Reposted from: 'HIF-net at WHO': working together to improve access to reliable information for healthcare workers and health professionals in developing and transitional countries. Send list messages to hif-net@who.int. To join the list, send an email to health@inasp.info with name, organisation, country, and brief description of professional interests. * The notes below were provided by Christine Porter (http://myprofile.cos.com/c_porter) SUMMARY OF EMAIL DISCUSSION ON HIF-net at WHO: 'BRAIN DRAIN' www.inasp.info/health/hif-net/braindrain.html 22 July 2002 - 3 November 2003 The notes below summarize the 41-message discussion on the brain drain of health professionals from developing to developed countries. Input came from 29 HIF-net at WHO members and additional messages were forwarded from 7 contributors to similar discussions in the BMJ and on AFRO-NETS. FRAMING THE PROBLEM Brain drain was discussed in this forum as the loss of trained health professionals from poorer to richer countries, and from rural areas to urban areas of poor countries. The loss of the education investment alone costs poor countries 500m US dollars per year, according to one resource cited in the discussion. Another resource cited the total loss to Africa across all professions at 4 billion US dollars per year. CAUSES OF BRAIN DRAIN In POORER Countries: -- Globalisation and trade liberalization: all countries are 'fishing from the same pond' and those with the better bait catch the fish. -- Lack of opportunities to have professional discussions with others in their own medical speciality. -- Attracted by better salaries in rich countries, further exacerbated by growing economic inequalities. -- Driven out by political upheaval, corrupt leaders, and/or civil unrest at home. This was mentioned specifically in Nigeria and Uganda. -- Driven out by poor working conditions, lack of facilities and/or opportunities to use specialized training. -- Some messages mentioned persecutions, humiliations and firings of medical professionals. -- Some countries have a surplus of medical staff and a shortage of postings, particularly desirable (urban) ones. -- Many available postings are rural where, as one contributor puts it, 'the level of income and career development is un-humane'. -- One contributor mentions that aggressive competition has crippled teaching, learning and professional information networking. In RICHER Countries: -- Nationals in developed countries avoid medical professions because of underfunding by their governments, which in turn has spurred hospitals to aggressively and desperately recruit from wherever they can. -- Nurses in particular have left the profession in droves due to 'terrible working conditions, poor pay, and lack of respect'. -- Nursing, though practitioners are in high demand globally, remains low status with working conditions and salaries to match. SOLUTIONS TO BRAIN DRAIN (counterpoints in brackets): -- Invest in more research and policy study about the causes of the drain and in educating policy makers about the causes. -- Rethink the nursing profession - compensate and treat according to their value. In POORER Countries: -- Improve access to information and communication: e.g., video conferencing, email, online and CD libraries. -- Produce graduates whose qualifications are not recognised abroad, e.g., as one participant said is/was done in Tanzania. (However, others were against 'inferior' qualifications and said this would reduce the numbers of people who apply for healthcare training) -- Provide training and qualifications that are specific to health issues in poorer countries and rural health service, specialized to local needs. -- Create a special 'HIV nurses' qualification, with better pay conditions. (But, who would pay for that?) -- Contract medical students to repay their universities for their education if they leave the country before a minimum service. This is reported to be the case at Makerere University Medical School in Uganda, and in Singapore and Malaysia. The richer countries that accept 'brain drain' professionals could pay the fees. -- Poorer countries need political commitment to create and implement strategies to reduce the drain. -- Improve conditions of service, particularly in rural areas, including capacity building, salaries, social recognition, and networking and research opportunities. -- Fund nursing schools separately from hospitals (as in Zambia) -- Produce enough graduates to supply both local and international markets. In RICHER Countries: -- Better policy planning for meeting their own health staff needs. -- Require reimbursement to poorer governments for brains drained. -- For each post, hire two 'imported' nurses for a fixed term, half of which is spent working in their home country. This could also be run via partnerships