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Hemant Patel, vice-president of the Commonwealth
Pharmaceutical Association
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I read with interest the article highlighting the brain
drain from poor
countries to rich countries (PJ, 24 January, p98). At the moment access
to pharmacy services in the developing world is compromised by the movement
of pharmacists from areas of real need in developing countries to areas
of comparative saturation in the West. This inevitably leads to the disintegration
and disruption of communities that are least able to resist and there
are likely to be disastrous consequences for developing countries. Unless
steps are taken now to ease problems generated by the brain drain we
will engender fierce hostility, resentment and resistance.
In pharmacy the brain drain is a relatively new problem, but it is growing
fast. The problem has a number of separate but intertwined aspects. There
are personal, demographic, political, business and professional aspects
to consider. There is greater uncertainty than ever before and powerful
new forces are reshaping the boundaries between countries, professions
and peoples.
As the developed world’s demography changes with old people making
up a larger proportion of the population, the movement of skilled, young
people from developing countries to look after them will become greater
with potentially disturbing consequences. I fear that, if it is simply
left to market forces, what we will see will not be just and will be
insensitive to cultural, humane, democratic or regulated needs.
It is most important, to recognise that the brain drain is, in reality,
a transfer of intellectual capital — organised knowledge that can
be used to produce wealth, which can be packaged and sold at a higher
price than the cost of retention. This intellectual capital which can
be traded for a profit is today’s gold, silver, silk and spices,
the search for which, leads to plunder, looting and colonisation of vulnerable
communities.
Currently, managing intellectual capital in pharmacy has become a major
subject of both conversation and action in the UK. As innovation and
responsiveness begin to be rewarded, younger and more versatile pharmacists
will profit. Future roles like medicines management and prescribing will
demand flexibility, alertness and the ability to make decisions without
consulting a “superior”. So competition for those pharmacists
with confidence and clinical skills who accept responsibility will become
fierce and current shortages will become more acute.
Inevitably, and controversially, companies and organisations are already looking
elsewhere for staff. The methods used by some pharmacy recruiting organisations,
particularly in terms of financial inducements, are heavy handed. Their minions
are arrogant with little or no accountability; their philosophy, if they have
one, seems to be that of the bounty hunter.
In such circumstances, I also note the authors’ comments that “most
developing countries have invested scarce resources in training health professionals
and the ethics of luring such professionals from developing countries should
be questioned”. Having lived in and travelled to many developing countries,
I have much sympathy for the first part of the statement but I cannot see how,
based on ethics alone, anyone could succeed in stopping the human flow across
continents. I would argue for a planned co-ordination of the use and distribution
of resources in a co-operative community of equal partners where plundering is
replaced by fair exchange of skills, knowledge and resources.
Instead of building barriers to movement of people there should be controlled
movement based on principles of fairness, equity and affordability. Universities
in developing countries, like ours, need funding. People want to better themselves
regardless of whether they move to new lands rich with unexpected opportunities
or simply stay put. There are shortages of skilled pharmacists in nearly all
developing and developed countries, and independent organisations will do everything
they can to poach skilled labour. Their motivation is financial reward; their
thinking is short-term and local.
The UK Government, although not “poaching” directly, has eased entry
requirements for overseas pharmacists, although many believe that the Royal Pharmaceutical
Society could do more to help more pharmacists with right qualities to register
in Britain. When the new community pharmacy contract is introduced there will
be an even greater emphasis on the importance of intellectual capital. Pharmacy
owners and managers will soon find that knowledge (a pharmacist’s intellectual
capital) will be far more valuable, portable and powerful than the physical resources
found in pharmacies.
So, what is an effective way forward to ensure that planned high quality services
in the UK do not develop at the expense of poorer and less well co-ordinated
societies? I offer a possible solution that at first might appear laughable,
but its merits are worth examining.
Skilled sportsmen regularly move from one country to another without much opposition
or outcry. The movement is facilitated by a transfer system whereby money and
other resources go to those institutions that have helped develop them.
A similar scheme could lead to increased movement of skilled pharmacists that
recognises an individual’s right to better himself or herself and, at the
same time, ensure that the academic institutions produce increased numbers of
high quality graduates who will more than replace those who leave. In addition,
there could be schemes to allow retired pharmacists and others to serve populations
in areas of great need, according to their wishes and skills. This would allow
a two-way flow of pharmacists to overcome the “skills deserts” that
are created in institutions and communities when pharmacists leave. UK universities
should not see overseas universities as competitors because there is a growing
need for pharmacists everywhere.
To introduce a transfer system for pharmacists, we need a new philosophy and
new attitudes capable of sorting out what is tribal and what is universal. We
need to recognise that the assets belong to both the “buyer” and
the “seller”: each should have a stake in making them grow to long-term
mutual benefit. Transfer of skills, knowledge and technology from the West can
be rewarded many times over by a facilitated and controlled transfer of pharmacists
when a symbiotic relationship is established between the various universities
and countries.
Treating the brain drain like a commodity can deal with some aspects of the problem
including the ethics in a fair and open way. The NHS and other similar organisations
and private companies would benefit from a better planned workforce. To do that,
we need governments to discuss the creation of a system that mutually benefits
the developed and developing world and that respects individuals’ rights
to grow intellectually and financially. The discussions must take account of
demographic changes in the developed world and its effect on communities, new
patterns of human migration and technology transfer.
In short, we must collaborate to make all communities sustainable and give them
dignity and identity. |
The
Pharmaceutical Journal