Malawi, one of the poorest countries in the world, is currently losing health professionals to rich countries while its own health system suffers from a critical lack of human resources. Is this movement of medical staff fundamentally unjust, or could it be a ‘win-win’ for both developed and developing countries?

Many see the migration of nurses and doctors from developing countries to the developed world (the so-called medical ‘brain-drain’) as straightforward exploitation of the poor by the rich. However, new research suggests that health sector migration, if managed properly, could become a successful form of trade in services.

The researchers explored the costs and benefits for Malawi of health sector migration. They looked at recent reports, including an analysis by the Malawian Ministry of Health which stated an overall health sector vacancy rate of 33 percent (this figure hid a vacancy rate for nurses alone of 64 percent). Meanwhile, over 100 Malawian nurses and midwives continue to leave the country to work abroad each year, many to the UK, despite recent efforts to improve pay and conditions. This trend outstrips Malawi’s current annual training rate of approximately 60 nurses per year.

So what are the effects of this migration pattern? Its costs include loss of public educational investment, fewer and poorer health services and chronic staff shortages. However, remittances (sums of money sent home by those working abroad) are a growing source of foreign exchange in many poor countries. Previous studies from outside Malawi have shown that remittances have a significant impact on poverty. The researchers also found that:

• a major cause of the brain-drain is the huge pay gap between Malawi and other countries, with equivalent salaries for newly qualified nurses and doctors around ten times greater in the UK
• without any policy effort, Malawi has shown that it is globally competitive in the training or ‘production’ of doctors and nurses
• if migration is temporary, the migrants bring back a ‘brain gain’ in improved skills and knowledge.

The authors conclude that Malawi can benefit from ‘exporting’ health professionals, while providing incentives for some to remain within or return to the domestic health system. However, the current situation, where the cost of training lies with the state while the benefits accrue to the individual working abroad, amounts to market failure. They suggest various policy options:

• Rich host governments could remit part of a tax (such as income tax or national insurance) to the Malawian government for re-investment in public health.
• The state could charge fees for medical training in Malawi; the debt could then either be written off over a given number of years of public service in Malawi or paid through overseas earnings.
• The government could improve incentives for migrants to remit by allowing the holding of foreign currency accounts by Malawians working abroad, and reducing the cost of sending money from the UK to Malawi.

Source(s):
‘An economic perspective on Malawi’s medical “brain drain”’, Globalization and Health 2(12), by Richard Record and Abdu Mohiddin, 2006 Full document.

id21 Research Highlight: 28 August 2007

Further Information:
Richard Record
Ministry of Industry and Trade
PO Box 30366
Lilongwe 3
Malawi

Contact the contributor: richardrecord@hotmail.com

Ministry of Industry and Trade, Malawi

Abdu Mohiddin
Division of Health and Social Care Research
Guy’s, King’s and St Thomas’ School of Medicine
King’s College London
London SE1 3QD
UK

Contact the contributor: abdumohiddin@doctors.org.uk

Division of Health and Social Care Research, King's College London, UK

Other related links:
Paying for health care migration: the case for compensation

Managing the migration of health-care workers

The international migration of health workers: a human rights analysis

Shortages and shortcomings: the maternal health workforce crisis

Sub-Saharan Africa: Beyond the health worker migration crisis?

Skilled health professionals’ migration and its impact on health delivery in Zimbabwe