Brain drain: the flight of human capital.
2004; National Institutes of Health; Volume: 82; Issue: 10 Linguagem: Inglês
Autores Tópico(s)
Primary Care and Health Outcomes
ResumoThe international migration of highly skilled professionals first emerged as a major public health issue in 1940s, when many European health professionals emigrated to United Kingdom and United States. By mid-1960s, losses were enough to cause concern. In 1979, WHO published a detailed 40-country study on magnitude and flow of health professionals, whose findings suggested that close to 90% of all migrating physicians were moving to just five countries: Australia, Canada, Federal Republic of Germany, United Kingdom, and United States (1). In recent years, migration of health workers has become a prominent and controversial feature of health sector planning. A moral challenge There is growing recognition, in both developed and developing countries, of dangers posed by indiscriminate recruitment of skilled health professionals. Despite awareness of risks, little effort has been made to solve problem. Regardless of one's point of view in debate, fundamental issue is same: should skilled migration be left completely to market forces or should some form of intervention be introduced? If so, what are possible options? Intuitively, indiscriminate poaching of skilled health professionals is unlikely to be a neutral phenomenon. It is potentially damaging to effective delivery of health services in source country, where it constitutes a huge financial loss and could have a negative impact on economy. Indeed, likelihood that poor developing countries may be indirectly subsidizing health-care systems of richer countries raises ethical and moral questions. Fortunately, however, some developed countries are beginning to acknowledge potentially harmful effects of their recruitment practices. The United Kingdom is a case in point: in 2001 Department of Health initiated Code of practice far NHS employers involved in international recruitment of healthcare professionals. In 2003 Commonwealth adopted a non-binding code of practice to guide ethical recruitment from member countries. Despite these positive developments, many countries remain largely indifferent. Some, like Germany, are currently developing aggressive immigration policies targeted specifically at the best minds among professionals from developing countries (2). A manpower strategy that is based on indiscriminate poaching of skilled human resources is rather shortsighted, however, and can only be a temporary solution. Its long-term consequences for health and overall well-being of affected populations may extend well beyond health to other sectors of economy. To escape hardship, many skilled and unskilled persons may be forced to emigrate, and their destinations will almost certainly be in industrialized countries. Such developments can only exacerbate problems of illegal migration into many western countries. Consequently, more draconian measures will be needed to stem future waves of desperate refugees. Hence, merely for purely selfish reasons, developed countries cannot afford to be spectators in unfolding drama. Solutions Is there an inexpensive way to discourage richer countries from poaching scientists from poorer ones? Unfortunately not--the issues involved are complex and almost all countries are affected to varying degrees. At one end of spectrum are countries such as Cuba that produce an excess of health professionals; at other end are those such as United States that train too few. In between is a variety of sending and receiving countries, each with a pattern of migration that reflects its level of social, political and economic development. Consequently, focusing solely on pull factors that attract migrants may obscure importance of push factors encouraging them to leave, thereby diverting attention away from some important policy options. …
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