In 2013, the World Health Organization estimated that the world would be short of 12.9 million health-care workers by 2035, with the largest shortages expected to be in parts of Asia. This shortage is partly because of health workers migrating internationally as demand grows from national health systems in wealthy countries. This migration results in a “brain gain” for the recipient country and “brain drain” in the source country.

Drivers of migration

Active recruitment by the wealthy nations is a major contributor to health worker migration, but this alone is not to blame for the ever increasing number of health workers emigrating.
Many health workers leave their home country because of push factors such as: weak economies that result in poor remuneration and weak health systems and poor working conditions. This is in contrast to recipient countries that often offer better salaries and a better working environment.

Another factor that triggers brain drain is the internationalisation of education, which can be seen as a stepping stone for migration. Many students who seek education outside their countries end up staying and working in their host countries; which has been the case in many Asian countries.

Several strategies have been tried and shown to lower the number of health workers migrating to other countries. At the top of the list is to ensure the presence of a high quality database detailing the patterns of migration in health workers. Such a database enables policy makers to make evidence-based decisions.

As poor remuneration and working conditions is a major contributor of migration, financial and nonfinancial incentives is key to retaining health workers. These include better pay and allowances, improved leave days, better working hours and better worker patient ratio.

To address migration due to internationalization of education, medical schools should redesign their curriculum to make them more localized, with a focus on endemic problems and application of locally-adapted guidelines. This approach creates community-oriented doctors who are more desired locally while making them less marketable globally. Another approach is to make foreign education available locally through opening of branches locally, or local universities being affiliated with internationally renowned institutions. For example, many foreign universities have opened international branch campuses in China, Singapore and Malaysia, creating an opportunity for local students who desire to learn from international Universities.

International treaties to stem outflow

A good number of doctors, especially at postgraduate level migrate due to limited funding and opportunities to conduct research at home. To address this, doctors should be offered teaching and research opportunities in locally based institutions in local topics of interest.
Finally, many countries are part of ongoing international efforts to curb the issue of active recruitments, especially from low and middle income countries. Attempts are being made to establish international codes of conduct in terms of human resource recruitment. To date, two Global Forums on Human Resources for Health have occurred, convened by the Global Health Workforce Alliance, the first in 2008 and the second in 2011. Countries have gone further and created bilateral treaties preventing recruitment and enrolment of health workers from countries in the treaty. While disadvantaging the health worker, it helps reduce the outflow of health workers from the country.

It is nearly impossible to completely stop health worker brain drain since health workers will always be attracted to higher incomes and better work environments. Nevertheless, concerted efforts at improving training, task-shifting, improving health workers incentives and work environment could potentially retain health workers preventing further weakening of an already fragile health system. MIMS

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