The baffling phenomenon of brain drain
For Bangladeshis, it is very common to see students who have earned good CGPAs to apply to a developed country for their higher studies and subsequently migrating there permanently. This phenomenon itself actually has a name, which is called "brain drain" in slang and in proper terms it is known as human capital flight.
Brain drain is the migration of skilled human resources for trade, education, etc. Trained health professionals are needed in every part of the world. However, better standards of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in the developed countries attract talent from less developed areas. The majority of migration is from developing to developed countries. This is of growing concern worldwide because of its impact on the health systems in developing countries. These countries have invested in the education and training of young health professionals. This translates into a loss of considerable resources when these people migrate, with the direct benefit accruing to the recipient states who have not forked out the cost of educating them. The intellectuals of any country are some of the most expensive resources because of their training in terms of material cost and time, and most importantly, because of lost opportunity.
In 2000 almost 175 million people, or 2.9 per cent of the world's population, were living outside their country of birth for more than a year. Of these, about 65 million were economically active. This form of migration has in the past involved many health professionals: nurses and physicians have sought employment abroad for many reasons including high unemployment in their home country.
International migration first emerged as a major public health concern in the 1940s, when many European professionals emigrated to the UK and USA.4 In the 1970s, the World Health Organization (WHO) published a detailed 40-country study on the magnitude and flow of the health professionals. According to this report, close to 90 per cent of all migrating physicians, were moving to just five countries: Australia, Canada, Germany, UK and USA.
In 1972, about 6 per cent of the world's physicians (140000) were located outside their countries of origin. Over three-quarters were found in only three countries: in order of magnitude, the USA, UK and Canada. The main donor countries reflected colonial and linguistic ties, with a dominance of Asian countries: India, Pakistan and Sri Lanka. By linking the number of physicians per 10 000 population to gross domestic product (GDP) per capita, the countries that produced more physicians than they had the capacity to absorb were identified as Egypt, India, Pakistan, Philippines and South Korea. However, the lack of reliable data and the difficulties of defining whether a migrant is 'permanent' or 'temporary' still exist.
One may claim that this migration from developing countries is both useful and unavoidable. There are definite advantages -- enabling the migrant to spend time in other countries -- but at the same time, the very low emigration rate of professionals from USA or UK may be as disturbing a sign as the high rates of immigration to these countries.
Young, well-educated, healthy individuals are most likely to migrate, especially in pursuit of higher education and economic improvement. The distinction between 'push' and 'pull' factors has been recognized. Continuing disparities in working conditions between richer and poorer countries offer a greater 'pull' towards the more developed countries. The role of governments and recruitment agencies in systematically encouraging the migration of health professionals increases the pull.
Migrant health professionals are faced with a combination of economic, social and psychological factors, and family choices, and reflect the 'push-pull' nature of the choices underpinning these 'journeys of hope'. De-motivating working conditions, coupled with low salaries, are set against the likelihood of prosperity for themselves and their families, work in well-equipped hospitals, and the opportunity for professional development.
In many cases, the country is not only losing its investment in the education of health professionals, but also the contribution of these workers to health care. For example, healthcare expenditure in India is 3 per cent of GDP compared to 13 per cent of GDP in the USA and the ratio of doctor to patients in India is 1:2083 compared to the USA where the ratio is 1:500.13 Moreover, in many developing countries healthcare systems are suffering from years of underinvestment, which, for health professionals, has resulted in low wages, poor working conditions, a lack of leadership and very few incentives.
Employers in receiving countries take a different position; they have their own shortages of skilled people in specific fields and can drain a developing country of expertise by providing job opportunities. However, keeping the social, political and economic conditions in the developing countries in mind, can we stop the brain drain? Probably not!
Higher education is one of the principal conduits of permanent emigration. The majority of doctors acquire specialized and postgraduate professional qualifications in the host country. Half of the foreign-born graduate students in France, UK and USA remain there after completing their studies. Among the doctoral graduates in science and engineering in the USA in 1995, 79 per cent of those from India and 88 per cent from China remained in the USA.
As of 2017, brain drain has been a significant consequence of the ongoing Puerto Rican debt crisis. In particular, the exodus of skilled medical professionals has hit the island hard. While more than half of Puerto Rico's residents receive Medicare or Medicaid, the island receives significantly fewer federal funds to pay for these programs than similarly sized states on the mainland, such as Mississippi. This combined with the island's dire financial situation precludes its ability to offer competitive compensation to doctors, nurses and other medical staff. As a result, such professionals are leaving the island en masse for more lucrative opportunities on the mainland. This situation was exacerbated by Hurricane Maria, which occurred on September 2, 2017.
There are many things governments can do to combat brain drain. According to the OECD Observer, "Science and technology policies are key in this regard." The most beneficial tactic would be to increase job advancement opportunities and research opportunities in order to reduce the initial loss of brain drain as well as encourage highly-skilled workers both inside and outside the country to work in that country. The process is difficult, and it takes time to establish these sorts of facilities and opportunities, but it is possible, and becoming increasingly necessary.
These tactics, however, do not address the issue of reducing brain drain from countries with issues such as conflict, political instability or health risks, meaning that brain drain is likely to continue as long as these problems exist.
Asif Iqbal is an economist