Brain drain: the flight of human capital.

Abstract

The international migration of highly skilled professionals first emerged as a major public health issue in the 1940s, when many European health professionals emigrated to the United Kingdom and the United States. By the mid-1960s, the losses were enough to cause concern. In 1979, WHO published a detailed 40-country study on the magnitude and flow of health professionals, whose findings suggested that close to 90% of all migrating physicians were moving to just five countries: Australia, Canada, the Federal Republic of Germany, the United Kingdom, and the United States (1). In recent years, the migration of health workers has become a prominent and controversial feature of health sector planning. A moral challenge There is growing recognition, in both developed and developing countries, of the dangers posed by indiscriminate recruitment of skilled health professionals. Despite the awareness of the risks, little effort has been made to solve the problem. Regardless of one's point of view in the debate, the fundamental issue is the same: should skilled migration be left completely to market forces or should some form of intervention be introduced? If so, what are the possible options? Intuitively, the indiscriminate poaching of skilled health professionals is unlikely to be a neutral phenomenon. It is potentially damaging to the effective delivery of health services in the source country, where it constitutes a huge financial loss and could have a negative impact on the economy. Indeed, the likelihood that poor developing countries may be indirectly subsidizing the health-care systems of richer countries raises ethical and moral questions. Fortunately, however, some developed countries are beginning to acknowledge the potentially harmful effects of their recruitment practices. The United Kingdom is a case in point: in 2001 the Department of Health initiated the Code of practice far NHS employers involved in the international recruitment of healthcare professionals. In 2003 the Commonwealth adopted a non-binding code of practice to guide ethical recruitment from member countries. Despite these positive developments, many countries remain largely indifferent. Some, like Germany, are currently developing aggressive immigration policies targeted specifically at "the best minds" among professionals from the developing countries (2). A manpower strategy that is based on indiscriminate poaching of skilled human resources is rather shortsighted, however, and can only be a temporary solution. Its long-term consequences for the health and overall well-being of the affected populations may extend well beyond health to other sectors of the economy. To escape hardship, many skilled and unskilled persons may be forced to emigrate, and their destinations will almost certainly be in the industrialized countries. Such developments can only exacerbate the problems of illegal migration into many western countries. Consequently, more draconian measures will be needed to stem future waves of desperate refugees. Hence, merely for purely selfish reasons, the developed countries cannot afford to be spectators in the unfolding drama. Solutions Is there an inexpensive way to discourage richer countries from poaching scientists from poorer ones? Unfortunately not--the issues involved are complex and almost all countries are affected to varying degrees. At one end of the spectrum are countries such as Cuba that produce an excess of health professionals; at the other end are those such as the United States that train too few. In between is a variety of sending and receiving countries, each with a pattern of migration that reflects its level of social, political and economic development. Consequently, focusing solely on the "pull" factors that attract migrants may obscure the importance of the "push" factors encouraging them to leave, thereby diverting attention away from some important policy options. …