Health Workforce Brain Drain: From Denouncing the Challenge to Solving the Problem

Migration of health workers from lowand middle-income countries (LMICs) to high-income countries is one of the most controversial aspects of globalization, having attracted considerable attention in the health policy discourse at both the technical and political level [1]. Some countries (e.g., the Philippines [2]) train health workers to export them overseas and reap the financial benefits of remittances; such investments should therefore be considered as driven primarily by economic— rather than population health—motives. In most cases, however, migration of health professionals is unplanned for and represents a ‘‘brain drain’’ for source countries, a result of enormous wage differences and poor working conditions, including lack of support, adequate infrastructure, and career development opportunities, in LMICs. The increased recognition that this phenomenon contributes to exacerbating human resources for health (HRH) shortages in LMICs culminated in the adoption of the World Health Organization global code of practice on international recruitment of health personnel (the WHO Code) at the World Health Assembly in 2010 [3]. Four countries (US, UK, Australia, Canada) together employ 72% of foreign-born nurses and 69% of doctors working in the Organisation for Economic Co-operation and Development (OECD) bloc [4], with the US employing the most of any country. In this week’s issue of PLOS Medicine, a new analysis of physician migration from sub-Saharan Africa (SSA) to the United States by Tankwanchi and colleagues [5] highlights two inter-related and worrying trends: (1) migration of these physicians is on the rise; and (2) physician density is declining in the majority of African countries under investigation. The WHO Code represents an unprecedented opportunity for countries to collaborate on tackling the negative effects of HRH migration. In addition to the migration-specific measures (such as promoting bilateral or multilateral agreements to coordinate HRH flows between countries, or advocating fair treatment of migrant health workers), the Code recognizes the interconnectedness of HRH actions in the national and global health labor markets, and the need for a systemic approach to health workforce development, recommending that countries should aim towards self-sufficiency in HRH production, and put in place the regulation, education, and management policies, and incentives to enhance retention.