Medical Brain Drain Research Articles

Zimbabwe's Medical Brain Drain: Impact Assessment on Health Service Delivery and Examination of Policy Responses: A Literature Review

The migration of health professionals to greener pastures negatively impacts on the healthservice delivery of the source countries. The trend is that doctors and nurses migrate fromrural areas to urban areas or from developing countries to developed countries in search ofbetter economic welfare and working conditions. In search of the same conditions, healthprofessionals also migrate from the public sector to the private sector. The causes for thismigration, which are largely viewed to be of economic nature, constitute the ‘push’ and‘pull’ factors. It is these factors that policy-makers should carefully study in order to arrestthe medical brain drain. Zimbabwe has not been spared of this phenomenon. In theprocess, the poor, and especially in rural areas, have been the worst victims. ZimbabweanGovernment policies, though well-intended, have not been adequate enough to arrest thesituation. This paper argues that an integrated policy approach is best positioned toaddress the brain drain problem, which has negatively impacted on the health servicedelivery system. The integrated policy approach takes cognizance of the various factorsthat constitute the complex nature of the brain drain. Such factors include global, regional,national, international market labour, development theory and practice, and human rightsand justice issues, which, unfortunately, are not usually given much consideration duringthe policy formulation process.

The Iraqi Medical Brain Drain: A Cross-Sectional Study

This study aims to explore the independent predictors of physicians' emigration from Iraq and the emigration temporal trends of Iraqi doctors. We used a convenience sample of Iraqi physicians, extracting their e-mail addresses from public records of Iraqi Medical Association websites and asking them to complete an online survey. Of the 1,395 Iraqi physicians contacted, 599 responded and 567 were eligible for inclusion. Of these, 202 reside in Iraq and the rest live abroad. Doctors abroad describe better work atmospheres, job satisfaction, and training quality. The majority live in English-speaking countries. Of these, 60 percent left Iraq for security reasons, 99 percent left when they were juniors, and 66 percent of those completed their specialty training and settled abroad forever. Of doctors abroad, 17 percent want to return to Iraq, while 50 percent of doctors in Iraq want to leave. Iraqi doctors' rate of emigration peaked in 2006; these figures have since declined, but remain relatively high. Iraq has lost many of its doctors, and emigration is ongoing. The predictors of emigration shifted from financial issues during the 1990s to security and training concerns after 2003. The mass exodus will impact the health care system in the long term.

Perceptions of medical brain drain among young doctors in Kenya: a cross-sectional survey

BackgroundThe Kenyan health-care system has been subject to brain drain—the emigration of people with technical skills. The views of young doctors who remain in Kenya and provide health-care services are unknown. Our aim was to assess the perceptions of medical brain drain among young doctors in Kenya. MethodsWe did a descriptive cross-sectional study between March and May, 2012. We gave semi-structured self-administered questionnaires to doctors aged 50 years or younger in all seven provinces of Kenya with multi-stage sampling (doctors aged 50 years and younger were randomly selected from government provincial, district, and private hospitals in each of Kenya's seven provinces). Data were entered on Epi-data (version 3.1) and percentages calculated with SPSS (version 17). FindingsWe invited 1571 doctors to participate in the study, of whom 288 took part. 260 (90%) were not satisfied with their pay and 244 (85%) have thought, or are thinking of seeking employment outside of Kenya. Major reasons include poor economic returns (n=124, 43%), general job dissatisfaction (n=72, 25%), and dissatisfaction with social or political conditions (n=24, 8%). Potential solutions for prevention of medical brain drain include improved pay (n=220, 76%), increased funding for health services (n=204, 71%), and more opportunities to have input on policy changes (n=108, 38%). InterpretationMedical brain drain could be addressed by involving young doctors in key health policy-making decisions. The Kenyan Government should pay young doctors well to prevent medical brain drain and increase health-care funding as per the Abuja declaration. FundingNone.

POLICIES FOR GLOBALIZATION AND DEVELOPMENT: FOUR EXAMPLES

This paper addresses the role of policy in the relationship between globalization and development by considering four examples: trade-related capacity building, standards for multinational enterprises, medical brain drain, and access to medicines. The paper demonstrates that, despite concerns about policy space, there is some room for improving the way that globalisation processes contribute to development and poverty alleviation. None of the policies considered constitutes a fix-all but rather can make some marginal changes that could be significant in the long run.

