The Pharmaceutical Journal
Vol 275 (Supplement) F25-F26
October 2005

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FIP Congress 2005

Plugging the pharmacy brain drain

Migrating to a different country can offer health professionals a wealth of benefits but if large numbers of health professionals leave a country, the outcome can be devastating.

There are many reasons why health professionals choose to move abroad. Giselle Gallego, University of Sydney, Australia, shared her experience of moving from Colombia to Australia to undertake postgraduate education. Some of the challenges that she has had to overcome include obtaining a visa, improving her English language skills and finding a job to help finance her studies. She has also had to identify and adapt to practice differences between the two countries. For example, in Australia, pharmacists engage with patients in shared decision-making but, in Colombia, it is common for pharmacists to be the sole decision maker.

Ms Gallego commented that she had gained a huge amount of experience through migrating to another country but she has also experienced home sickness, cultural shock, language problems and isolation. She also noted how difficult it can be to return home. As an individual, your experiences may set you apart from old friends and colleagues and the skills that you have gained may not be required or be appropriate in your home country.

Hans-Petter Johannessen, a director of Apotek1, the largest community pharmacy chain in Norway, spoke about his own experiences of recruiting pharmacists from other Scandinavian countries. The reason his company looked to recruit from abroad was simple: there is a shortage of pharmacists in Norway. He commented that when looking to recruit from abroad, employers are likely to target countries with similar education systems and language.

The loss of large numbers of health professionals can greatly reduce the quality of a country’s health care system, said Grace Allen-Young, of Jamaica, president of the Commonwealth Pharmaceutical Association. Speaking on the impact that pharmacist migration had on the home/source country, Mrs Allen-Young commented that a lack of pharmacists can lead to reduced access to pharmacy services and long waiting times for dispensing services in clinics and hospitals. Nationally, the regulatory system may be weakened, with regulators forced to be flexible to ensure that the service can be maintained.

An outcome that is harder to quantify is the social cost of migration. For example, if a family member leaves the country, there is an impact on the remaining family. This effect is particularly important when it is a parent that leaves.

Fortunately, the “brain drain” also offers some benefits to countries. Mrs Allen-Young commented on the “reverse brain drain”, where health professionals return home to their source country, bringing new skills and financial resources. Nationally, this can make a significant contribution to a country’s economy.

Possible solutions

Migration flows are changing, with migration now shaped more by market forces than cultural ties, reported Sabine Kopp, of the World Health Organization. In the past, health workers mainly migrated from a small number of developing countries to developed countries, whereas now migration flows are more complex, encouraged by targeted recruitment and including inter-regional movement.

Dr Kopp suggested a number of solutions to the “brain drain”, including managing migration through agreements and ethical recruitment. Some success has been seen with bilateral agreements between countries and, although codes of practice need more evaluation, they appear to be having a limited effect.

Consideration should be given to investing in education, said Dr Kopp. This could be through investing in education in the source country. For example, if a country knows that 20 per cent of its workforce is likely to leave the country, the student intake could be increased accordingly. Recognising the benefits for the economy of workers moving overseas, some countries are capitalising on the movement. For example, the Philippines purposely trains more nurses than the country requires.

Distance learning provides a method of educating professionals remotely. Alternatively, rapid, competency-based education could be developed to prepare non-pharmacists to practise in primary care settings. Dr Kopp recognised that this was an imperfect solution but may be necessary to ensure continued provision of the service.

Developing policies around pay are often unrealistic in developing countries because the differences in the economy of countries often make it impossible to match pay between developing and developed nations but Dr Kopp suggested that since health workers want good working conditions and continuing professional development, there may be ways to create packages of incentives to help retain them. Non-financial incentives that could be considered include training opportunities, study leave, providing day care and allowing staff to combine posts in both the public and private sector.

Dr Kopp also suggested improving workforce planning, facilitating the return of skilled professionals and encouraging “medical tourism”, with lower cost health care in developing countries providing an opportunity for patients from developed countries to travel abroad to receive care.

(During a panel discussion, a number of other solutions were proposed. Mabel Torongo, of Zimbabwe, commented that her country had recently introduced compulsory service of one year in the public sector for all recent graduates, and Ms Gallego, who had spoken earlier, suggested only providing scholarships for courses or work experience in line with a country’s national priorities.)

In 2004, the World Heath Assembly, through Resolution WHA57.19, mandated the WHO to explore mechanisms to strengthen the capacity of member states to manage migration flows and to develop systems to monitor and account for the impact of such flows. During the 2005 World Health Assembly, the WHO director-general announced that the WHO will be dedicating the 2006 World Health Report and the 2006 World Health Day to “Human resources for health”.

The “brain drain” is a complex issue in times of increasing global mobility and because of the international nature of the problem, the solution lies in international collaboration. Dr Kopp confirmed that the WHO will continue to help facilitate dialogue on solutions to the problem.

A concern expressed by all speakers was the lack of available data on the migration of pharmacists. Although a large amount of research has been done on the migration of other health workers, including doctors and nurses, there is only a limited amount of information available on pharmacist migration flows.

Linda Stone, of the UK, reported that the Royal Pharmaceutical Society of Great Britain closely monitored the number of overseas-trained pharmacists who registered in Britain but commented that there was no information available on the number of overseas trained pharmacists who have been unsuccessful in their bid to register in Britain but have remained in the country.