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[Bayo Yusuf Adenuga]

Dear Acime

The issue of brain drain I believe is both an ethical and moral issue. I share the views of all the schools of thoughts.
A small percentage of the blame can be attributed to lack of patriotism on the part of some of the health personnel. This category are only interested more in enriching themselves and in their personal career development at the expense of their poor populations who are in desperate need of health care. One should balance patriotism and career development and monetary gain
I equally agree with the second school of thought which blames the developed countries who actively recruit health personnel from the developing countries by deliberately offering attractive remuneration packages to attract them. It is thus unethical for developed countries to benefit from the efforts of developing countries, therefore using these countries as training ground for health personnel for use in the developed countries.
Finally the greatest percentage of blame is on the developing countries, for refusing to make sufficient efforts to retain their health personnel. The poor working conditions present in most developing countries frustrate and drive out trained personnel. This is further compounded by the perennial shortages of essential drugs and other resources and the poor remuneration packages. The overall effect is to hinder the well being and career development efforts of the health personnel, hence their exodus to the developed countries.
In addition, developing countries have persistently failed to invest in their national health sectors, leading to the poor state of health delivery systems in these countries. Countries cannot neglect their national health sectors and then expect the poor health personnel to sacrifice their career development prospects in the name of patriotism.
My solutions to this problem include:

1. Health personnel should be encouraged to be patriotic by providing them with all the necessary logistics and motivation to do their jobs
2. Developed countries can be made to contribute to the training of health personnel by providing financial logistics and technical capabilities to support the developing countries training of health personnel
3 Developing countries should increase financial commitment to their health systems to make them running efficiently

Bayo Yusuf Adenuga
Kintampo

[rokine]

This involves the health sector which deals with issues concerning human life so ethics cannot be entirely ruled out.
but i tend to associate with the third school of thought. the issue of governments supporting the education of individuals is overblown. For example, medical education in most countries (developed and developing) is highly subsidized for citizens, thus support for training of individuals is not just limited to developing or under- developed countries.
The problem has to do with the provision of effective tools and infrastructure for work. I believe health workers will gladly accept posting to rural communities if they know the working environment wiil be condusive. They will be happy if their children will get access to good quality education in these localities.thus, the issue of rural development in terms of basic social ammenities and infrastructure is linked to this crisis.
Most workers favour working in urban areas because of the mentioned problem.
Unfortunately most urban cities in developing countries are faced with the same infrastructural problem. the next obvious option is the dreaded BRAIN DRAIN.
The issue of remmuneration can also not be ruled out.
Thus it basically boils down to good conditons of work tied into developing not only the basic health infrastructure but other social nfrastructure NATIONALLY.
Developing countries should also strongly consider setting up post-graduate trainig schools and other facilities to develop capacities internally.
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rafiq okine

[Cecilia Addae]

yes brain drain is an ethical issue because if you brain drain your mind it can affect your life and ethics are to protect life of people i agree with the second school of thought for developing countries not making efforts to retrain health personnel but i think that should not be a chance for the developed countries to use packages to win health personnels of developing countries thank you.
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Ceci

[oakadeneye]

I absolutely agree that the issue of brain drain in the health sector is an ethical issue. I stand to subscribe to the ideology of the third school of thought. I would not really blame the developed countries for dangling carrots before the health personnel from developing countries who are striving to survive in the midst of plenty. Rather, I would blame the governments of developing countries for making their health personnel vulnerable to such irresistible temptations. The so-called attractive offers in form of good remuneration packages represent the standard that obtains there for their people. If ethics is all about doing good i.e. good practices, what good have governments of most developing countries done their populations particularly the health personnel to bring out the much desired patriotism in them? What they rather do is loot the treasury with little or nothing left for the development of the different sectors of their nations particularly health. What has patriotism got to do with survival following gruesome experience as students before graduating particularly now when we have private universities all over in a country like Nigeria that parents sacrifice a lot to send their children? How then can one expect the poor health personnel to sacrifice their career development prospects in the name of patriotism? We have got only one life to live and one must enjoy it to fullest. Hence the temptation to seek greener pastures for better life by many affected health personnel.

