Retaining health manpower in developing countries

Abstract

I was pleased to see the undergraduates' concern about health-care delivery in developing countries (May 16, p 1665).1Agwu K Llewelyn M on behalf of undergraduates in International Health at UCLCompensation for the brain drain from developing countries.Lancet. 2009; 373: 1665-1666Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar As they discuss, compensation could be a solution to the problem of migration, but it would only be a temporary one. The main reasons health-care workers migrate are to look for better opportunities, a better lifestyle, better education for their children, and safe working conditions. So unless home countries are able to give some hope in these regards, the migration of health-care workers from developing to developed countries will continue. The following options might help further.Bonding systems could require medical or nursing graduates to serve for a minimum number of years in the home country before going for further training. Such a scheme has helped rural Nepal keep hold of more of its young doctors in recent times. Increasing facilities such as schools, police posts, and the availability of telephone networks and the internet could help doctors to remain in the rural setting of developing countries where they are urgently needed.Finally, increasing both the numbers and skill sets of mid-level health-care workers such as health assistants and community medical assistants could boost the backbone of the health-care service in rural settings. Additionally, because the qualification is not internationally recognised, such workers are less likely to migrate. So, rather than producing more doctors, shifting the focus to mid-level health care workers might help developing countries, at least in the delivery of basic health care and to move towards achieving the Millennium Development Goals.I declare that I have no conflicts of interest. I was pleased to see the undergraduates' concern about health-care delivery in developing countries (May 16, p 1665).1Agwu K Llewelyn M on behalf of undergraduates in International Health at UCLCompensation for the brain drain from developing countries.Lancet. 2009; 373: 1665-1666Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar As they discuss, compensation could be a solution to the problem of migration, but it would only be a temporary one. The main reasons health-care workers migrate are to look for better opportunities, a better lifestyle, better education for their children, and safe working conditions. So unless home countries are able to give some hope in these regards, the migration of health-care workers from developing to developed countries will continue. The following options might help further. Bonding systems could require medical or nursing graduates to serve for a minimum number of years in the home country before going for further training. Such a scheme has helped rural Nepal keep hold of more of its young doctors in recent times. Increasing facilities such as schools, police posts, and the availability of telephone networks and the internet could help doctors to remain in the rural setting of developing countries where they are urgently needed. Finally, increasing both the numbers and skill sets of mid-level health-care workers such as health assistants and community medical assistants could boost the backbone of the health-care service in rural settings. Additionally, because the qualification is not internationally recognised, such workers are less likely to migrate. So, rather than producing more doctors, shifting the focus to mid-level health care workers might help developing countries, at least in the delivery of basic health care and to move towards achieving the Millennium Development Goals. I declare that I have no conflicts of interest.