Recruitment is ethical

Dear sir,

The article of Vikram Patel highlights the concerns of a sincere
citizen of a third world whose country government spends a handsome amount
of its already thin medical budget on training of medical professionals.
But the argument that availability of doctors and health professionals
itself will make health care accessible to all the population is another
day light robbery. If it is so, why the city called Mumbai has 60 per cent
of the doctors in the State, but only 12 percent of the State's
population, because the nature of private practitioners is that they will
be concentrating mostly on "islands of purchasing power". The reply by
the Indian Minister about the "self-sufficiency" of doctors is also hiding
the most unpalatable truth that large number of primary health centres and
rural areas are starved of doctors as revealed by the government data.

Let's go back to the brain drain issue, whether this outgoing
professionals are going forever or coming back to their country and also
how much monetary resources they are sending back to compensate for their
"loss" to the mother country is a moot question? To find an answer to
bring brain drain to halt is as difficult as making the "market" work for
the poor. The controversy of "brain drain" in the articles is still
standing at the periphery by saying that this can be cured by steps like
intergovernmental agreements or conventions. The most important reason for
forcing the third world professionals to fly out is, I feel, is the
amasing difference in the nominal and actual purchasing power of the
different currencies of the world in different countries. If we take an
example by Vikram Patel, an amount of £46000 in U.K which a specialist can
earn in one year is worth about Rs.3450000 in India,(£1=Rs.75 at current
exchange rates)which is beyond the imagination of the same doctor, had
he/she practiced in the country of origin within, say, 5 years. That is
also the reason why professionals are not migrating to those countries
whose nominal purchasing power is low compared to the mother country, and
unfortunately majority are third worlds. The theoretical reasons for
jumping out of the counrty are not far to seek, as individuals are utility
maximisers he/she will be looking forward to maximise his/her utility
subject to the consraints of thier material and spirirtual relations or
conceptions and the society's rules and regulations. From the point of
view of an individual who had been on the boiling point of exams and
frowning teachers, he/she wants to compensate the "loss" by earning and
enjoying the maximum, which opportunity may not be available in third
world countries, for which the third world heirarchical system is to be
blamed for. It is also obvious that the professionals attach special
weightage to other aspects of the work culture in developed countries.

The reason why the relative wages are high in developed countries is
that their input prices like rent, cost of living etc are also high and
that gets reflected ultimately in the compensation package through DA hike
etc, which often does not take place in the third world where majority of
the occupation is unorganised and non monetised. My point is that unless
policies which do not take into account the difference in the real and
nominal purchasing power of the currency, there is possiblity of further
worsening the inequality. Intergovernmnetal agreements should take into
account this factor while formulation of policies and there should be
close monitoring by the authorities of the mother country over the
migration of such highly qualified personnel and atleast the training cost
plus some minimum costs of loss is to be recovered from the individual
migrating abroad.

Competing interests:
None declared