Intended for healthcare professionals


Africa's medical brain drain

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:780

Summary of responses to recent editorial on stopping Africa's brain drain

  1. Birte Twisselmann, assistant editor (web)
  1. BMJ

    The 20-odd international responses to Johnson's editorial on stopping Africa's medical brain drain agreed that the brain drain is an inescapable reality for the countries of Africa (although India and other parts of Asia were also mentioned or implied).1 Some correspondents proffered possible reasons or attributed blame; some suggested possible solutions; some saw advantages to “medical migration”; and many raised pertinent questions.

    Few correspondents simply “blamed” developed countries for luring the talent away from developing countries. Many of them with African or Asian names found fault with their own countries for not being able to keep talented health professionals. The reasons included general poverty and poor working conditions resulting from local health policies and depleted economies—some of which were laid at the door of the countries' governments but some were attributed to greedy rich countries, whose trade arrangements (in arms, among other things) keep fuelling social conflict.

    Individual doctors were understood to be striving for a better life elsewhere—some for themselves and for personal gain, but many so that they could better support their families who had been left behind. Doctors and nurses also desired and needed better training, which poor countries cannot satisfy.

    Among the practical solutions proffered were an ethical recruitment policy whereby no medical professionals would be taken on from countries that did not have a surplus (similar to what happens in Cuba); training rotations and exchange programmes in the UK and the US for doctors from developing countries; the abolition of poverty to improve countries' economies and reduce migration; the standardisation of doctors' pay worldwide to counteract merely financial motives; training all doctors in developing countries, where the costs would be lower and sufficient medical professionals could be trained for all countries in the world; paying “rent” for medical graduates whom developed countries “borrow” from developing ones; and so on on.

    Many correspondents agreed, however, that the brain drain is essentially an intractable dilemma. As Richard Rosin, consultant psychiatrist in Seattle, points out: “Society needs doctors, and there is always somewhere where conditions are worse. Given these factors there is no end in sight to the brain drain.”

    And even if developed countries did not need any more doctors from abroad, they would still have a moral responsibility not to keep trained medical workers out even if they produced enough of their own, finds family doctor Richard Lyus from Seattle.

    Andrew Wilson, radiation oncologist from Cape Town, smells a form of latter day colonialism: “Why do qualified people (of all professions/trades) seek to leave Africa? Simply put, it is for a better future for them, and especially their children. It is their basic human right to do so. Your editorial is sadly quite typical of the UK's chattering classes, people who demand freedom and rights for themselves, and yet will happily acquiesce to the effective enslavement of others in some grand social engineering scheme.”


    • Competing interests None declared.


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