The opportunity to work in different societies is a rich experience with benefits that go beyond financial gains. There is no place for creating new barriers to the movement of peoples between countries. What is needed is an acknowledgment that institutions in developed countries have an ethical obligation to facilitate the return of health professionals to developing countries (box).
Requirements for ethical recruitment from overseas
- Flexible training schemes that permit doctors from developed countries to work in developing countries
- Long term partnerships, including funding and training, to strengthen the research, clinical, and teaching infrastructure of institutions in developing countries
- Grants to enable returning doctors to establish personal and professional lives
- Audit of the outcome of overseas doctor training schemes in terms of proportion of doctors who return home
Institutions in developed countries must engage with those in developing countries to facilitate an attractive environment for returning doctors to work in. Doctors from developing countries who go abroad to train and work have a key role in this process. The opportunity to choose the country we live and work in is the result of the opportunities that were available to us in the country of our birth. Doctors going to work overseas must search for ways to share their expertise and resources—for example, by partnering their new institutions with the ones in which they trained.
The developing world has fewer doctors per population than developed countries
Schemes to recruit doctors from developing countries risk damaging their fragile health systems
Working and training in another country provides valuable experience
Partnerships between institutions in developed and developing countries are needed to encourage doctors to return
Institutions in developed countries need to reform to provide more rewarding professional environments
Institutions in developing countries must acknowledge that doctors leave not only for monetary gain but also to escape from stifling hierarchies and bureaucracies. In India, for example, doctors who want to attend scientific meetings often have to obtain a “no objection certificate” from the head of their institution. Promotions are more likely to be determined by the number of years of service than academic skills and achievements. Institutions must reform to allow professional environments to flourish by rewarding achievements—for example, by reducing routine clinical load and by providing alternative paths for career progression, honorariums, and training opportunities.
Ultimately, all concerned parties need to define the obligations and responsibilities of institutions in rich and developing countries. Unless these steps are taken urgently, the brain drain will continue to fuel the huge inequities in global health.