Migration of health personnel and brain drain

Abstract

Within global bioethics, global inequities in terms of life expectancy, morbidity, and the distribution of health resources have been identified as areas of serious ethical concern. These inequities are caused and compounded by a grossly unequal global distribution of health workers, both between and within countries. In many communities, there are insufficient health human resources to provide primary and preventative care, to distribute new interventions provided by external donors such as antiretroviral drugs to combat the spread of HIV, and, most pressingly, to train future generations of health workers. Thus, these inequities in human welfare are likely to persist or even worsen, if the problem of health human resource levels in these areas is not addressed. This problem is compounded by an ongoing pattern of migration of health workers from relatively low- to high-income countries and from countries with severe health human resource shortfalls to those countries with relatively many health workers. This chapter begins with a brief background on the effects and causes of health worker migration. The next section of this chapter consists of a survey of the range of arguments on the ethical terrain of health worker migration, noting that multiple forms of unethical behavior are likely taking place. The chapter concludes with a survey of policy responses to the problem of health worker migration with discussion of their chances of success and implementation and therefore their ability to address global inequities in health human resources.