BRAIN DRAIN

Brain drain is defined as the migration of health personnel in search of the

better standard of living and quality of life, higher salaries, access to advanced
technology and more stable political conditions in different places worldwide. This
migration of health professionals for better opportunities, both within countries and
across international borders, is of growing concern worldwide because of its
impact on health systems in developing countries. Why do talented people leave
their countries and go abroad? What are the consequences of such migrations
especially on the educational sector? What policies can be adopted to stem such
movements from developing countries to developed countries?

INTRODUCTION

Brain drain is the migration of skilled human resources for trade, education,
etc.1 Trained health professionals are needed in every part of the world. However,
better standards of living and quality of life, higher salaries, access to advanced
technology and more stable political conditions in the developed countries attract
talent from less developed areas. The majority of migration is from developing to
developed countries. This is of growing concern worldwide because of its impact
on the health systems in developing countries. These countries have invested in the
education and training of young health professionals. This translates into a loss of
considerable resources when these people migrate, with the direct benefit accruing
to the recipient states who have not forked out the cost of educating them. The
intellectuals of any country are some of the most expensive resources because of
their training in terms of material cost and time, and most importantly, because of
lost opportunity. Brain drain, which is the action of having highly skilled and
educated people leaving their country to work abroad, has become one of the
developing countries concern. Brain drain is also referred to as human capital
flight. More and more third world science and technology educated people are
heading for more prosperous countries seeking higher wages and better working
conditions. This has of course serious consequences on the sending countries.

While many people believe that immigration is a personal choice that must
be understood and respected, others look at the phenomenon from a different
perspective. What makes those educated people leave their countries should be
seriously considered and a distinction between push and pull factors must be made.
The push factors include low wages and lack of satisfactory working and living
conditions. Social unrest, political conflicts and wars may also be determining
causes. The pull factors, however, include intellectual freedom and substantial
funds for research.

Brain drain has negative impact on the sending countries economic

prospects and competitiveness. It reduces the number of dynamic and creative
people who can contribute to the development of their country. Likewise, with
more entrepreneurs taking their investments abroad, developing countries are
missing an opportunity of wealth creation. This has also negative consequences on
tax revenue and employment.

Most of the measures taken so far have not had any success in alleviating the
effects of brain drain. A more global view must take into consideration the
provision of adequate working and living conditions in the sending countries. An
other option should involve encouraging the expatriates to contribute their skill to
the development of their countries without necessarily physically relocating.
Brian Drain refers the situation when highly qualified and trained people leave a
country to permanently settle in some other country. It is also referred to as Human
capital flight. Highly educated professional people immigrate to other advanced
countries for better opportunities and a comfortable life style.The problem of
Brain-drain, in our age, has become very elusive. The developing countries like
India are desperately in need of talents, especially in the field of science and
technology but for one reason or the other the talents and fleeing their countries,
leaving their native lands impoverished in the process.

Brain Drain is an extremely serious problem for a developing countries. The

destiny of such countries lies in the solution to this great problem. India can be
taken as an instance in point. After independence this country is engaged in
difficult struggle against poverty. But struggles cannot be launched in papers; they
require armies of trained personnel – the scientists, technical knowhow and
specialists in the field of planned development. If, instead of contributing to the
prosperity of India, the Indian scientists, research scholars, engineers, doctors and
economists immigrate to other countries, it is difficult to see how India can
implement her development plans and attain her goal of prosperity.

In ancient times the scholars of one country visited neighboring countries,

and they often stayed there for years, both learning and teaching. The great
scholars of China and Persia and other scholars from the West visited India during
her prosperous days in the past and wrote memoirs which are precious materials
for Indian history. But these were not considered brain drain then. For when Hiuen
Tsang came to India or Shilbhadra visited Tibet, staying there for many years, their
absence from their own countries did not make much difference. On the contrary,
their experiences and wisdom gained from their visits enriched their countries.
Such exchanges benefited the countries in those days and built a bridge of
understanding and amity when communication between even the neighbours was
not easy.

In the under-developed countries like India, the ambitious and highly

educated people found it very difficult to climb the peak, for the obstacles were
many and the bureaucratic bungling was irritating. Hence, the alarming exodus
started in the fifties and in the seventies the brain-drain appeared to be complete.
Hundred of talents emigrated to the U.S.A. and Europe which assured them of
great opportunities for getting to the top, of secure and comfortable living, of
satisfaction and of glory in their respective fields. If the emigrants could have all
those assurances they would not think of fleeing their country.

But the problem is that a developing country like India could hardly afford
to accommodate so many ambitious people, nor could the scope be made broad
enough to secure affluence for all. Some of them, after training and experiences in
foreign countries, return home with individual drams and when they fail to fit in
with the evolving patterns at home, despair drives them away again.