between medical institutions. -- Recruit from the health professional diaspora from poorer countries to return for short services stints in their home countries, funded by donors. This diaspora could also lobby for policy changes and donate funds to help their home countries -- Send health professionals to countries that need them on rotation. OTHER ISSUES -- If the drain were stemmed or stopped, could poorer countries absorb the workers? -- Is it sensible to train more staff with public money than the country can afford to hire? -- What damage would be caused by the loss of foreign currency transfers to family back home? -- What is the value of the information and experience exchange that the drain creates? -- What are the ethics of restricting the movement of people? -- How much 'reverse' drain is there from richer to poorer countries? Should total flow be measured? -- A few discussants noted that the drain problem began in West Africa only in the 1970's. Before that time, in Nigeria, the vast majority of health professionals returned to Nigeria after post-graduate training abroad. -- With modern technology, can health professionals provide health care at a distance? (e.g., see the Teledoc telemedicine project in India, which just won the UN's World Summit Award for eHealth: www.jiva.org/news_details.asp?news_id=95) BRAIN DRAIN RESOURCES (All the websites below were tested and okay on 7 December 2003) -- "Global Market in Medical Workers: Exporting Health" by D Frommel in Le Monde Diplomatique, May 2002. "There is now an international trade in doctors and nurses, and every year poor countries lose both the 500m US dollars that it has cost them to train health workers recruited by the developed world, and the health workers, who could be crucial to a permanent improvement in conditions in the South." -- "Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges" in Human Resources for Health, Oct 2003 by B Stilwell et al. Free at www.human-resources-health.com/content/1/1/8 -- "Pull factors in international migration of health professionals". Presentation by W Meeus and D Sanders, South Africa. March 2003. www.hst.org.za/conf03/presentations/L0080.ppt (or download the PowerPoint file from www.hst.org.za/conf03/program.htm). -- "Brain Drain" by O. Gish in The Daily Nation, Pakistan. November 1997. http://meltingpot.fortunecity.com/botswana/616/oscar.html -- "Health Personnel in Southern Africa: Confronting maldistribution and brain drain" by A Padarath et al. 2003. www.equinetafrica.org/Resources/downloads/HRH%20Review.pdf (a 600KB pdf file). -- From A. Odutola's (work-in-progress) bibliographic listing of online resources on brain drain in Africa: * The Brain Drain - Africa's Achilles Heel www.worldmarketsanalysis.com/InFocus2002/articles/africa_braindrain.html *The brain drain: Old myths, new realities www.oecdobserver.org/news/fullstory.php/aid/673/The_brain_drain:_Old_myths,_ new_realities.html * Brain-drain and -gain in South Africa: Who loses, who gains? www.nrf.ac.za/news/braindrain.stm * Gender and the brain drain from South Africa www.queensu.ca/samp/publications/policyseries/policy23.htm * International Mobility of Scientists and Engineers to the United States -Brain Drain or Brain Circulation? www.nsf.gov/sbe/srs/issuebrf/sib98316.htm * Education in Africa: The Brain Drain (Interview) http://emeagwali.com/interviews/brain-drain/education-in-africa-brain-drain- problem-worldnet-africa-journal.html * Brain drain reportedly costing 4 billion US dollars a year www.irinnews.org/report.asp?ReportID=27536 * Reversing brain drain is Africa's major challenge www.arabicnews.com/ansub/Daily/Day/000223/2000022363.html * Brain drain and capacity building in Africa: The Gambian experience www.iom.int/africandiaspora/pdf/WADDA.pdf * South Africa asks Canada to stop stealing doctors away http://cbc.ca/cgi-bin/templates/view.cgi?/news/2001/02/07/safr_docs010207 * Should Africa tolerate the brain drain? http://news.bbc.co.uk/2/hi/talking_point/debates/african_debates/564479.stm * Action needed on brain drain http://manila.djh.dk/global/stories/storyReader$98 * Intellectual Colonisation: Insidious Debt-for-Equity Swap. IMF/WB link in brain drain conspiracy www.africa2000.com/SNDX/brain.htm * Causes and Consequences of Brain Drain - How long should Africa tolerate this? http://chora.virtualave.net/brain-drain7.htm * Brain drain is an euphemism for modern slavery www.nigerdeltacongress.com/barticles/brain_drain_is_an_euphemism_for_.htm * African Brain Drain: Igbo Decisions to Immigrate to the US www.roape.org/cgi-bin/roape/show/9205.html * Losing Our Minds: Migration and the 'brain drain' from South Africa www.queensu.ca/samp/publications/policyseries/policy18.htm * Brain drain and undocumented migrants of national importance www.hsrc.ac.za/media/1999/3/19990330.html