Physician Brain Drain from Sub-Saharan Africa: Exploring the Utility of an Eco-psychopolitical Validity Framework for Medical Migration Research

Abstract In-depth understanding of any critical social issue requires investigators to use analytical tools that reflect the complexity of the social issue of interest. Toward this aim, I examine the medical brain drain from Sub-Saharan Africa to the United States through the lens of the eco-psychopolitical validity model (see, Christen & Perkins, 2008; Prilleltensky, 2008), an integrative approach that stresses the combined influences of structural factors, individual agency, and power at play in human dynamics and social systems. By adapting the eco-psychopolitical validity model to the study of medical skilled migration, I construe migration as a liberating venture articulated around the triadic process of oppression, empowerment, and wellness. If migrants yearn to breathe free, then emigre physicians are essentially in pursuit of liberation and wellbeing. However, in a world of profound health disparities, where the increasing emigration of medical doctors from resource-constrained countries ultimately leads to loss of lives in the communities left behind, migrant doctors’ individual agency and the multilevel contexts that enable or constrain them to emigrate require critical reflection. Some emerging themes and variations of an ongoing qualitative study are examined using the eco-psychopolitical validity paradigm.

Is there a medical brain drain?

Résumé Cet article propose d’étudier les conditions sous lesquelles l’émigration du personnel médical peut être bénéfique ou néfaste pour les pays d’origine des migrants. Nous utilisons la base de données de Bhargava et Docquier (2007) afin d’analyser l’évolution du nombre de médecins par habitant dans le monde depuis le début des années 1990. Plus précisément, nous analysons si les pays convergent ou divergent en termes de nombre de médecins par habitant et si les perspectives de migration peuvent influencer le choix d’entreprendre des études médicales. Nos résultats économétriques montrent que (i) il existe un processus de convergence (conditionnelle) du nombre de médecins par habitant des pays vers leur équilibre de long terme ; (ii) le taux d’émigration des médecins a un impact significatif sur la décision d’entreprendre des études médicales dans les pays les plus pauvres (notamment la région d’Afrique Sub-Saharienne). Enfin, les expériences contrefactuelles portant sur les pays africains montrent que certains de ces pays peuvent profiter du départ de leurs travailleurs médicaux, mais uniquement sous certaines conditions très restrictives relatives à leur taux d’émigration des médecins. Classification JEL : O15 ; F22 ; J61 ; I10.

Why the ex-colonial medical brain drain?

The migration of health professionals, especially doctors, from the developing (third) world to the developed (first) world has caused much guilty rumination in the host countries, and lamentation in the donor countries. Accusations of immoral ‘poaching’ have been levied, non-poaching treaties have been proposed and financial compensation has been suggested as a remedy. In all of this uproar, the doctors concerned have made sporadic attempts, in the correspondence columns of journals like the BMJ and the Lancet, to explain their decisions.1,2 Less thought has been given to the historical background, and indeed the historical inevitability, of this phenomenon. Researching the migration motives of one group of medical migrants led me, a South African medical graduate who migrated to Australia, to consider what common factors might have led these tens of thousands of doctors to leave home and hearth, family and friends, colleagues and careers.

Globalization, Brain Drain, and Development

This paper reviews four decades of economics research on the brain drain, with a focus on recent contributions and on development issues. We first assess the magnitude, intensity, and determinants of the brain drain, showing that brain drain (or high-skill) migration is becoming a dominant pattern of international migration and a major aspect of globalization. We then use a stylized growth model to analyze the various channels through which a brain drain affects the sending countries and review the evidence on these channels. The recent empirical literature shows that high-skill emigration need not deplete a country's human capital stock and can generate positive network externalities. Three case studies are also considered: the African medical brain drain, the exodus of European scientists to the United States, and the role of the Indian diaspora in the development of India's information technology sector. We conclude with a discussion of the implications of the analysis for education, immigration, and international taxation policies in a global context. (JEL F02, F22, J24, J61, O15)

Modeling the effects of physician emigration on human development

We analyzed the effects of physician emigration on human development indicators in developing countries. First, the geographical distribution of physician brain drain was documented for the period 1991–2004. Second, random and fixed effects models were employed to investigate the effects of physicians in the home countries and abroad on child mortality and vaccination rates. Third, models were estimated to investigate migration-induced incentives in the medical sector that would increase the number of physicians. The results showed positive effects of migration prospects on medical training though the magnitude was too small for generating a net brain gain. Also, infant and child mortality rates were negatively associated with the number of physicians per capita after adult literacy rates exceeded 60%. The results for DPT and measles vaccinations underscored the importance of literacy rates and physicians per capita for higher vaccination rates. From the standpoint of Millennium Development Goals, reducing medical brain drain is likely to have only small benefits for child mortality and vaccination rates.

