Third world brain drain

Editor—As a developing country professional working in the developed world, I believe that Levy did not consider the reality of life in the 21st century.¹ Brain “drain” defines a one way process of a potential public good moving from one location to another and measures the “stock” of manpower—a static indicator.

The fact is that health professionals move in many more directions, from developed to developing, from developing to developing, and within nations. Thus it is more important to measure “flows” of manpower—a dynamic variable.

In a globalised world the physical location of a person may or may not have any relation to the ability to make an impact on human health. Health professionals in the developed world may have most of their work portfolios in the developing world. Easy communication, quick travel, and greater collaborations between developed and developing countries are increasingly more common.

Countries need to recognise that they compete with the best institutions in the world for quality manpower. A study in Pakistan shows a small proportion of people funded for a doctorate returning, and on return, facing major non-financial disincentives for good performance.² Thus the financial component of such flows is only part of the picture and in some case not the major push or pull factor.

It is time to understand and accept that health professionals' mobility is part of life in the 21st century. It is time to bury the archaic concept of brain drain and turn to assessing the performance of health professionals and systems, wherever they are in the world.³