Brain Drain of Workers from Poor to Rich Countries

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  • by Anup Shah
  • This Page Created Friday, April 14, 2006

“Brain drain” is the phenomena whereby nations lose skilled labor because there are better paid jobs elsewhere. In recent years, this has affected poorer countries more so, as some rich countries tempt workers away, and workers look to escape bleak situations in their poor home countries.

Poor Countries Providing Rich With Educated Workforce

According to, the term “Brain drain” originated in the 1960s, “when many British scientists and intellectuals emigrated to the United States for a better working climate.” In recent years, however, the problem of “brain drain” has been acute for poorer countries that lose workers to wealthier countries. Almost ironically, England is now a country where many such workers end up.

Brain Drain of Healthcare workers

The problem has been noted in healthcare in particular because the loss of healthcare professionals in poorer countries leaves already struggling healthcare systems in an even more desperate state.

For its World Health Report 2006, the World Health Organization (WHO) noted that there is a global shortage of 4.3 million doctors, midwives, nurses, and support workers. Furthermore, “these [shortfalls] often coexist in a country with large numbers of unemployed health professionals. Poverty, imperfect private labor markets, lack of public funds, bureaucratic red tape and political interference produce this paradox of shortages in the midst of underutilized talent.” In addition, “Unplanned or excessive exits may cause significant losses of workers and compromise the system’s knowledge, memory and culture.”

The prestigious journal, British Medical Journal (BMJ) sums up another aspect of the “brain drain” problem in the title of an article: “Developed world is robbing African countries of health staff” (Rebecca Coombes, BMJ, Volume 230, p.923, April 23, 2005.) This, Coombes notes, is because rich countries are also hiring medical staff from abroad, because they are far cheaper. (Many health systems in the first world are under budgetary pressures.) In a way, this becomes a form of subsidy for the rich!

Some countries are left with just 500 doctors each, with large areas without any health workers of any kind. A shocking one third of practicing doctors in UK were from overseas in mid 2005 for example as the “BBC” reported. The British Medical Association and the Royal College of Nursing have described this as “poaching” because “staff migration from developing nations is killing millions and compounding poverty.” (See previous BBC article for more on this.)

The WHO admits that numbers are difficult to come by, but looking at countries that do track such data (often limited to nurses and doctors only), the number of doctors and nurses from abroad working in the OECD (rich) countries comprises a significant percentage of the workforce:

Doctors and nurses trained abroad working in OECD countries. Source: World Health Report 2006, World Health Organization, Chapter 5, p. 98, Table 5.1.
Doctors from abroadNurses from abroad
OECD countryNumber% of TotalNumber% of Total
New Zealand2,8323410,61621
United Kingdom69,8133365,00010
United States213,3312799,4565

The following chart images have been generated from the above data:

Doctors from abroad

As percentage

In numbers

Nurses from abroad

As percentage

In numbers

Additionally, doctors trained in sub-Saharan Africa and working in OECD countries represent close to one quarter (23%) of the current doctor workforce in those source countries.

And yet, this is not just a problem Africa faces, but many other poor countries, such as various Asian countries, Central and Latin America, Eastern Europe, the Caribbean, etc.

Other areas also suffer brain drain

Other industries also suffer this issue. Some countries are able to afford this loss. For example, during the tech boom in the US around 2000, many IT workers from India were attracted to the US under the H1-B visa program. At that time, concerns were raised in India that this was a form of brain drain as highly skilled workers were being lost. However, some Indian politicians confidently claimed that this was not a problem because there were so many tech workers in the pool. Indeed, today India is a major off-sourcing center for technology. However, most poor countries are not of the size of India and per person lost, the impact can be more severe. (This section of course needs expanding and more will be added over time.)

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Escaping Poor Conditions

It can be understandable that people in poorer countries will want to get away from poverty and corruption, and if they can afford to do so, why should they be denied the ability to try? The World Health Report 2006 from the WHO summarized a number of reasons why health workers moved to richer countries:

  • Workers’ concerns about
    • Lack of promotion prospects,
    • Poor management,
    • Heavy workload,
    • Lack of facilities,
    • A declining health service,
    • Inadequate living conditions, and
    • High levels of violence and crime
  • Prospects for
    • Better remuneration,
    • Upgrading qualifications,
    • Gaining experience,
    • A safer environment, and
    • Family-related matters

The factors arising form concerns are described as “push factors” for they push people away, and those factors that offer prospects for better circumstances are known as “pull factors.”

A major reason for the declining health services in the poorer countries has been the structural adjustment programs imposed by richer countries and international institutions on poorer countries, which then contributes to this brain drain, thus twisting the knife in the back, so to speak. The small amounts that rich countries do allow the poor to spend on health is now lost to the already rich, and the poor have to bear the burden. (See this site’s section on structural adjustment for more on how the rich dictate to the poor how to structure their economies and run their countries.)

The changes to most economies around the world due to “globalization” and the accompanying changes required in labor markets has an impact on this issue, as well. This means that both rich and poor countries are inter-linked by this problem as the WHO notes:

As exemplified by the case of international migration, the health workforce is strongly linked to global labor markets. Shortages in richer countries send strong market signals to poorer countries with an inevitable response through increased flows of migrant workers. In articulating their plans for the workforce, countries must recognize this and other linkages beyond their borders.

Managing Exits From The Workforce, World Health Report 2006, WHO, Chapter 5, p. 112

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Author and Page Information

  • by Anup Shah
  • Created: Friday, April 14, 2006

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