Migration of Doctors and Nurses from Developing to Developed Countries

Is the "brain drain" of doctors and nurses from poor to rich countries hurting health care in those developing lands? Is the massive inflow of donor dollars to pay for HIV/AIDS treatment in poor countries diverting resources away from other health concerns in those already underserved places?

These two issues were front and center at an HSPH symposium sponsored by the Department of Population and International Health on April 18 in Kresge G-2. The event was organized by Thomas Bossert, director of the International Health Systems Program at HSPH.

Kicking off the symposium, Lincoln Chen, president of the China Medical Board and founder of the Global Equity Initiative at Harvard University's Asia Center, cautioned the audience about simplistic conclusions based on incomplete data and insufficient analyses. Statistics do not tell the whole story, he argued, noting that the migration of doctors can be a serious problem.

"When half the doctors in Ghana leave [for example], you've got to be missing something,' he said.

There have been suggestions that migration of doctors and other health care workers from developing countries to developed countries be banned in order to stem the tide. Or, that wealthy nations make complusory payments to poorer nations for importing such workers.

Chen rejected such dramatic proposals. He supported the idea that rich nations become more self-sufficient in producing their own doctors, and he argued that wealthier countries should invest foreign aid in strengthening the education of health workers in the poorest countries. Chen described the concept as "human resource development" and noted that a number of steps have been taken recently to help boost the idea, including a bill filed in the U.S. Congress to fund such initiatives.

Economist Michael Clemens from the Center for Global Development in Washington, D.C., suggested that fixes, such as forcing Western nations to stop recruiting or hiring these health professionals, would be unwise.

There is no evidence that the international movement of health professionals, in and of itself, causes substantial degradation of health systems in Africa, said Clemens. That movement, and weak health systems, are caused by much deeper problems that are not solved by stopping movement alone.

In any case, he said, it would be wrong to restrict opportunities for jobs with better pay and more professional advancement.

Doing anything to keep them from leaving countries they wish to leave is profoundly unethical, Clemens said, adding, "Their dreams and rights are as valid as anybody else's."

Clemens noted that doctors who come to the U.S. from Africa send back on average $5,400 per year to family at home. "That's doing something for their countries,' he said.

On the issue of HIV/AIDS funding, Mead Over from the Center for Global Development said that there are no data available to prove whether the immense focus on one syndrome is interfering with the capacity of health care systems to cope with other illnesses. "We're trying to collect data right now," he said. "But it is obvious that the roll out of AIDS treatment has been a big shock to the system."

Availability of antiretroviral therapy has increased the need for services while the supply of workers has decreased, he noted. "We're at the beginning of a population explosion of AIDS patients who need to take drugs every day to stay alive," he said. "It adds a whole new set of demands on the health care system."

Both shifting tasks from doctors to workers with less training and increasing wages for all workers will be needed to help stabilize the situation, he said.

Other speakers at the event included economist Caglar Ozden of the World Bank and Mary O'Neil of Management Sciences for Health in Boston.

—Michael Lasalandra. Photo by Suzanne Camarata.