In the modern age of globalisation, migration is rather commonplace with healthcare workers, including medical practitioners and nurses. The reasons for migration differ by individual case but commonly cited pull factors include, but are not limited to, greater financial stability or income, better quality of living, better opportunities for overall family, and recruitment from overseas, commonly OECD, countries. Migrants are also extremely likely to send remittances back to their families. According to the World Bank semi-annual report Migration and Development Brief 35, remittance flows towards low-and middle-income countries (LMICs) began to show signs of recovery with a 7.3 percent increase after effects of the COVID-19 pandemic in 2020 began to subside. Regions that have seen an increase in remittances since the beginning of 2021 include Latin America, Central Asia, the Middle East, Sub-Saharan Africa, and South Asia. The figures highlight that remittances for 2021 are estimated to reach $589 billion, 50% higher than the value of foreign direct investment for official development assistance. However, the WHO has noted that the situation of “international migration and mobility of health workers is increasing in volume and growing in its complexity”. This is due to the ramifications of effective health responses for developing countries, especially in light of the pandemic. Therefore, this article will examine the implications of international healthcare migration in terms of how this situation presents a scenario of brain drain from developing countries, leaving behind fragile healthcare systems, especially in light of pandemic recovery.
To begin, brain drain is defined by an article by the Journal of the Royal Society of Medicine as “migration of skilled human resources for trade, education etc…[from] less developed areas…These [developing] countries have invested in the education and training of young health professionals. This translates into a loss of considerable resources when these people migrate, with the direct benefit accruing to the recipient states who have not forked out the cost of educating them”. It can be difficult for developing countries to reckon with the fact that migration overseas often presents better economic and living standards for their national individuals. We must also consider that the country individuals leave behind likely does not have the resources to develop their healthcare system in the first; a system that is oftentimes one that is already fragile and underinvested in. On the other hand, countries like Canada that benefit from this migration show that the proportion of immigrants who come to work as either “licensed practical nurses, nurse aides, orderlies, and patient service associates” has steadily grown in each of these groups since the 1990s. The value of migrant healthcare workers has been indispensable throughout the pandemic, this not only includes those working daily shifts on the ground, treating patients with COVID-19 or other illnesses, but also within the responsibility to support family members overseas during this economically tenuous time. According to the WHO, COVID-19 actually created economic opportunity in some capacities. Through the implementation of emergency COVID-19 fiscal stimuli and related monetary policy, healthcare worker migration increased to address the shortage within hospitals overseas, thus increasing employment for migrants. But, it is critical to note that it is quite difficult to project long-term socio-political and economic development while in the extraordinary and volatile circumstances of a global pandemic.
Data for the increase in international migration has been available since the 1940s in Europe, where signs of a potential health crisis were imminent with a large influx of immigrants to the US and UK. Three decades later, evidence from the WHO in the 1970s showed that migration pull factors for 90% of international physicians were being congregated largely in Australia, Canada, Germany, UK, and US. While this has been on the radar of the global stage for decades now, its devastating effects were only realised during the pandemic. The migration of healthcare practitioners made it very transparent that when less developed regions like Africa, Latin America, and Asia were faced with increasing numbers, each healthcare worker left behind a knowledge vacuum, making the maintenance of these healthcare systems much more precarious and fragile. There is also a gendered dimension to this issue as according to Broom, Owings, and Badr “women account for about 90% of nurses and midwives, close to 50% of all doctors, and make up 70% of all health and care workers worldwide”. Therefore, there is a large call for international organisations such as the WHO and IOM to create and encourage developing countries to establish policies that help manage healthcare migration by incentivising domestic healthcare practice. Existing practices include the 2010 WHO Global Code of Practice on the International Recruitment of Health Personnel, otherwise referred to as ‘the code’. This establishment aims to collate data on health personnel migration every three years to fully understand the issues underlying it and to work with how each country can best solve this issue with the resources they have. Moreover, the IOM’s work also encompasses trying to “promote effective management of health worker migration, health systems capacity-building in source countries and skill/knowledge transfer from the diaspora.” These projects serve as a global toolkit to try and enforce larger resolutions and global strategies to make sure that lessons are learned from the pandemic and progress is made to ensure that developing countries’ healthcare systems gain some strength. Additionally, The Gender Equal Health and Care Workforce Initiative was created not only to work towards equal treatment of healthcare workers but also to address the reasons underlying migration for female health workers. Efforts are being made to propose other initiatives that can allow for domestic work while having the necessary outcomes of “visibility, dialogue, and action”. Finally, it is integral to mention that these organisations operate under the assumption that labour healthcare mobility will only increase in the coming years and is an inevitable consequence of the development of the international labour market. As we have seen with vaccine distribution, many Global South countries have not been given the same access to health resources as other wealthier countries. Therefore, if any of these developing countries have sacrificed their healthcare workers to respond to the global health effort, it is imperative for the future of Global South health security and health systems to have policies and active cooperation in place to manage healthcare migration for the long-term.
Edited by Misbah Lalani
Sokhema Sreang is in her last year at McGill University and she is pursuing a major in International Development and a minor in Sociology. She has joined Catalyst as a staff writer and is particularly interested in the politics of developing countries, social protection and social change.