Poor countries need to tackle the health brain drain
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《英国医生杂志》
With the United Kingdom needing 10 000 more doctors, and with more than 7000 nurses from the Philippines alone currently registered in the United Kingdom, compared with just 52 in 1999, a new report says that the countries providing the workers, as well as those that hire them, need to look for solutions.
"Source countries must work on improving staff attraction and retention. Recipient countries should also try to get their own houses in order so they are not a permanent drain on health professionals from the South," says a study in Health Policy ( 2004;70: 1-10).
In research funded by the UK's Department for International Development, the authors looked at Ghana, a net exporter of health workers; South Africa, an importer and exporter; and England, a net importer.
The authors, Peter Bundred from the department of primary care, Liverpool University, Tim Martineau from the Liverpool School of Tropical Medicine, and Karola Decker from the University of Hamburg, say that the effects on source countries of losing health workers can be serious.
"The Centre for Spinal Injuries in Boxburg, near Johannesburg, South Africa was the referral centre for the whole region. On the same day in 2000 the two anaesthetists were recruited by a Canadian institution opening a new Spinal Injuries Unit. A consequence of the loss of these two key staff was the temporary closure of the centre," says the report.
The authors report that India has lost up to $5bn (￡2.7bn; 4.1bn) in investment in training of doctors since 1951 and that Ghana has lost around $60m.
The authors say a "carousel" movement of doctors exists. The Canadian provinces of Alberta and Saskatchewan, for example, have been recruiting actively in South Africa for GPs to work in remote rural areas. At the same time South Africa has been recruiting internationally to fill rural posts.
The report says that many African doctors also migrate within the continent, mostly to southern African states where salaries are often higher: for instance, $1242 a month in South Africa, compared with $50 in Sierra Leone.
It suggests that some of the demand in developed countries is due to the pyramidal structure of the workforce: a large number of junior and intermediate level doctors supporting a small number of consultants. "The structure works if foreign medical graduates contribute to the mid- and lower level posts in hospitals. In the UK foreign medical graduates trained outside the European Economic Area make up 65% of the staff grades compared with 17% of consultants," the report says.
It says that, to allow proper monitoring, accurate data on the numbers of migrating health professionals are needed.
"The negative impact on health services in certain poor countries of mass recruitment of health professionals by industrialised countries seems to be beyond dispute. Since the pressure from richer nations on the international health labour market is clearly set to increase, the situation is likely to get worse."(Roger Dobson)
"Source countries must work on improving staff attraction and retention. Recipient countries should also try to get their own houses in order so they are not a permanent drain on health professionals from the South," says a study in Health Policy ( 2004;70: 1-10).
In research funded by the UK's Department for International Development, the authors looked at Ghana, a net exporter of health workers; South Africa, an importer and exporter; and England, a net importer.
The authors, Peter Bundred from the department of primary care, Liverpool University, Tim Martineau from the Liverpool School of Tropical Medicine, and Karola Decker from the University of Hamburg, say that the effects on source countries of losing health workers can be serious.
"The Centre for Spinal Injuries in Boxburg, near Johannesburg, South Africa was the referral centre for the whole region. On the same day in 2000 the two anaesthetists were recruited by a Canadian institution opening a new Spinal Injuries Unit. A consequence of the loss of these two key staff was the temporary closure of the centre," says the report.
The authors report that India has lost up to $5bn (￡2.7bn; 4.1bn) in investment in training of doctors since 1951 and that Ghana has lost around $60m.
The authors say a "carousel" movement of doctors exists. The Canadian provinces of Alberta and Saskatchewan, for example, have been recruiting actively in South Africa for GPs to work in remote rural areas. At the same time South Africa has been recruiting internationally to fill rural posts.
The report says that many African doctors also migrate within the continent, mostly to southern African states where salaries are often higher: for instance, $1242 a month in South Africa, compared with $50 in Sierra Leone.
It suggests that some of the demand in developed countries is due to the pyramidal structure of the workforce: a large number of junior and intermediate level doctors supporting a small number of consultants. "The structure works if foreign medical graduates contribute to the mid- and lower level posts in hospitals. In the UK foreign medical graduates trained outside the European Economic Area make up 65% of the staff grades compared with 17% of consultants," the report says.
It says that, to allow proper monitoring, accurate data on the numbers of migrating health professionals are needed.
"The negative impact on health services in certain poor countries of mass recruitment of health professionals by industrialised countries seems to be beyond dispute. Since the pressure from richer nations on the international health labour market is clearly set to increase, the situation is likely to get worse."(Roger Dobson)