Writer: Saniya Pendharkar | Editor: Ava Inman
Introduction
In recent years, the substantial migration of healthcare workers has become a growing global concern. This emigration of highly skilled individuals from a particular country is termed “brain drain,” and it has profound implications in a variety of sectors, including healthcare. Trained health professionals are essential in every area of the world, but the high quality of living, better salaries, advanced technology, and more stable political atmospheres in developed countries are becoming increasingly attractive to the skilled populations in developing nations.
As a result, over 25% of healthcare workers in low-income countries have migrated to high-income ones (particularly significant for countries in Sub-Saharan Africa and South Asia). According to OECD data on health workforce migration, 25% – 32% of doctors in Austria, Canada, the United States, and the United Kingdom are immigrated medical graduates. While an influx of the world’s most talented healthcare individuals benefits high-income nations, this is a severe strain on the countries from which these people are coming. For instance, in some specialties like nephrology and pulmonology, most specialists in developed countries are international individuals who come from countries already facing severe shortages in their disciplines.
Figure 1: Countries with critical health worker shortages
Sourced From: The “Brain Drain”: Migration of Healthcare Workers out of sub-Saharan Africa
Not only does this medical brain drain affect the supply of adequate healthcare in developing countries, but it is also a considerable financial cost for them as well. After investing in the training and education of these skilled individuals, their emigration is a significant loss of resources, while only the recipient countries experience the benefits of these newly minted professionals.
Financial Loss of Brain Drain: African Nations
As alluded to above, the brain drain of healthcare workers is a substantial financial strain on developing nations. Looking at Africa, the continent with arguably the most pronounced healthcare needs, around 23,000 qualified academics migrate each year. Further data states that 33%-50% of South African medical school graduates leave to pursue a career in developing countries, leaving behind a financial cost of $37 million. The UN Commissioner for Trade even estimated that each skilled healthcare worker who leaves Africa is a $184,000 loss to the continent. Since February 2021, 4000 healthcare workers have left Zimbabwe alone. In Kenya, it is estimated that of the 5000 doctors registered to work in public hospitals, only 600 do so; the rest work in the private sector or have moved abroad.
Doctors are not the only medical professionals lost by developing nations, nor have they been the most extreme. In South Africa, for instance, the number of nurses migrating is almost 7 times that of doctors; more than 180,000 Zimbabwean nurses work abroad.
Figure 2: Percent of health workers intending to migrate
Sourced From: The “Brain Drain”: Migration of Healthcare Workers out of sub-Saharan Africa
More Patients, Less Physicians: India and Pakistan
In addition to the significant financial losses, countries also lose the contribution of these skilled healthcare workers to domestic healthcare. According to OECD and WHO data, India has the highest number of domestically trained doctors practicing abroad, and Pakistan is a close second.
Comparing the U.S. to India, healthcare expenditures in India are 3% of their GDP versus 13% in the U.S. Furthermore, the ratio of doctors to patients is 1:2083 in India compared to 1:500 in the U.S. These ratios could be attributed to the considerable population disparity between the two nations, but there were almost 950,000 active physicians in the US as of 2019, and 8.5% of them were of Indian origin.
Pakistan faces similar issues. Fewer resources and an overwhelming patient population are worsening the doctor-to-patient ratio and have become major push factors in Pakistan. A survey by Mayo Hospital, Lahore, found that 83% of doctors were unsatisfied with the compensation and healthcare infrastructure in the community. Additionally, 81% of respondents expressed that growing political instability and terrorism threats were incentives to leave, an issue not uncommon in developing nations.
Can Brain Drain Be Prevented & Reversed?
In order to address the medical brain drain, nations must critically analyze the push factors causing skilled workers to leave. Countries need to figure out how to retain their young graduates without limiting their access to world-class training opportunities. Doctors tend to remain in the location of their residency program when beginning their careers and tend to choose them accordingly. Residency programs abroad are incredibly attractive, especially with many guaranteeing medical licenses and permanent visa status. Some suggest developing countries increase their residency opportunities—much easier said than done as these programs are expensive and will thus require significant funding and know-how that these nations simply don’t possess.
The most obvious incentive, of course, is the financial one. Higher salaries abroad are the main reason for brain drain, but even domestic salary increases won’t be able to compete with international ones, especially when considering the US or UK. One solution could be to implement a scholarship system with a “pay it back if you don’t come back” contingency. With such limitations on the scholarships issued by the home countries of emigrating professionals, there might be a greater incentive to remain home. Trinidad has already successfully implemented this kind of strategy: doctors trained abroad are required to return for 5 years in order to collect their government scholarship.
Finally, in areas like Pakistan and Ethiopia, where political conflict is a primary reason for the exodus of medical professionals, the development of safe working conditions and increased diplomacy is crucial for preserving the future of healthcare.
Ultimately, the “brain drain” is a serious issue that further exacerbates the global inequities we witness in the modern age. As an economic phenomenon, it has served to further stratify countries and cement their positions in the spectrum of development. Reversing this issue means rewiring individual incentives on a global scale, which will take time, money, and effective policy measures. Addressing this dilemma will require pragmatic approaches that support national interests and needs without infringing on educational and professional mobility. Whether through incentives or systemic reforms, tackling brain drain is essential for long-term economic stability and growth.
Featured Image by Dmitriy Gutarev from Pixabay
