“Who should be the ideal steward for health to best serve the public's interest?” – In my opinion, this question, raised during our policy seminar, focuses the problems of global health policy and foreign aid onto one salient topic: infrastructure. Infrastructure is a critical backbone to the delivery of any global health policy, and it relies on leadership. A significant amount of leadership behind global health policy and especially foreign aid is concentrated outside of the countries targeted with aid. It makes sense to me that this is unsustainable. We need homegrown leaders managing policy at the ground level. Physicians are probably the most important piece of infrastructure in the global health blueprint, and often enough the nations requiring their leadership to sustain global health advances find it absent.
Physicians are the highest trained leaders within medical society and can best direct the execution of global health policy. Too often, we find that these physicians are lost to developed nations. In Zambia, roughly 600 medical students have been trained at university, yet only 50 have remained to work within the Zambian public health sector. These forces are not unique to Zambia.
“Many Ugandan doctors are poorly paid and have left to
practise in the health systems of more affluent countries,
including South Africa where one of the medical schools
has several senior faculty members from Uganda. The
South African Medical Journal describes a “medical
carousel”, in which doctors seem to be continually moving
to countries with a perceived higher standard of living.4
Pakistani doctors move to the UK, UK doctors move to
Canada, and Canadians move to the USA.”
-quote from “Medical Migration…”
Obviously, the reasons for moving are incentive-based and not malicious in intent. Physicians leave for honorable reasons including economic opportunity, intellectual stimulation, family concerns, and even safety. What’s even more striking to me is the degree to which developed nations like Canada and the United states actively seek out foreign-trained doctors to fulfill their health system’s demand. This perpetuates the brain drain, with foreign doctors comprising the vast majority of the doctors practicing in inner-city hospitals. I think the bottom line is simple: without properly trained doctors, how can developing nations ever hope to properly execute global health policy and sustain health growth?
So how can we fix this? Perhaps soft power (name drop, woot!!!) could help. Developed nations behind the “drain” of “brain drain” must seek to train physicians at a number sufficient to satisfy the demand of their populations. The US could use policy to increase medical school seats and residency slots to satisfy demand and rely less on filling spots with foreign doctors. Developing countries could complement these moves by creating both incentives and policies to encourage physicians to remain in their home countries. At the very least, developed nations could compensate developing nations for the money lost in training a doctor that immigrates. These manners are only a few methods to encourage reduction in medical brain drain, but I like them because they require international collaboration between developed and developing nations to work. If we can begin to slow brain drain, maybe we can then build the infrastructure necessary for developing nations to wean themselves off foreign aid and become the stewards and champions of their own health reform.
Quick refs:
1. Bundred, P., and C. Levitt. "Medical Migration: Who Are the Real Losers?" The Lancet 356.9225 (2000): 245-46.
2. Pang, Tikki, Mary A. Lansang, and Andy Haines. "Brain Drain and Health Professionals A Global Problem Needs Global Solutions." BMJ 324 (2002).
