Part of this week’s readings discussed the problem of “brain drain,” or more specifically the migration of skilled healthcare workers from resource-poor countries to developed ones. In my studies thus far this topic has barely been addressed, so much of this information was new. Some of the statistics mentioned by Garrett in “The Challenge of Global Health” were staggering (only 50 of 600 Zambian-trained doctors remain in country?) and show just how deep the issue of “access to healthcare” goes. Many examples have been given of failed interventions due to of the lack of infrastructure. A huge piece of that infrastructure is a sufficient quantity of adequately trained health workers to deliver basic health care.
Many factors come into play when healthcare workers choose to migrate, both personal and systemic. From the perspective of global health, the context of different countries’ policies and regulations, economy and medical educational systems is crucial. A primary reason for trained healthcare workers to leave their home country is because of the opportunity to earn significantly higher income. For example, the average salary of an R.N. in Botswana is approximately $17,700 compared to nearly $66,000 in the United States. It seems a hopeless problem as countries with severely limited funds and/or resources cannot afford to simply start paying their nurses and doctors higher salaries.
There are other ways of attacking the problem, however. As Onias mentioned in class, many Zimbabwean physicians leave the country to work in the U.K. because their training and credentials are accepted there. Changing accreditation and licensing between countries would affect the ability of healthcare workers to move about and could be a tool used to retain human resources. Or perhaps in countries where the government subsidizes the cost of education, medical professionals would be required to work for a certain number of years in their local community. This would enable the government to gain from their investment.
I was also highly surprised to learn about how actively some developed countries recruit skilled workers from resource-poor areas. My gut reaction was to view these actions as incredibly careless and unjust. Previously I had not thought deeply about the implications of foreign physicians and healthcare professionals working in other countries, or had simply viewed it as a personal choice of that individual. As attractive as opportunities abroad may seem, the impact it leaves on home countries is shown to be devastating. The other side of the coin is that even developed countries such as the U.S. and the U.K. are predicting major shortages of healthcare workers as well. The root cause of this problem is not a scarcity of qualified trainees, but rather not enough educators available to train. It is fascinating to me that, in a sense, opening more nursing schools in the U.S. and retaining those nurses could indirectly improve healthcare issues in a different country.
Thanks for the great blog Kelly. This is a complicated issue to address. We can talk about it as much as we want but the real solution is far from being realized. I am an example of a migrant health worker. On one continent, I had not opportunity for further studies, was making as little as $12K per year, I could not afford to own a house, and I was driving a car that was older than my wife (not technically a vintage on the other side). When I crossed the Atlantic ocean, my salary was no longer an issue. I am now completing my PhD, my wife is a nurse practitioner, and my kids have a future.
ReplyDeleteHow this issue can be addressed is a million dollar question. It is an issue of human right, empowerment, and sacrifice. I want to sacrifice and work in these poor regions where my services are needed but at the same time, I need to create opportunities for my children. I also need to own a house so that I can pull my kids from the the generational poverty that have gripped many African families.
So what is the way forward? Any takers? I am open to criticisms, opinions, etc.
Well, Kelly and Onias, these are excellent reflections. We need country specific and global strategies to address the imbalance in medical resources. As Onias rightly observed getting out of generational poverty and the exploitative structures will continue to motivate these migrations. The global situation is bad, but not hopeless! As a whole we have much less doctors per population and the problem is unique in each country situation. For example, In India, we have the need for more medical doctors and so the government and private organizations have made many medical schools. But the quality of education there is not weak and the concern now is that we are not getting knowledgeable doctors. India does have rules where medical professionals have to spend time working with local communities; but still the problem persists. The migration is even more critical within country situations. For example, its very difficult to keep a doctor in remote, rural areas of India. Most open shop in big cities to earn more money, stay more connected, send their children to good schools, access better infrastructure and so on. So, our health system analysis needs to critically examine these internal and external migrations of medical professionals.
ReplyDeleteFor a health worker working in a remote location, refusing him/her the access to a better salary and working conditions becomes a human rights issue (in my view). Each health worker deserves the right to access opportunities to advance their career and improve their quality of life. That health worker worked so hard to be where he/she is. Allow me to suggest that migration of health workers may be necessary pain like teething pain, labor pains etc.
DeleteOnias, you bring up a point I've been thinking about as we discuss these public health issues - where is the line between working for the highest good of the entire population and yet still protecting individual rights? Many widespread issues could be solved fairly completely if we could control others' lives. The rich, educated and powerful could set mandates and force the masses to comply. For an extreme example, what if a government forced the sterilization of their entire population to decrease the transmission of HIV/AIDS? Besides the obvious repercussions of a people unable to repopulate, this is obviously a gross human rights injustice. However, there are plenty of examples of smaller intrusions into personal freedom for the good of many. In order to attend school in the U.S., for example, you are required to have certain immunizations. Without them, you cannot go. There are some exemptions provided, but by and large this health decision is handed down from policies and regulations to the individual. What is the difference? And how important are individual rights? Here in western culture, those rights are highly valued, but in other areas of the world a cooperative mindset dominates. In her talk on food and nutrition, Dr. Connie Weaver even mentioned how sometimes she wonders if a global overseeing body ought not to dictate when and where different crops are produced to better steward the world's resources. This seems like a noble goal, but would certainly have a huge impact on the rights and autonomy of the agricultural sector. Protection of the greater good and personal freedom both come with a price.
DeleteKelly- you bring up some really important points when it comes to the migration of health workers. I think it is very important to not only look at the medical doctors that are leaving this poverty-ridden countries but also the nurses and other support staff. Sometimes, these people an even more crucial part in the healthcare system of poor and rural countries. In one of the readings this week, Farmer discusses how healthcare workers are not only leaving their county of origin because of better pay and conditions in other countries but also for more resources. In sub-Saharan Africa, the medical professionals do not have the tools to adequately treat patients like they do in the UK or France. Compare it to the difficulty of completing a Masters or Doctorate program without a notebook, pen or book. I too would be frustrated and would seek better opportunities.
ReplyDeleteOnias- the balance between moving your family forward while still pursing your passions for serving the poor is a tricky one. I wish there was a simple answer that could make all parties happy. I do not envy your position. I too would like the opportunity to pursue a career that is centered on serving the health of the poor. Even as a single person, I struggle with the thought of possibly not making ends meet. I think it is important to make sure all your values are aligned. If I take this job or travel to this country, will it still align with what my children need or with what I want for my family?
You make a very good point Jaci. Let me give you more information about my scenario. Because as a health worker I moved from an under privileged society that really needed me in search of better job opportunities (educational advancement, better salary, better working conditions etc), I managed to help several of my siblings move out of generational poverty by sending them to school outside the country. I have also helped several AIDS orphans from my village attain a university education. Yes at times I feel guilt about leaving but at the same time I improved my capacity to help.
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