But India needs these professionally trained people, so they should be

persuaded to stay in India and be content with less lucrative jobs. When India is
rich enough to reward them, they would not find much to complain about. All
these people are among the fortunate few, enjoying the privilege of education,
while some eighty percent of Indians languish in dark hovels – poor, ignorant and
superstitious. It is they duty and responsibility of those privileged few to take them
out of the morass, instead of jointing the mad rush for careerism. There may be
many obstacles in their way, but their dedicated services and patriotic zeal will
help them rise above them and restore to India her lost glory.
 In 2000 almost 175 million people, or 2.9% of the world’s population, were
living outside their country of birth for more than a year. Of these, about 65 million
were economically active.2 This form of migration has in the past involved many
health professionals3: nurses and physicians have sought employment abroad for
many reasons including high unemployment in their home country.

International migration first emerged as a major public health concern in the

1940s when many European professionals emigrated to the UK and USA.4 In the
1970s, the World Health Organization (WHO) published a detailed 40-country
study on the magnitude and flow of the health professionals.5 According to this
report, close to 90% of all migrating physicians, were moving to just five
countries: Australia, Canada, Germany, UK and USA.5

In 1972, about 6% of the world’s physicians (140 000) were located outside their
countries of origin. Over three-quarters were found in only three countries: in order
of magnitude, the USA, UK and Canada.6 The main donor countries reflected
colonial and linguistic ties, with a dominance of Asian countries: India, Pakistan
and Sri Lanka. By linking the number of physicians per 10 000 population to gross
domestic product (GDP) per capita, the countries that produced more physicians
than they had the capacity to absorb were identified7 as Egypt, India, Pakistan,
Philippines and South Korea. However, the lack of reliable data and the difficulties
of defining whether a migrant is ‘permanent’ or ‘temporary’ still exist.

One may claim that this migration from developing countries is both useful
and unavoidable. There are definite advantages—enabling the migrant to spend
time in other countries—but at the same time, the very low emigration rate of
professionals from USA or UK may be as disturbing a sign as the high rates of
immigration to these countries.
Young, well-educated, healthy individuals are most likely to migrate, especially in
pursuit of higher education and economic improvement.8,9 The distinction
between ‘push’ and ‘pull’ factors has been recognized.10 Continuing disparities in
working conditions between richer and poorer countries offer a greater ‘pull’
towards the more developed countries. The role of governments and recruitment
agencies in systematically encouraging the migration of health professionals
increases the pull.10 Migrant health professionals are faced with a combination of
economic, social and psychological factors, and family choices11, and reflect the
‘push–pull’ nature of the choices underpinning these ‘journeys of hope’. De-
motivating working conditions, coupled with low salaries, are set against the
likelihood of prosperity for themselves and their families, work in well-equipped
hospitals, and the opportunity for professional development.12

In many cases, the country is not only losing its investment in the education
of health professionals, but also the contribution of these workers to health care.
For example, healthcare expenditure in India is 3% of GDP compared to 13% of
GDP in the USA and the ratio of doctor to patients in India is 1:2083 compared to
the USA where the ratio is 1:500.13 Moreover, in many developing countries
healthcare systems are suffering from years of underinvestment, which, for health
professionals, has resulted in low wages, poor working conditions, a lack of
leadership and very few incentives.14

Employers in receiving countries take a different position; they have their

own shortages of skilled people in specific fields and can drain a developing
country of expertise by providing job opportunities.15 Kupfer et al. provided the
strategies to discourage migration to the USA, a major recipient country.16
However, keeping the social, political and economic conditions in the developing
countries in mind, can we stop the brain drain? Probably not!
Higher education is one of the principal conduits of permanent emigration.17 The
majority of doctors acquire specialized and postgraduate professional
qualifications in the host country. Half of the foreign-born graduate students in
France, UK and USA remain there after completing their studies.18 Among the
doctoral graduates in science and engineering in the USA in 1995, 79% of those
from India and 88% from China remained in the USA.19 The recent study on brain
drain from 24 major countries published by the World Bank20 also presented data
on South Asian immigration to the USA (Table 1). Migration to OECD
(Organization for Economic Cooperation and Development) countries is also
shown in Table 2. Yet more data showing the momentum and demand for skilled
people by high tech and research and development (R&D) industries illustrating
accelerated flows of highly skilled workers to OECD countries are shown in Figure

These statistics suggest that if developing countries provided world-class

education and training opportunities, as well as opportunities for career
advancement and employment, the migratory flow could be reduced.21 However,
in reality, this may not make much difference. On the plus side, foreign-born
graduates acquire expensive skills which are not available within their countries.
On the negative side, these skills and knowledge never migrate back to their own
countries.

