Introduction

In the past, the migration of skilled health professionals from poorer to richer countries was essentially a passive process. Movement was driven mainly by the political, economic, social, and professional circumstances of the individual migrant. In recent years, however, demand for health workers in many countries in the Organisation for Economic Cooperation and Development has been greatly increased by changes in population dynamics. In response, some of these countries are relying increasingly on imported labour, with potentially damaging consequences for the healthcare systems in many developing countries, especially Africa. Indiscriminate poaching of health professionals is also likely to damage receiving countries in the long term. In this article I explore the policy options likely to minimise the consequences of migration of health workers.

Why do health workers emigrate?

Studies focusing on why skilled health professionals emigrate have identified two broad categories: the “push” and the “pull” factors.1 2 Among the push factors are low wages, poor motivation, persistent shortages of basic medical supplies, dangerous working conditions, outdated equipment, lack of supervision, and limited career opportunities.2 3 Involuntary factors such as human rights violations, ethnic and religious tensions, political persecution, wars, and economic collapse also play a part.4 Economic reasons, access to professional development opportunities, and job security are among the most important pull factors.

Empirical evidence on the size of the problem is only now emerging.5 6 For instance, in Ghana over 60% of all doctors trained locally in the 1980s had emigrated by 1999.7 In 2001 alone, it lost over 2972 nurses compared with 387 nurses in 1999.8 The vacancy rate for nurses in 2002 was 57% compared with 25% …