Brain drain is an international pheno-menon and has been a major concern of the World Health Organization. The Philippines is one of its victims.

I shall begin with the situation before 1985 and shall adopt the findings on the subject of the 1986 conference of the Council of International Organizations of Medical Sciences (CIOMS) on Health Manpower Out of Balance. 

I shall read the findings of the conference on Brain Drain which covered the first two waves of migration, word for word. What is happening today is the third wave.

The First Wave

“First, the emigration of professional manpower amounted to an extensive form of unplanned donation from poor countries to rich countries. The poor countries paid for or heavily subsidized the education of health manpower, and the rich countries received the gift of qualified manpower without having to pay anything for the original cost of their education. A net loss of 50,000 doctors from the developing countries to the developed, even at the Canadian cost of educating a doctor, was a gift of 10 billion Canadian dollars from the poor to the rich. The Philippines alone had lost by 1982 a total of 14,000 doctors, mainly to the USA, and 89,000 nurses—imports worth billion dollars to the recipients. The argument that emigrants transfer funds back to relatives in their developing country of origin and thus serve as invisible exports was hardly a convincing reply to this basic point—particularly if the funds came back through black markets at unfavorable rates of exchange for the recipient country and thus outside the grasp of the governments, which had paid the original cost of the education.

“Secondly, the developed countries generally used foreign medical graduates under the guise of training as “interns” and “residents” —in practice, pairs of hands working long hours—in the less prestigious hospitals in which nationals refused to accept appointments.

“Thirdly, a substantial proportion of emigrants stayed on and was given full rights of citizenship. When the United States was short of doctors it recruited them from the United Kingdom (often via Canada), Latin America and the Far East. When Britain became short of doctors owing to losses, mainly to North America, it made good the loss mainly from India, Pakistan and Sri Lanka.  Britain also made good its shortage of nurses by recruitment of trained or trainee nurses from Ireland, the West Indies, Mauritius and other countries.”

The Second Wave

“The next wave of migration was to the newly oil-rich countries of the Middle East and Africa. It included doctors and dentists but also nurses and allied health workers, probably on a scale greater than earlier patterns of migration. Syria lost doctors to both Europe and the Middle East. Malta lost more to the former, Egypt more to the latter. This, however, is far from completing the story of the movement of medical manpower and its complex patterns based on culture, language and acceptability of qualifications.”

Health Manpower Imbalance

Brain drain is an element of manpower imbalance.

Health manpower imbalance is a diverse and complex phenomenon. It has three dimensions: numerical, over- or under-supply of one or several categories of health workers in relation to what a country or community needs; qualitative, a mismatch between training and job requirements; and distribu-tional, which may be geographical, occupational, institutional and by specialty.

Balance implies that the supply of health manpower and its distribution and utilization in a country are in line with the values of social accountability: equity, relevance, cost-effectiveness and high quality. The health professionals and workers must respond to the health needs and demands of the people. Imbalance is a serious obstacle to the organization and provision of health care and the attainment of health for all.

From 1946 to 1985, there was unprecedented growth in the supply of health manpower, particularly of doctors and nurses. There was overproduction of these professionals. But the economics of the developing countries could not support them. There was much under- and inappropriate employment.  Migration to developed countries escalated. The unmet needs for health care expanded. Thus the growth in the production and supply of health workers did not narrow the gap between developed and developing countries as regards adequacy of health care. On the contrary, the growth in production in certain countries has accentuated some types of imbalance in distribution by discipline and geographically.

At the peak of the medical diaspora, a medical degree from an internationally recognized school was equivalent to an international passport. But after 1980 the developed countries began closing their doors to physicians. They erected barriers to keep them out as readily as they once created loopholes to let them in. In the Middle East, foreign doctors were replaced by graduates of their own schools.

Doctors who returned after training in the developed countries found themselves over-trained for the medical infrastructure in their homeland.  Neither could they adjust to the relatively low salaries or income. The Philippines has been fortunate that we were able to build our infrastructure, but salaries and income of health workers remain very low as the country’s economy floundered.

In countries that do not control migration of health workers, nurses leave with impunity. Nurses stay in their own countries only for a very short time.  Turnover of nurses in hospitals is generally less than a year on the average.