Brain drain and the public health
Brain drain refers to the flow of trained and talented individuals such as scientists, researchers, or health professionals to other nations. It is a phenomenon most problematic in developing countries like the Philippines where higher education and a professional certification could provide better opportunities abroad than what is locally available. Consider for example the health sector. More doctors and nurses are now leaving the country for higher wages or better opportunities abroad. This movement of trained health professionals is now perceived to be creating a crisis in public health. The Health Secretary Francisco Duque III himself has been reported in the Philippine Daily Inquirer last week that if he had his way, he would bar the migration of Filipino doctors abroad to prevent a shortage of medical practitioners in the country by invoking the Migrant Workers and Overseas Filipinos Act of 1995. But is the international movement of health professionals the real culprit here?
I remember a short article in Nature early this year that touched on this subject. The article is entitled “In praise of the ‘brain drain'” and appeared in the March 15 issue of the journal (Nature 446, 15 Mar 2007 p. 231). According to this article, “countries and professions that export skilled staff do not always lose out.” There are losses as well as gains. The open question is the degree to which these benefits counteract the unquestionable initial loss. The article cited a study by Michael Clemens of the Center for Global Development on the emigration of African health workers. In this study, Clemens found a clear correlation between emigration and the state of public health care system, but not the one leading to a crisis in public health. On the contrary, the study suggested that the higher the number of health professionals moving abroad, the better shape its health care system is likely to be in.
Why is this so? According to the article, “countries and professions with more openness and greater mobility of personnel are more likely to be in touch with global trends – and more likely to attract able trainees in the first place.” To be able to compete globally, it is also necessary to offer training that is at par with global standard. This will likely increase the local pool of highly skilled health profesionals in sending countries. Another factor cited is the tendency of emigrants to return home later on in their careers. The experience gained by these returning professionals while working abroad is an asset that can be utilized for the advantage of the community. There is also the renumeration and the amount of cash that migrants send back home. We all know how the country benefitted from the influx of foreign remittances from Filipinos working abroad. OFWs are contributing more than US$10B in foreign remittances every year. These are undeniable benefits the country enjoyed from those who left. How to make use of these benefits to counteract the loss brought about by the emigration of our skilled workers is an open issue.
Clemen’s study also suggested that Africa’s low staffing levels and poor health care conditions are due to factors entirely unrelated to international movement of health professionals. The same can be said of ours. There are definitely other factors contributing to the declining number of health professionals in the country. The migration of Filipino doctors is just the effect rather than the cause of the problem. So if we want to prevent a crisis in public health, it maybe high time to identify these other factors and do something about them rather than putting the blame entirely on brain drain.