Abstract
Since the creation of Pakistan in August 1947, political instability has been a persistent issue in the country, causing a migration of highly qualified, skilled people, and healthcare professionals. From 1971 to 2022 the total number of highly qualified and skilled people including healthcare professionals who migrated from the country is 60,19,888. Among them, 251677 (4.18%), were highly qualified, 455097 (7.55%) were highly skilled, and 5313114 (88.27%) were skilled professionals. Moreover, 50110 (0.83%) were healthcare professionals including doctors 31418 (62.69%), nurses 12853 (25.64%), and pharmacists 5839 (11.65%). The unsustainable political environment, lack of advanced technology-based institutes, poor healthcare infrastructure, low job opportunities and salary benefits in Pakistan caused the brain drain of highly qualified people including healthcare professionals. It adversely affected the academic institutes, the healthcare system, socio-economic growth, research productivity, and the development of the nation. The government of Pakistan must establish sustainable policies to minimize the brain drain of highly qualified people, and healthcare professionals, and recuperate the prosperity of their academic institutes and healthcare system for better healthcare services, and the advancement and sustainable development of the nation.
KEYWORDS: Brain drain, Healthcare professionals, Intellectual migration, Pakistan
INTRODUCTION
Pakistan is home to 231.4 million people,1 blessed with many rivers, mountains, minerals, natural gas reserves, coal and salt mines, and well-fertile agricultural land with multi-seasonal products. The country has 247 universities and degree-awarding institutions,2 including 176 medical and dental schools.3 Since the creation of Pakistan in August 1947, political instability has been a persistent issue in the country.4 Political instability reduces economic growth, threatens regional and foreign investors, and minimizes people’s savings, earning capacity and purchasing powers. Moreover, political instability causes inflation and unemployment, creating social unrest and uncertainty among people.5 An unstable political environment creates ambiguity among the public, academicians, healthcare workers, and researchers, and causes uncertainty in policies and decisions.6 The sociopolitical unrest significantly contributes to the instability in low and middle-income countries and causes a brain drain of skilled professionals,7 academicians, researchers, and healthcare professionals. The literature is lacking in highlighting the barn drain from Pakistan. This article emphasizes the brain drain of highly skilled people and healthcare professionals from Pakistan during the period 1971-2022.
Brain Drain in Pakistan: 1971 to 2022:
From 1971 to 2022 the total number of highly qualified and skilled professionals who migrated from Pakistan is 60,19,888. Among them, 251677 (4.18%), were highly qualified, 455097 (7.55%) were highly skilled, and 5314004 (88.27%) were skilled professionals (Table-I, Fig.1). While analyzing the profession of these highly qualified people, it was found that 50110 (0.83%) were healthcare professionals including doctors 31418 (62.69%), nurses 12853 (25.64%), and pharmacists 5839 (11.65%) (Table-II, Fig.2).
Table-I.
Brain drains of highly qualified and skilled professionals including healthcare professionals from Pakistan (1971-2022).8
| Year | Highly Qualified | Highly Skilled | Skilled | Total |
|---|---|---|---|---|
| 1971 | 163 | 892 | 1499 | 2554 |
| 1972 | 782 | 904 | 1860 | 3546 |
| 1973 | 916 | 954 | 3408 | 5278 |
| 1974 | 954 | 582 | 3992 | 5528 |
| 1975 | 985 | 569 | 8848 | 10402 |
| 1976 | 835 | 1529 | 15087 | 17451 |
| 1977 | 2570 | 4413 | 51845 | 58828 |
| 1978 | 2155 | 5903 | 53805 | 61863 |
| 1979 | 1527 | 5245 | 49756 | 56528 |
| 1980 | 1729 | 4041 | 47569 | 53339 |
| 1981 | 2467 | 6984 | 60503 | 69954 |
| 1982 | 2190 | 7449 | 60748 | 70387 |
| 1983 | 2123 | 6473 | 58042 | 66638 |
| 1984 | 1427 | 4527 | 42005 | 47959 |
| 1985 | 968 | 4259 | 37244 | 42471 |
| 1986 | 717 | 3787 | 25225 | 29729 |
| 1987 | 796 | 3558 | 27294 | 31648 |
| 1988 | 743 | 4739 | 36276 | 41758 |
| 1989 | 925 | 6095 | 44483 | 51503 |
| 1990 | 1115 | 6834 | 52895 | 60844 |
| 1991 | 1308 | 7752 | 67215 | 76275 |
| 1992 | 2293 | 11653 | 93795 | 107741 |
| 1993 | 1908 | 10105 | 77820 | 89833 |
| 1994 | 1328 | 6916 | 58197 | 66441 |
| 1995 | 1292 | 7681 | 61177 | 70150 |
| 1996 | 1794 | 10168 | 59816 | 71778 |
| 1997 | 1669 | 9292 | 76599 | 87560 |
| 1998 | 2024 | 8230 | 50122 | 60376 |
| 1999 | 2699 | 13860 | 31678 | 48237 |
| 2000 | 2999 | 10292 | 54110 | 67401 |
| 2001 | 3155 | 10846 | 64098 | 78099 |
| 2002 | 2618 | 14778 | 74968 | 92364 |
| 2003 | 2719 | 22152 | 101713 | 126584 |
| 2004 | 3291 | 15557 | 77033 | 95881 |
| 2005 | 3737 | 15467 | 57793 | 76997 |
| 2006 | 5708 | 16332 | 71898 | 93938 |
| 2007 | 8178 | 20975 | 110938 | 140091 |
| 2008 | 9713 | 33173 | 177791 | 220677 |
| 2009 | 4954 | 3260 | 182657 | 190871 |
| 2010 | 7081 | 31650 | 165726 | 204457 |
| 2011 | 6974 | 3018 | 171672 | 181664 |
| 2012 | 9298 | 4202 | 261531 | 275031 |
