Public Comment

Commentary: Brain Drain: The Quiet Killer

By Lucy Anderson
Tuesday December 04, 2007

It is devastatingly ironic that the world’s poorest countries are, to some degree, subsidizing the healthcare of the wealthiest nations. For years, rich nations encouraged African countries to invest in infrastructure (education, hospitals, medicine); much aid was given to strengthen these very systems. Although it was unintentional, the donations proved to be quite self-serving. As wealthy countries give aid to struggling nations to improve healthcare outcomes with one hand, they siphon off graduates of medical schools with the other. The developed world benefits from the skills and knowledge of newly arrived doctors and nurses while the countries that produced these professionals suffer from staffing shortages. 

The reasons behind the migration of health care workers are fairly obvious. Most hospitals in Sub-Saharan Africa are dismal places: over-crowded, grossly understaffed and under-equipped. Medical personnel are often frustrated. Salaries are very low and rarely enough to entice doctors, nurses, and clinical officers to stay in rural areas or even capitol cities. Trained in the treatment of patients, they are unable provide these services due to a lack of essential equipment and supplies. It may be difficult to imagine a hospital wanting in stethoscopes, hospital beds, gloves, and syringes yet these are the issues countless providers face every day.  

Of course the West did not intend to decimate Africa’s medical force but this is what is happening. Countries like the United States, England, and Australia have nursing shortages they are unable to meet. The United States alone needs 129,000 additional nurses to meet today’s health requirements. There are not enough American nurses to fill the demand and the US and other developed countries in similar positions eagerly hire doctors and nurses trained in other parts of the world. This is especially true for former commonwealth nations as English-speaking staff from poor countries are quickly absorbed by hospitals in London and New York. The United States employs half the world’s English speaking physicians. Developed countries need staff to maintain high medical standards and to care for aging populations. Cataclysmically, underdeveloped countries face a double burden of disease; chronic non-communicable diseases as well as HIV/AIDS and many diseases that no longer affect rich countries.  

Market forces and a bleak future at home have led many health workers to emigrate. The more that leave, the worse the situation becomes and the more difficult it is to keep floundering health systems afloat. As poor governments struggle to run schools of medicine, pharmacology, nursing, dentistry, etc students graduate and leave to look after patients in richer parts of the world. Poor countries cannot compete with the salaries offered in industrialized nations. International aid organizations who hire national staff exacerbate the problem as well. By paying medical personnel up to ten times their public sector jobs they draw them away from district and rural facilities and provide no one to fill the gap.  

In Malawi, which has one of the lowest physician/patient ratios, there are about 250 doctors for a country of 13 million. With one physician per 52,000 people, and serious problem with HIV and AIDS, the situation is grim. The irony is that the areas with the highest disease burdens have the lowest numbers of professionals to provide essential care. Medical staff are not immune to the diseases that affect their patients; particularly in Sub-Saharan Africa, systems are wracked by loss of staff to AIDS.  

What is to be done about this brain drain on the developing world? The reality is that more medical staff, particularly nurses, are needed worldwide. Developed countries should commit to training enough medical personnel to meet their own health needs. Expanded and new nursing schools are crucial to producing the necessary cadre of providers. Professors of nursing need to be adequately compensated and retained to teach future generations of nurses. Exchange programs between facilities in rich and resource-poor settings would allow for a wider clinical experiences and collaboration between colleagues. Wealthy nations could encourage their nurses to gain work experience in less developed settings. The Peace Corps, or a similar agency, could place American nurses in under-developed settings for a couple years in exchange for some student loan forgiveness. The situation requires new and innovative solutions. At the end of the day, it is vitally essential that developing countries are able to retain the staff in whose training they invest. Literally, the health of millions depends upon it.  


Former Berkeley resident Lucy Anderson is currently working toward a masters degree in public health at Columbia University.