Is there a medical brain drain?

This paper offers initial insights on the general circumstances under which a beneficial or a detrimental brain drain is obtained in the medical sector. For that purpose, we use an original dataset so as to analyze determinants of the evolution in the relative number of medical doctors in the world since the beginning of the 1990s. More precisely, we ask whether countries are converging or diverging in terms of the number of medical doctors and whether migration perspective gives an incentive to undergo medical studies. Our econometrics results show that (i) countries experience a (conditional) convergence process in their long-run equilibrium in terms of medical doctors per capita; (ii) the emigration rate of medical doctors has a positive and significant impact on education decision in the poorest countries. Some counterfactual experiments reveal that some African countries can benefit from the departure of their medical workers if emigration rates but under very restrictive conditions on medical doctors' emigration rates.

Les transferts des migrants sont-ils plus efficaces que l'aide pour améliorer la santé des enfants ? Une évaluation économétrique sur des données inter et intra-pays

Résumé Cet article analyse l’impact respectif de l’aide publique au développement et des envois de fonds des migrants sur le développement humain mesuré par les taux de mortalité infantile et infanto-juvénile. Il mobilise pour ce faire des données de panel portant sur un échantillon de 109 pays en développement ainsi que des données désagrégées par quintile de revenu portant sur un échantillon de 47 pays en développement. Outre l’évaluation de l’impact des transferts et de l’aide sur la réduction de la mortalité infantile et infanto-juvénile, cet article examine deux autres questions : quel est l’effet net de la migration une fois pris en compte l’effet de la migration des personnels de santé ? Quel est l’impact de l’aide et des transferts sur les disparités intra-pays en matière de mortalité infantile ? Nos résultats tendent à montrer que les transferts des migrants réduisent significativement le taux de mortalité des enfants et que l’impact de l’aide publique est non linéaire, cette dernière étant plus efficace dans les pays les plus pauvres. En revanche, la migration des personnels de santé apparaît particulièrement dommageable pour les performances en matière de santé de ces pays. L’effet net de la migration sur le taux de mortalité des enfants s’en trouve donc réduit. Enfin, les transferts des migrants semblent davantage réduire la mortalité des enfants des ménages appartenant aux quintiles les plus riches, alors qu’aucun effet pro-pauvre ou pro-riche de l’aide n’est décelé.

Documenting the Brain Drain of “La Crème de la Crème”

Summary Most of the recent literature on the effects of the brain drain on source countries consists of theoretical papers and cross-country empirical studies. In this paper we complement the literature through three case studies on very different regional and professional contexts: the African medical brain drain, the exodus of European researchers to the United States, and the contribution of the Indian diaspora to the rise of the IT sector in India. While the three case studies concern the very upper tail of the skill and education distribution, their effects of source countries are contrasted: clearly negative in the case of the exodus of European researchers, clearly positive in the case of the Indian diaspora’s contribution to putting India on the IT global map, and mixed in the case of the medical brain drain out of Africa.

The Economic Impact of Medical Migration: An Overview of the Literature

This paper provides an overview of the evidence and applied literature on medical migration. The economic impacts of medical migration have been little researched, causing a polarisation in the debate between its critics and its proponents. The paucity of quantitative studies may be explained by the lack of comprehensive and consistent data. Investments in statistical resources on medical migration are therefore a major priority. The available evidence suggests that particularly English‐speaking countries in Sub‐Saharan African countries and the Caribbean with relatively few health workers and a high disease burden suffer most from the medical brain drain. However, the exodus of health workers is not the main cause of the health status crisis, but rather a symptom of deeper underlying problems, which often extend beyond the health sector towards the broader economic and political environment. In such situations, medical brain drain does pose challenges for human resource management and health service delivery. The only effective and long‐term sustainable policy is one that addresses the underlying push and pull factors. Reforms have to be country‐led, but may be supported via temporary migration schemes, remittances, enhancement of diaspora networks, and financial aid for which a strong moral case exists.

