Efforts under way to stem "brain drain" of doctors and nurses.

Abstract

The migration of skilled professionals to industrialized countries is one of the factors behind the chronic shortage of health workers in many developing countries. Last year the problem was highlighted at the World Health Assembly; 2005 may be the year when a series of initiatives to address the problem start to gather momentum. 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. "I hope that 2005 will finally be the year when we achieve some concrete results," said Davide Mosca, the International Organization for Migration's (IOM) regional medical officer for Africa and the Middle East. "Everything has been analysed. We now need action. If we don't address this problem it will be a disaster. It is increasingly difficult to find doctors in many countries and impossible to retain them," Mosca, who is based in the Kenyan capital, Nairobi, told the Bulletin. This year's World Health Assembly in May is expected to discuss how to limit the adverse effects of the migration and to promote fairer recruitment tactics by developed countries as a follow-up to a resolution passed in 2004. It will also hold preliminary discussions on an international code of practice, according to Dr Pascal Zurn, a health economist at WHO's Department of Human Resources for Health in Geneva. The Commonwealth set a precedent for action in 2003 when it agreed on guidelines "for the international recruitment of health workers in a manner that takes into account the potential impact of such recruitment on services in the source country". But the code of practice has been signed primarily by developing country members rather than importers of health workers such as Australia, Canada and the United Kingdom, who are reluctant to make a formal commitment to provide compensation or reparations. Thus, negotiations on any international code will be protracted, Zurn and Mosca cautioned. In the interim, WHO, IOM and the International Labour Organization plan to step up their collaboration to gathering statistics and other information to gain a better understanding of the dynamics of health worker migration, which is often clandestine. "Once you know what is going on, you can find appropriate solutions," said Zurn. Even countries such as India and the Philippines, which have long encouraged the export of health and other skilled workers because of their return remittances, are increasingly complaining of domestic shortages--especially in the public sector in rural areas. In Africa, it is estimated that an additional one million health workers will be needed over the next decade to deliver basic health interventions. The extent to which eastern European countries, especially those which recently joined the European Union, can provide medical staff for the West and thus ease pressure on developing countries, is uncertain, according to Galina Perfilieva of WHO's Regional Office for Europe. The United Kingdom, which absorbed more than 13 000 foreign nurses and 4000 physicians in 2002, according to figures presented to an IOM seminar last June, is widely regarded as setting the standards for bilateral agreements on ethical recruitment. Health minister John Hutton announced on 9 December last year that the United Kingdom would toughen its code on international recruitment, which restricts recruitment from over 150 developing countries. …