Creo oportuno trasladar el incipiente debate sobre las migraciones de los mejores al Primer Mundo que se esta desarrollando en la web de ProCOR.
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ProCOR colleagues,
Colonialism was replaced by neocolonialism, the intent of either was to divert
precious resources from poor to rich countries. But what shall we designate a
global system wherein the very human potential, both brain and heart, is being
poached?
While visiting Zambia more than a decade ago, I was informed that of a
graduating medical class of 44 students, 35 had plans to migrate. Sub-Saharan
Africa is now being depleted of all health manpower. There are currently more
Ghanaian physicians in the United States than in Ghana. This is occurring at a
time when the catastrophic AIDS epidemic and a growing cardiovascular epidemic
are burdening depleted health professionals to the breaking point. In the
Philippines, doctors are training to become nurses to avail of a higher standard
of living for themselves and their families in industrialized countries.
In addition to the brain drain, unspoken is the parallel, hidden and wrenching
migration of women who usually care for the young, the sick, the old in their
own poor countries as they move to do the same in rich countries as nannies,
maids, and health workers. This heart drain magnifies the tragic impact of the
brain drain.
Unless the hemorrhaging of human resources is halted and reversed, no costly and
fancy schemes for upgrading health systems in the developing world will have
meaningful impact. ProCOR will therefore devote much space and energies to
address these paramount problems.
Bernard Lown, MD
Founder and Chairman, ProCOR
-----Original Message-----
From: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] On
Behalf Of Coleman, Catherine
Sent: Thursday, July 07, 2005 12:15 PM
To: procor@healthnet.org
Subject: [ProCOR] Brain Drain: Recent articles
[Addressing brain drain is critical to promoting health in developing countries.
Recent articles in the Malawi Medical Journal and British Medical Journal
explore responses to brain drain from different perspectives. Excerpts and links
are provided below. We welcome you to share your comments and ideas.]
What is required to retain registered nurses in the public health sector in
Malawi?
Malawi Medical Journal, Vol. 16, No. 2 (2005)
Fresier C Maseko, Paul Msoma, Anne Phoya, Adamson S Muula, Kumbukani Kuntiya
Abstract
Western recruiting agencies and countries has been blamed for the 'brain drain'
of medical doctors and nurses from developing countries. The increasing demand
for skilled human resources and better remuneration of the developed countries
coupled with the poor work environment and low remuneration of the developing
countries militate against the retention of skilled human resources in the
developing countries. Health professionals in the developing countries are also
leaving the public sector in search for better remuneration in the private
sector including non-governmental organizations within their countries. The
massive loss of health professionals from the developing countries to developed
countries has sometimes resulted in the developed countries of the world being
blamed for the phenomenon. This questionnaire study was carried out in order to
deter mine factors that may facilitate the poor retention of registered nurses
in the Malawian public health sector. The results indicate that poor salaries,
heavy workloads, lack of promotional opportunities and poorly resourced and
equipped health facilities are a de-motivating factor for registered nurses and
could resulting loss from the public sector. We argue that while western nations
have a role to play in ensuring retention of skilled health workers in
developing countries, developing country governments also have a part to play in
improving the work environment and remuneration of their employees.
Malawi Medical Journal Vol.16(2) 2005: 30-32
http://www.ajol.info/viewarticle.php?jid=64&id=21713
Editorial: Stopping Africa's medical brain drain
BMJ 2005;331:2-3 (2 July), doi:10.1136/bmj.331.7507.2
The rich countries of the North must stop looting doctors and nurses from
developing countries
... Although the developed countries of the North are giving aid with one hand,
they are robbing African countries with the other by siphoning off their most
precious resource-trained doctors and nurses. The Commonwealth's developing
countries are particularly hard hit because their health professionals speak
English and are therefore and Australia.
Large parts of sub-Saharan Africa have effectively no health care at all, with
only 600 000 healthcare workers for a population of 682 million.(2) For example
in Ghana, faced with a ratio of nine doctors to every 100 000 patients,(3) is it
any wonder that young, talented health professionals are burnt out and
despairing, and that they leave for a better life in the North? Only 60 of the
500 doctors trained in Zambia since independence are still there.(4) Mozambique
has only 500 doctors for a population of 18 million. (5)
What can be done? We cannot and should not prevent completely the migration of
doctors and nurses. Medicine has a strong tradition of international
collaboration, with doctors moving around the globe to gain further training and
different clinical experience. Indeed, we like to think that international
exchange and diversity enrich us all. This is a romantic delusion. We gain in
the North, but developing countries lose out by losing their doctors
permanently. Any number of incentives have been tried to persuade doctors to
remain in or return to their countries of origin-enhanced salaries, better
pensions, cars, and housing allowances. Ethical recruitment codes may make us
feel that we occupy the moral high ground. But, as long as the rich countries
have plenty of vacancies, the flow of healthcare professionals from South to
North will continue.
