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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 21; 335(7611): 119.
PMCID: PMC1925202

Poor countries lose 15% of their skilled staff to rich countries, UN report says

Poor and rich countries alike need policies to reduce the serious effects of the medical sector “brain drain” on the world's 50 poorest nations, most of which are in sub-Saharan Africa, a UN report says.

“It's a very real problem, and at present there aren't policies in place,” said Charles Gore, the report's lead author and chief of research and policy analysis at UNCTAD (the UN Conference on Trade and Development), the UN body that promotes the integration of poor countries into the world economy.

“Something has to be done about this: it cannot all rest on the shoulders of the LDCs [least developed countries],” he said.

The main point of the agency's report is that emigration of skilled workers will continue and that policies need to be crafted to address the serious problems this causes for the 767 million people living in the 50 least developed countries, who earn an average of $750 (£370; €545) a year.

The report says, “The main factors that have been identified as contributing to the brain drain among medical practitioners are very large wage differentials between countries of origin, poor working environments and poorly designed career paths.”

It adds that other factors also contribute: inefficient healthcare systems in the poorest countries and the risks to the health of practitioners there, such as those involved in HIV programmes; and the active recruitment of skilled professionals by rich nations.

The report says that in 2004 a million skilled people from the least developed countries were living and working in rich countries, representing “a brain drain of 15%, considering there are some 6.6 million people in LDCs who have university educations.”

However, the proportion of medical professionals who work abroad is often much higher in particular countries, with African countries such as Ethiopia, Uganda, Zambia, and Liberia the most affected. It says that in 2002 the number of doctors from such countries residing in the United States and Canada as a percentage of the total number of doctors in those countries ranged in 2002 from 10% in Zambia to 43% in Liberia.

In that year the total number of trained doctors from sub-Saharan Africa living in the US and Canada totalled 5334, while 12 912 stayed in their country of origin. The average number of doctors per 100 000 inhabitants is 12.5 in sub-Saharan African countries, whereas in the US it is 300 per 100 000 people.

Dan Toole, acting deputy executive director of Unicef, says that the brain drain adds to the numerous problems that African countries may experience, from drought to malnutrition and major humanitarian emergencies in countries such as Zimbabwe. He said that the shortage of drugs, doctors, and nurses had wrecked Zimbabwe's healthcare system and that “50% of all healthcare positions are vacant.”

Zimbabwe was already suffering an economic crisis, but the brain drain of doctors and nurses had exacerbated the problem, as it had in neighbouring countries such as Lesotho.

Mr Gore said that poor countries were trying to create more employment opportunities for medical professionals but were limited by a lack of resources.

The report suggests a number of policy measures that could help to decrease the demand for professionals from developing countries, such as rich countries hiring doctors on a temporary and not permanent basis and helping to establish development assistance programmes so that poor countries retain their medical and other core professionals. This implies some kind of salary supplementation, Mr Gore says.

The report observes that new initiatives are under way in Botswana, Malawi, Zambia, and Mozambique, ranging from higher salaries for nurses to new programmes to manage the return of emigrants.

It notes that the United Kingdom has been “at the forefront of policies to reduce the impact of brain drain in the health sector in poorer countries.”

More emphasis should be placed, it says, on science, technology, and innovation in general, and it estimates that the amount of aid funds disbursed to the least developed countries between 2003 and 2005 was only 0.1% of total aid disbursements.


The Least Developed Countries Report 2007 is available at

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