Medical Brain Drain and Its Consequences for Poland - A Country Case Study

This paper looks at some negative effects of Brain Drain for Poland. We propose to look at specific numbers of human capital emigration from Poland, in particular those for the medical professions outflow. We juxtapose the relevant data on human capital migration from Poland with the most fundamental demographic data and the demographic predictions for Poland until 2054. Our hypothesis is that brain drain, especially the outflow of the medical professionals from Poland, which has a stable population regime, a TFR of 1.2 and unfavorable prospects for the labor market structure as well as unfavorable predictions for the Net Dependency Ratio will - if not counteracted - pose a serious challenge in the future, especially for policy makers. We conclude that medical staff brain drain from Poland is detrimental and may harm Poland's Raison d'Etat in the long run. Policy measures are necessary.

Physician Brain Drain: Can Nothing Be Done?

Access to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ‘locally relevant medical training’—teaching primarily locally endemic diseases and practice in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries.

New data on African health professionals abroad

BackgroundThe migration of doctors and nurses from Africa to developed countries has raised fears of an African medical brain drain. But empirical research on the causes and effects of the phenomenon has been hampered by a lack of systematic data on the extent of African health workers' international movements.MethodsWe use destination-country census data to estimate the number of African-born doctors and professional nurses working abroad in a developed country circa 2000, and compare this to the stocks of these workers in each country of origin.ResultsApproximately 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in a developed country in the year 2000. This represents about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses. The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country.ConclusionThese numbers are the first standardized, systematic, occupation-specific measure of skilled professionals working in developed countries and born in a large number of developing countries.

HIV Pandemic, Medical Brain Drain, and Economic Development in Sub-Saharan Africa

Country-level longitudinal data at three-year intervals over 1990–2004 are used to analyze the factors affecting emigration of physicians from Sub-Saharan countries and the effects of this medical brain drain on life expectancy and number of deaths due to AIDS. Data are compiled on emigrating African physicians from 16 receiving Organisation for Economic Co-operation and Development (OECD) countries. A comprehensive longitudinal database is developed by merging the medical brain drain variables with recent data on HIV prevalence rates, public health expenditures, physicians' wages, and economic and demographic variables. A triangular system of equations is estimated in a random effects framework using five time observations for medical brain drain rates, life expectancy, and number of deaths due to AIDS, taking into account the interdependence of these variables. Lower wages and higher HIV prevalence rates are strongly associated with the brain drain of physicians from Sub-Saharan African to OECD countries. In countries in which the HIV prevalence rate exceeds 3 percent, a doubling of the medical brain drain rate is associated with a 20 percent increase in adult deaths from AIDS; medical brain drain does not appear to affect life expectancy. These findings underscore the need to improve economic conditions for physicians in order to retain physicians in Sub-Saharan Africa, especially as antiretroviral treatment becomes more widely available.

Is the medical brain drain beneficial? Evidence from overseas doctors in the UK

The ‘beneficial brain drain’ hypothesis suggests that skilled migration can be good for a sending country because the incentives it creates for obtaining training increase that country's net supply of skilled labour. Necessary conditions for this hypothesis to work are that the possibility of migration significantly affects decisions to take medical training and that migrants are not strongly screened by the host country. We conducted a survey among overseas doctors in the UK in 2002, which suggested that neither condition is likely to be fulfilled. Apart from the ‘beneficial brain drain’ argument, the survey findings also cast light on the backgrounds and motives of migrant doctors, and finds evidence that there could, nonetheless, be other benefits to sending countries via routes like remittances and return migration.

Medical migration from Zimbabwe: magnitude, causes and impact on the poor

This article examines the migration of health professionals from Zimbabwe in the face of a worsening economic and political crisis. Drawing on data from selected health institutions, it shows that the magnitude of this migration is increasing, with no signs of slowing down, and that economic factors are largely responsible. This outflow has negatively affected the users of the health system, particularly the poor who cannot afford the alternative health services offered by the better-staffed and well-equipped private clinics and consequently have resorted to visiting traditional and faith healers. Based on the research findings, the study calls for a speedy resolution of the current economic and political crisis as a long-term solution for reducing the medical brain drain from Zimbabwe.

New Data on African Health Professionals Abroad

The migration of doctors and nurses from Africa to developed countries has raised fears of an African medical brain drain. But empirical research on the causes and effects of the phenomenon has been hampered by a lack of systematic data on the extent of African health workers' international movements. We use destination-country census data to estimate the number of African-born doctors and professional nurses working abroad in a developed country circa 2000, and compare this to the stocks of these workers in each country of origin. Approximately 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in a developed country in the year 2000. This represents about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses. The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country. These numbers are the first standardized, systematic, occupation-specific measure of skilled professionals working in developed countries and born in a large number of developing countries.