Health Without Care? Vulnerability, Medical Brain Drain, and Health Worker Responsibilities in Underserved Contexts

Yusuf Yuksekdag

doi:10.1007/s10728-017-0342-x

Abstract

There is a consensus that the effects of medical brain drain, especially in the Sub-Saharan African countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue—while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In the first step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves would hold responsibilities to assist with respect to vital needs of their compatriots. These are fair reciprocity, duty to support vital institutions, and attending to the unintended harmful consequences of one’s actions. While the first two are explained and also largely discussed in the literature, the third requires an explication on how and on which basis skilled workers would have a responsibility as such. In this article, I offer a vulnerability approach with its dependency aspect that may account for why the health workers in underserved contexts would have a responsibility to attend to the unintended side effects of their actions that may lead to a vital risk of harm for the population. I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility.

Highlights

There is—with few exceptions [19]—a consensus that the effects of medical brain drain, especially in the Sub-Saharan African (SSA) countries, ought to be perceived as more than a simple misfortune [5, 7, 13, 21, 41]
I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility
This article, focuses only on a small element of a much larger debate—by offering an approach which addresses medical brain drain and explains why health workers in certain contexts may hold a responsibility to assist the individuals who are vulnerable to their actions

Summary

Introduction

There is—with few exceptions [19]—a consensus that the effects of medical brain drain, especially in the Sub-Saharan African (SSA) countries, ought to be perceived as more than a simple misfortune [5, 7, 13, 21, 41]. Taking the example of the child with the symptoms of HIV/AIDS as an illustration, responsibilities of a physician can be pointed out— when an agent (the child), especially depends on the care of another agent (the physician), who has a distinct capacity or skill set to prevent a vital harm (mortality or ill-health), in a certain context (resource-poor and underserved region). A shared history would strengthen the basis of a care professional’s responsibility to assist the vulnerable This line of reasoning addresses morally urgent needs and interests, and more importantly, it provides the basis why and when certain agents, the physician in this case, would have a responsibility to prevent the risk of harm towards the individuals who are vulnerable to his or her actions. Implications of the physician emigration on the efficiency of ART warrants a closer look

Background

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Conclusion