| 2013 | 12057 | 5032 | 263138 | 280227 |
| 2014 | 14647 | 6216 | 287649 | 308512 |
| 2015 | 17484 | 7853 | 397317 | 422654 |
| 2016 | 16510 | 8172 | 335671 | 360353 |
| 2017 | 16029 | 9886 | 188745 | 214660 |
| 2018 | 16105 | 9770 | 142486 | 168361 |
| 2019 | 15525 | 9899 | 285960 | 311384 |
| 2020 | 5121 | 3745 | 102336 | 112092 |
| 2021 | 7396 | 6563 | 131348 | 145307 |
| 2022 | 17976 | 20865 | 347733 | 386574 |
|
| ||||
| Total | 251677 | 455097 | 5313114 | 6019888 |
Fig.1.
Migration of highly qualified, highly skilled people including healthcare Professionals from Pakistan (1971-2022).
Table-II.
Healthcare professionals migrated from Pakistan during the period 1971-2022.8
| Healthcare Professionals | 1971-2010 | 2011 | 2012 | 2013 | 2014 | 2105 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doctors | 9854 | 1453 | 1218 | 1131 | 2074 | 2276 | 2779 | 1632 | 1945 | 1678 | 1223 | 1691 | 2464 | 31418 |
| Nurses | 6429 | 131 | 449 | 315 | 251 | 223 | 271 | 293 | 177 | 337 | 421 | 1788 | 1768 | 12853 |
| Pharmacists | 673 | 48 | 167 | 187 | 171 | 335 | 365 | 1217 | 1346 | 1121 | 67 | 66 | 76 | 5839 |
|
| ||||||||||||||
| Total | 16956 | 1632 | 1834 | 1633 | 2496 | 2834 | 3415 | 3142 | 3468 | 3136 | 1711 | 3545 | 4308 | 50110 |
Fig.2.
Migration of healthcare professionals from Pakistan during the period (1971-2022).
While analyzing the data for the year 2022, about 832,339, skilled professionals headed abroad. Among them, 17976 (2.15%) were highly qualified and 20865 (2.50%) were highly skilled professionals. It shows that 2312 people left their homeland per day during the recent year. Among them, 2,464 (0.29%) were doctors, 1768 (0.21%) were nurses and paramedics (Table-I & II and Fig.1 & 2).
Brain drain: origination and destination:
From 1971 to 2022, most people migrated from Pakistan to Saudi Arabia, UAE, Kuwait, Qatar, Oman, Bahrain, South Korea, Malaysia, the UK, USA, Switzerland, China, Brunei, and Germany. In the recent year 2022, the people travelled from Pakistan to the Saudi Arabia 514909 (61.86%), UAE 128477 (15.43%), Oman 82380 (9.89%), Malaysia 6175 (0.74%), Qatar 57999 (6.96%), Bahrain 3653 (0.43%), UK 2922 (0.35%), Cyprus 2906 (0.34%), Iraq 2387 (0.28%), Kuwait 2089 (0.25%), South Korea 2025 (0.24%), Japan 900 (0.10%), USA 801 (0.09%), China 673 (0.08%), Italy 350 (0.04%), and 23693 (2.845) people were left to the rest of the world.8
In the year 2022, people who migrated from Pakistan are from Islamabad 83169 (9.99%), Lahore 66708 (8.01%), Karachi 44341 (5.32%), Faisalabad 28385 (3.41%), Peshawar 20519 (2.46%), Rawalpindi 12437 (1.49%), Multan 7563 (0.90%), Abbottabad 6737 (0.80%), Jamshoro 5924 (0.71%), Bahawalpur 4788 (0.57%), Quetta 4328 (0.51%). These are the major cities of Pakistan from where most people migrated abroad.8
Brain drain factors:
The brain drain or the human capital flight, occur in their pursuit of better living situations, high wages, advanced technology base environment, and better political conditions in various places worldwide. People pursue their careers because of the freedom of independence, and intellectual satisfaction of creativity.9 Although these characteristics are inspiring, society always needs minds of creative thinking. There are multiple factors including political instability influence the migration of skilled people from Pakistan. The most concerning factor is that young people are not the only ones who are rushing for the exit, people in their middle age are also trying to move out of the country due to unemployment, inflation, poverty, security, and economic issues.9,10
The people get disheartened because of low incentives for their academic credentials and experience causing them to migrate to developed countries. The common reasons why the brain drain takes place are fewer career options, low salary packages, lack of benefits, low quality of life, political instability, and crime conditions.10,11 Moreover, long term war in Afghanistan also effected the state and caused brain drain. The brain drain of highly qualified people including physicians, researchers and academicians adversely affected the academic institutes, science, research productivity, socioeconomic growth and sustainable development of the nation.12
Impact of brain drain on academia and research:
In Pakistan, political instability, lack of job opportunities and limited resources negatively affect the progress and prospects of universities and academic institutions and cause the university faculty to flee from their universities and homeland.11 The science faculty not only migrate but also carry inventions and scientific prints. The migration of university faculty members developed a gap in the global standing of universities. This may be one of the reasons that Pakistani universities did not achieve a place among the top-ranked universities in the world.13,14 Although, Higher Education Commission (HEC) was established in year 2002, and a lot of efforts were made, opportunities were provided to enhance the quality of research by foreign collaborations, but the important aspect of brain drain was not amply addressed.