Besides the pull–push factors described earlier, some researchers from

developing countries cite other reasons for not returning after training which
include: lack of research funding; poor facilities; limited career structures; poor
intellectual stimulation; threats of violence; and lack of good education for children
in their home country.20 Incentives for migrants to return to developing countries
have been insufficient to override the limitations at home—both real and perceived
—and the attraction of opportunities found abroad. Many of these countries have
made significant investments in infrastructure and education but have not achieved
the scientific development, technological and innovative capability either to retain
or to recover the human capital that they have generated. Is there a solution to this
problem? This raises the question of whether one can justify losing human capital
or whether one should make the additional investment in science and technology
and bring about the innovations that will stop the loss and convert it into wealth
generation.

CONVERTING BRAIN DRAIN INTO WISDOM GAIN

Developing countries, especially South Asia, are now the main source of
healthcare migration to developed countries. This trend has led to concerns that the
outflow of healthcare professionals is adversely affecting the healthcare system in
developing countries and, hence, the health of the population. As a result, decision-
makers in source countries are searching for policy options to slow down and even
reverse the outflow of healthcare professionals. Is it possible to do so? Maybe not,
bearing in mind the current political and economic situations of the source
countries and globalization. The increasing demand for health care in the higher
income countries is fuelled to a large extent by demographic trends, e.g. the ageing
of the baby-boom generation.

The opening up of international borders for goods and labour, a key strategy
in the current liberal global economy, is accompanied by a linguistic shift from
‘human capital flight’ and ‘brain drain’ to ‘professional mobility’ or ‘brain
circulation’.22 Solutions should therefore be based on this wider perspective,
interrelating health workforce imbalances between, but also within developing and
developed countries.
CONTRIBUTIONS BY SHARING KNOWLEDGE AND SKILLS TO
DEVELOPING COUNTRIES

It is time to understand and accept that health professionals’ mobility is part

of life in the 21st century. Countries need to recognize that they compete with the
best institutions in the world for quality manpower. It is time to bury the archaic
concept of brain drain and turn to assessing the performance of health
professionals and systems, wherever they are in the world. The turn of the 21st
century has not only brought technology, but also modes by which scientists
around the world can be connected in no time. In this globalized world the physical
location of a person may or may not have any relation to the ability to make an
impact on human health. Health professionals in the developed world may have
most of their work portfolios in the developing world. Easy communication, quick
travel, and greater collaborations between developed and developing countries are
increasingly more common and we need to develop ways in which foreign
professionals can contribute to their countries of origin.

Remittances from expatriates living abroad constitute a significant proportion of

foreign revenue for many developing countries.24 In Bangladesh for example US$
2 billion is received from citizens who have emigrated overseas, and these
remittances are the second largest source of foreign revenue.25 The transfer and
management of remittance revenues are potentially exploitable factors in plumbing
the brain drain. Formalizing the transfer of remittances might permit the generation
of revenues that could be invested nationally in the social and economic
development of the developing home country. However, the magnitude and
economic importance of remittances, economic development and growth, and
ultimately social equity, depend on the endogenous capacity of each nation’s
human resources. If only a small percentage of the multimillion dollar sums sent
home by emigrants could be invested in research and development, might not
opportunities for highly skilled and educated nationals improve at home? And
would this not in turn spur economic development? Maybe to some extent—but
without resources and skills, this may not have a huge impact on health and disease
prevention.

The availability of both high-quality education and opportunities in research

are the keys to retaining and attracting regional talent. The steps taken by China
towards becoming a leader in biological research and biotechnology illustrate the
empowerment. The scientific leadership positioned China to become the only
developing country participating in the Human Genome Project.28 Experience
gained through the participation of its institutions in the Human Genome Project
(including large-scale sequencing, the use of bioinformatics and the coordination
of multi-centre research protocols) provided the platform for developing
biotechnology that can be applied to human diseases and agriculture. The
opportunities generated by the Chinese in biotechnology attract both international
collaboration in joint ventures and gifted scientists from China and abroad.

CONCLUSION

Scientists who have emigrated for several reasons are recoverable assets who can
play a part in developing opportunities at home. However, recovery requires the
opening of diverse and creative conduits. The health services in the developing
world must be supported to maintain their skilled personnel. Only when health
staff, whatever their cadre, have the tools they require to do their job, training
opportunities, a network of supportive colleagues, and recognition for the difficult
job they do, are they likely to feel motivated to stay put when opportunity beckons
from elsewhere. Foreign professionals could be used to develop innovative
graduate education opportunities at home and technology to be transfered to areas
of national priorities for research and development. Ultimately, involving
individuals who are living abroad in creating opportunities at home favours both
the retention and repatriation of national talent. Building an enlightened leadership
and an enabling national scientific community, with the help of expatriate citizens,
for the coherent development of scientific and technological capacity in developing
countries will be mutually beneficial.