This study uses a new database of health worker emigration from Africa to test whether exogenous decreases in emigration raise the number of domestic health professionals, increase the mass availability of basic primary care, or improve a range of public health outcomes.

This article discusses the issue the brain drain of doctors to more developed countries and Ghana's efforts to supply an adequate health workforce in the face of this problem.

The medical brain drain has been described as rich countries looting doctors and nurses from developing countries undermining their health systems and public health. However this brain-drain might also be seen as a success in the training and export of health professionals and the benefits this provides. This paper illustrates the arguments and possible policy options by focusing on the situation in one of the poorest countries in the world, Malawi. [author's description]

International recognition that the growing shortage of health workers poses a major threat to fighting diseases such as HIV/AIDS and tuberculosis has prompted a flurry of measures to stem the exodus of health professionals from developing countries. The initiatives — such as ethical recruitment codes to try to limit damage inflicted by the brain drain, and exchange and training programmes and projects to tap the resources of what has become known as the diaspora of migrant health workers — remain fragmented but at least mark a start in the search for solutions to the crisis. [autho

Many countries are using the strategy of international recruitment to make up for shortages of health professionals. This is often to the detriment of health systems in the poorest parts of the world. Codes of practice on ethical international recruitment or similar instruments are beginning to be introduced at both national and international levels to protect the health systems of vulnerable countries. This study was designed to review the potential impact of existing instruments. [from executive summary]

This report calls for provincial governments to take a closer look at the way they hire doctors, nurses and other health professionals from developing countries. Canada has always relied on newcomers to help deal with shortages in this field, but increasingly these professionals are coming from developing countries, especially from Africa and Asia, which have staffing shortages and critical health problems of their own. The report, The Ethical Recruitment of Internationally Educated Health Professionals: Lessons from Abroad and Options for Canada, looks at how other countries are handling the issue, examines the views of key players and outlines some first steps for Canada's provinces to begin the process of developing a code of practice or series of guidelines. [publisher's description]