More recently, Nadir et al 202315 reported that one in three medical students intends to migrate abroad after graduation due to a lack of resources and mismanagement in Pakistan. This has been adversely affecting Pakistan’s health system. Saluja and colleagues, 202016 estimate the cost due to mortality linked with physician migration. The authors reported an annual loss of about $15·86 billion with the greatest costs incurred by India, Nigeria, Pakistan, and South Africa. The economic, social, and political instability in low-middle-income countries has induced further migration waves of healthcare workers compounding the pressure on already overstretched health systems.16
The recent wave of political instability in Pakistan in the year 2022 caused the migration of about 832,339 highly qualified and skilled people including healthcare professionals to head abroad. The migration of such a large number of professionals is likely to negatively impact research productivity and visibility. From January 2000 to December 2022, the number of articles published in the web of science-indexed journals worldwide was 248457. As per the Web of Science 2022 report, the rising trend decreased in the year 2022.17 The most potential reason for decreasing research productivity may be the political instability and brain drain from Pakistan.
In Pakistan, there are a total of 380 Higher Education Commission (HEC) indexed journals in various academic disciplines.18 Out of 380 HEC-indexed academic journals only 11 (2.89%) academic journals achieved a place in the Web of Science and quartile ranking. Among these journals only one journal, the Pakistan Journal of Medical Sciences (Impact Factor 2.340) crossed the IF of more than 2.0; the remaining journals have an impact factor of between 0.57-1.80.17 The highly qualified and skilled people are sending regular remittances, but it cannot compensate the loss of country in terms of qualified people that are much needed to participate in the universities, research institutes, and healthcare sector for the overall prosperity of the nation. It must be analyzed deep down whether this compensation is good enough or whether it is a great loss for the country to lose the highly qualified and skilled professionals who could help the country in a better way rather than just sending the remittances earned. The higher number of highly qualified and skilled professionals who departed the country is a cause of concern and it decreases academic and research productivity.
Science itself is one of the more migrant professions, and many scientists’ cross borders in search of better options and opportunities. Today, more people live outside the country of their birth than ever before.19 Knowledge and research productivity is a borderless enterprise, but some states such as Pakistan are worried that they are losing their top researchers. The worldwide highly cited scientists, one in eight scientists were born in developing countries, and 80% of those had since moved to developed states.20 A large number of Pakistan intellectuals try to return to their placental place after staying a long period in developed nations but once they return too late, they feel misfits in the system and their career structure. Moreover, the system is not easily accepting these intellectuals, hence the brain drain is a highly challenging issue for the state.
CONCLUSIONS
Over the last fifty years, about six million highly qualified and skilled professionals migrated from the country. The unsustainable political environment, poor healthcare infrastructure, low job opportunities and salary benefits in Pakistan caused the brain drain of highly qualified people including healthcare professionals. Moreover, Afghanistan war and war on terror also had a compounding adverse affect on Pakistan’s state, society and brain drain. It adversely affected the academic institutes, healthcare system, socio-economic growth, research productivity, and the development of the nation. The government of Pakistan must establish sustainable policies to minimize the brain drain and recuperate the prosperity of their academic institutes and healthcare system for better healthcare services, and the advancement and sustainable development of the nation.
Authors’ Contributions:
SAM: Study design, writing and editing the manuscript.
TS: Literature review, data collection, entry, and checking and analysis.
Acknowledgements:
The authors extend their appreciation to the “Researchers Supporting Project (RSP-2023 R47), King Saud University, Riyadh, Saudi Arabia”.
Footnotes
Declaration of interests: None.
Institutional review board statement: None.
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