The most important element of the solution is self sufficiency. The BMA and the
Royal College of Nursing have urged the prime minister and the chancellor of the
exchequer to commit the UK to training enough people to become self sufficient
in workforces of doctors and nurses. This would not be a huge leap for the UK
since we have been expanding the number of medical school places year on year
since 1997. Over the same period, we could radically expand the number of
exchanges, overseas elective periods, and twinning programmes that would help
our very hard pressed colleagues to feel less isolated and overburdened.
But what of the US? Already, it employs half of all English speaking doctors in
the world. And it wants more. By deadly coincidence, the US wants to employ one
million more healthcare workers in the next 15 years (6)-exactly the extra
number needed for sub-Saharan Africa to fulfil the millennium development goals.
(7) The US system regards healthcare professionals as a commodity to be
purchased in the market and is making little provision currently to increase the
number of doctors and nurses it trains at home. Nurses in the US, with an
average salary of $65 000 (#36 000; 53 000), (8) are the most highly paid in the
world.
The US is a great place to live and work. Unless it can be persuaded to think
and act differently, it will soak up skilled workforce from every available
source, including the UK. We would find it difficult and irksome to spend UK
taxpayers' money training doctors to care for American patients. But we are a
rich country, and many of those doctors would eventually return home. Ghana is
already contributing to an obscene reversal of the flow of aid: it spends around
$9m each year on medical education (9) only to lose its doctors to a voracious
and insatiable health market in the North. The African initiative of the G8
countries will fail spectacularly if the richest nations of the world do not
allow the poorest to maintain the bare essentials of healthcare provision.
James Johnson, chairman of council
BMA, BMA House, London WC1H 9JP
(jjohnson{at}bma.org.uk)
BMJ VOLUME 331 2 JULY 2005
www.bmj.com
Managing medical migration from poor countries
Omar B Ahmad
Migration of health workers from poorer to richer nations is unlikely to stop,
but we can and must put policies in place to minimise the damage it causes In
the past, the migration of skilled health professionals from poorer to richer
countries was essentially a passive process. Movement was driven mainly by the
political, economic, social, and professional circumstances of the individual
migrant. In recent years, however, demand for health workers in many countries
in the Organisation for Economic Cooperation and Development has been greatly
increased by changes in population dynamics. In response, some of these
countries are relying increasingly on imported labour, with potentially damaging
consequences for the healthcare systems in many developing countries, especially
Africa. Indiscriminate poaching of health professionals is also likely to damage
receiving countries in the long term. In this article I explore the policy
options likely to minimise the consequences of migration of health workers.
. . . .
[summary]
Suggested national strategies for migration of health workers
Developing countries
. Determine the socioeconomic, political, and professional factors influencing
migration
. Restructure training programmes to reflect critical national needs without
compromising on quality
. Involve traditional community leaders in awarding foreign training grants
(people may feel more obligated to return if grants are channelled through their
community leaders as opposed to faceless, nameless bureaucratic systems)
. Invest in improving the working conditions of health professionals by
rechannelling resources spent in recruiting foreign health professionals
. Require publicly funded trainees to commit to a specified period of national
service
. Vigorously pursue policies that emphasise development of science and
technology research
. Enter into bilateral agreements with receiving countries to control skill flow
and derive some compensation
Developed countries
. Make a genuine commitment to train more health professionals
. Develop and implement a code of conduct for ethical international recruitment
. Limit recruitment from countries with clear staffing shortages
. Issue non-extendable visas geared towards acquiring skills that benefit the
source country
. Implement policies that facilitate the re-entry of skilled professionals back
into the host country after a period in their country of origin
. Pay some compensation to source country through bilateral arrangements
(financial help, expansion of infrastructure or technology, targeted research
funding, or exchange of health professionals)
BMJ VOLUME 331 2 JULY 2005
www.bmj.com
Catherine Coleman
Editor in Chief, ProCOR
_____________________________________________________________________
Contribute to ProCOR's Global Dialogue by replying to this message or
sending an email to .
Engage others in the discussion by forwarding this message to colleagues.
We welcome new participants! Subscribing is free--simply send an email to
.
Questions, comments? Send feedback to Catherine Coleman, Editor in Chief, ProCOR
.
ProCOR (www.procor.org) is a program of the Lown Cardiovascular
Research Foundation. ProCOR's email discussion is hosted by SATELLIFE
(www.healthnet.org), The Global Health Information Network.
Change subscription options by sending email with 'help' in subject to
, or by visiting
http://list.healthnet.org/mailman/listinfo/procor
_____________________________________________________________________
Contribute to ProCOR's Global Dialogue by replying to this message or
sending an email to .
Engage others in the discussion by forwarding this message to colleagues.
We welcome new participants! Subscribing is free--simply send an email to
.
Questions, comments? Send feedback to Catherine Coleman, Editor in Chief, ProCOR
.
ProCOR (www.procor.org) is a program of the Lown Cardiovascular
Research Foundation. ProCOR's email discussion is hosted by SATELLIFE
(www.healthnet.org), The Global Health Information Network.
Change subscription options by sending email with 'help' in subject to
, or by visiting
http://list.healthnet.org/mailman/listinfo/procor
