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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.


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  1. Education Guidebook

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  2. Fred Kintanar

    I don’t think concerned Filipinos should be talking about “stopping” brain drain, it is managing it to ameliorate the worst effects (and maximize the benefits if any). The trade-off between institutional and national requirements for trained and experienced health personnel vs. the human right of freedom of movement is a no-brainer. Human rights win, they are absolutely uncompromisable, even for the educated elite whose actions may have negative consequences for the majority like the rural and urban poor.
    The argument summarized in the post doesn’t deny that brain drain has negative consequences, and doesn’t really present any positive consequences. It just points out that there is a correlated causal factor, openness and professional mobility. I won’t argue for isolationism, I think openness is here to stay for better or worse (even if the Cuba model is challenging and surprising). But if the Philippines will have openness and professional mobility, we can have policies to better manage the migration of professionals.
    One is that we should “charge” the countries receiving trained personnel, insisting that they invest back into the remote education system they benefit from. They invest back in their own education systems, they should do the same for the foreign systems where they are beneficiaries. This may be easier to do in some countries than others, U.S. is probably hard because of complicated state health systems, while Britain and Canada should be easier. One problem is the Philippine government actively promotes exporting nurses, so the receiving countries don’t think they owe us anything. But migrating health personnel take up limited education slots, and Philippine society pays the social costs of supporting that education when another country gets the main benefits.
    Two is that we should collaborate with receiving countries to seriously improve the quality as well as volume of health education, growing the pie in quality and size. This will help us move up the value chain (more Advanced Nurse Practitioners and locally trained specialists, even if many or most leave, they still work in the Philippines for a few years and some do stay for whatever reasons). We should ask receiving countries to send visiting professors with PhD’s to our struggling nursing, medical and health education programs, and achieve a much higher standard of qualification for Philippine faculty (all Nursing teachers should have a serious MS, most professors of medicine have a PhD or comparable research experience). An teaching loads have to go down! The beneficiary countries should help fund a transition to smaller class sizes and lower teaching loads, they know they want better quality and they know this is how to get it.
    And three, the Philippine government, with foreign assistance, should put in mechanisms to assist the institutions that suffer loss, a safety net for the disruptive migrations that they are promoting. Hospitals and service providers with significant levels of turnover should get funding to train understudies before they (and their patients) are left in a lurch. I work in the software industry, and I know that high turnover can be managed successfully. But it takes massive investment in ongoing training, so that somebody pops out of the in-house training pipeline everytime somebody submits a resignation letter. An having replacements who are already familiar with the tasks and processes at hand is critical, government should fund in-house training programs so that they can overtrain in anticipation of turnover.
    I have thought about these three policy responses for some time, but I have no idea how to get them implemented. Perhaps some of you people out there who are working directly with the health sector might have some ideas about action.

    Fred K.
    Cebu City

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