Global Governance Policy Addressing Brain Drain: Promoting Health Equity and Justice
Stemming the Brain Drain: GRF 2012Exploring Global Health Policy Solutions for Brain Drain Timothy Mackey February 2012
Background:The Healthcare Worker Brain Drain • Brain Drain: Migration of professionals from resource-poor to developed/high- income countries • Global Health: Major problem in global health, global shortage of 4 million in health workers worsened by brain drain • Globalization: High emigration of 60 million health workers worldwide due to liberalization of trade and travel • Multi Sector: Challenge encompasses public-private sectors, governance, political, societal and economic factors
Background:Negative Impacts of Brain Drain • Brain drain involves physicians, nurses, pharmacists, public and community health workers, Key Facts: health care managers and administrators, and other -60 million health care health care workers (“HCWs.”) workers globally -4 million global shortage • Financial and human resource loss and health system weakening through maldistribution of resources • Inability to deliver life-saving health interventions for HIV/AIDS, malaria, tuberculosis, and other infectious diseases (PEPFAR, Global Fund, etc.) • Failure in meeting health-related Millennium Development Goals
Background: Factors driving brain drain from both developed and resource-poor Aging Poor career Population in advancement D CA C developed and work E OD O world environment V UV U E NA N L TN T O RC R High chronic Low disease income/benef P IE I prevalance its I ED E N S S G High tech Risk to and resource personal intense safety, health healthcare and security
Global Imbalances North to South Inequitable distribution• The 57: World Health Organization has recognized 57 countries with HCW critical shortage, 36 in sub- Saharan Africa• Not Universal: Some high-income countries, such as France and Japan, have less than 3% of workforce originating from abroad• Export: Countries such as Philippines rely on export economy of health workers
Global Imbalances North to South One way emigration outOECD Countries 20% of physicians in OECD 1 countries originate from abroadDeveloped Country Dependence USA, UK, Canada, and 2 Australia utilize 23-28% of all int’l medical graduatesLower Income Exodus Figure: Share of foreign-trained doctors in Lower-income countries selected OECD countries in 2008 (or latest 3 provide 40-75% of their int’l year for which data are available) (%) medical graduates Source: www.oecd.org/health/workforce
Imbalances in Political Economy TemplatesGlobal Economic MaldistributionLoss of Health Investment Global Political Economy NGOs and State Subsidies1 • Estimated $500 2 • Liberalization of 3 • NGOs aggressively million in annual markets and opening recruit HCWs from losses in educational of trade barriers resource-poor expenditures for leads to easier countries with higher HCWs (RPCs) migration wages • Studies show 9 SS- • Macroeconomic • Becoming larger African countries policies of IMF and players in global have lost $2.17 billion World Bank create health governance from physician brain barriers in health with decline of int’l drain while USA and systems investment organizations UK have gained 2.7b and 846m • Structural adjustment • Domestic subsidies, respectively policies imposed cut such as USA public spending Medicare residency • May result in higher programs, create transaction costs due immigration demand to recruitment Your own footer Your Logo
Imbalances in Political Economy Other Financial Implications and Waste• Lost tax revenue• Remittances not sufficient to make up gap• Brain waste: When HCWs are underutilized in destination countries• HCW export may be good for export economy but fails to meet domestic health needs
Responses to Brain DrainHealthcare System Strengthening • Task Shifting: Delegation of tasks to less specialized health care workers • Rebalancing Incentives: Address microeconomic reasons by improving incentives, resources, and providing assistance • Limitations: Requires substantial investment/funding and coordinated efforts which may not be available in resource-poor or rural populations
Responses to Brain DrainWHO Global Code of Practice Global Code of Practice on the Int’l Recruitment of Health Personnel (May 2010) • Non-binding code (soft law) to C maximize benefits and minimize negative factors of health worker migration, protect HCW rights, and strengthen health systems • Framework for bilateral and multilateral agreements on equitable HCW resource sharing especially for NGOs • Limitations: Voluntary by nature and to be enforced by member states as recommendations. Still relatively new but implementation reports may help
Policy Solutions Better Global Health Governance Systems Would establish rules requiring healthcare facilities hiring Health from shortage countries to allow HCWs to return to home Exchange countries in event of emergency or require sharing of Programs specialists for joint capacity building projects Would eliminate certain barriers for re-entry in event of public Brain emergencies, enhance capacity building programs, and Mobility enhance knowledge sharing and equitable migration pathways. Accreditation: WHO and ILO could implement fee-based credentialing program and provide technical assistance forGlobal Health adherence to HEP structure, labor and migrationGovernance standards, and WHO Code. They could also actively engage in data collection.
The One Health ParadigmBrain drain is not just HCWs • Brain Drain is not just HCWs: Global Health brain drain includes all professionals, including veterinarians, a multitude of researchers and scientists (basic sciences, agricultural, environmental) also internal migration. • Impacts Everyone: Brain drain of professionals has impact on disease surveillance, vector control, biosecurity and social determinants of health (economic consequences of brain drain) • Global Health Security: In an era of globalization, diseases can be spread around the world quickly, lack of adequate infrastructure in parts of the world can impact everyone.
SummaryAddressing Brain Drain Brain Drain is Global Health Crisis Brain drain is a global health crisis disproportionately affecting the health and well- 1 being of the resource-poor. Serious imbalances persist and must be addressed to ensure global public health. Current Responses Have Limitations Current responses to brain drain require sustained investment in order to be 2 effective. This may be difficult in countries who already domestic financing or depend on international aid/funding. Global Health Governance Policy Global health governance needs to be improved and coordinated to provide a 3 unified reform policy of more equitable resource sharing and international agreement on HCW migration policies