Intended for healthcare professionals

Feature Medicine in developing countries

Fighting the brain drain

BMJ 2008; 337 doi: (Published 15 September 2008) Cite this as: BMJ 2008;337:a1496
  1. Karen McColl, freelance writer
  1. 1Savoie, France
  1. karen{at}

    The WHO’s goal to close differences in life expectancy requires equal access to health care, but incentives are needed to get and keep health staff. Karen McColl reports

    In sub-Saharan Africa, 3% of the world’s health workforce cares for 10% of the world’s population bearing 24% of the global disease burden.1 Developing countries need an extra 4.3 million health workers, and urgent action is required to scale up education and training.1 Last month the World Health Organization’s Commission on Social Determinants of Health emphasised the importance of building and strengthening the health workforce if the goal of achieving health equity within a generation is to be realised.2 International cooperation will be essential to strengthen health systems and to manage the migration of health workers from developing to developed countries.

    But these measures will take time. What can African and Asian health systems do to recruit and retain health workers now? How can health workers be persuaded to practise in rural areas? Recent guidelines, commissioned by the Global Health Workforce Alliance, aim to help countries make the best use of incentives to attract and retain health professionals.3

    Improving recruitment and retention

    “It is important that we effectively utilise what is available now. The efficient and effective utilisation of the health workforce which is available is the key,” according to Mubashar Sheikh, executive director of the Global Health Workforce Alliance. “That is why retention—providing the right kind of incentives, motivation, and support—is absolutely critical.”

    WHO has identified 57 countries that have been particularly hard hit by shortages in health workers.4 There are many reasons why health systems in these countries find it difficult to attract and keep staff, particularly in rural areas. Some of these reasons are global; others are local. There are both “push” factors that drive people to leave …

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