I would not see the relatively adequate resources of health research projects in the countries as unduly inducing participation in them; rather these investigators are doing what is required as a standard of care for research participants. The solution to this problem of brain drain is governments of developing countries waking up to their responsibilities of making life more meaningful for their populations through the provision of the basic infrastructure that will meet the needs of life particularly as it concerns health personnel.
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AKAdeneye

[bukaradam]

It is an ethical issue considering that fact that such movemet of professionals leaves their country of origin with the burden of training new personnel and the burden of providing services.

I strongly agree with the third school for the mere fact that if governments in developing countries have not made bad policies which rather than help talents grow, earn good pay and have a bright future, have made it impossible for them to achive their aim. A part from lack of employment of trained health personnel, sometimes there are lack of proportionate opportunities. In my Country, for instance, a graduate of history of political science who is lucky to be employed in the government oil corporation earns about five times more than his medical doctor counterpart in the government hospital. Government therefore must provide greater opportunities. Poor countries should realize that when talents leave their countries, it takes time and resources to develop new talents. Movement of people will not be easily stopped or hindered because people move voluntarily on their own, no matter the restrictions. Studies have shown that aging people are found more in the developed world and they need to be catered for by younger people. These younger people live in poor developing countries.

One of the important ways of tackling this menace is for our governments to provide conducive environment where professionals can earn better income, opportunity to develop their skills with provisions of working materials. Most of our professionals are not very satisfied with what they are doing in some of this countries but because of such opportunities, they dont have other alternatives. If not, how can one justify a qualified medical doctor taking up a nursing job.

[Mbanga Muleba]

Yes this is an ethical issue. The people that suffer the most are the poor, expecting their country and their fellow citizens (trained personnel) to look after them in times of need.

I'm inclined to agree with the third school of thought. It should be the responsibility of respective governments to ensure that adquate health resources and resonable remenurations are made available in the health sector. Most trained health personnel will prefer to do their work in their home contries when the working conditions are favourable. But I become very dissapointed most of the times when our politicians or other senior government officials in Zambia fall sick. They are quickly rushed to South Africa where medical care is better. Interestingly it is alleged that Zambian-trained doctors attend to some of these officials. Conditions of service provided by that country's health policies make our doctors seem more professional. If our politicians lack confidence in the health system of their country when they are the ones who should make things work better then what are the health personnel supposed to do? This surely does not inspire hope in them and they would leave the country in frustration when the opportunity arises.

Government officials should be partriotic in the first place by ensuring adequate funding to the health sector before calling for the same quality to be exhibited by health personnel. The affected countries should implement policies that will ensure that their trained professionals are given an enabling environment in which they would happily discharge their duties.
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Mbanga Muleba

[gdzombo]

1.
Brain drain in the health sector is an ethical issue because of the push and pull factors that exist and contribution to such social changes.
Both the government and individual have a role to play in the health sector. However there is an alarming increase of health inequalities and depleted health systems in many resource poor settings. When the government solicit for tax, the tax should be utilized in the provision of quality and adequate basic services life health delivery. The individual on the other hand, has the responsibility of paying tax and a right to consume the services provided. However, in most developing countries this is not the case. The governments continue to collect tax but no services are provided for the citizens. The number of slots available for medical/nurse training compared to the gap in the profession is incomparable. Some of the trainees are not simulated into the health system leading to unemployment and work overload for the existing staff. Those who are employment find the system unbearable forcing them to look for other avenues. This lead to poor and unhealthy nations where the masses rights to health services are denied and therefore exploited.

2. Which school of thought do you agree with and why? Rolling Eyes

All school of thoughts address ethical considerations on the concept of brain drain. However, i bet to concur more with the 3rd school of thought. This is because i believe developing countries have resources which if used efficiently and effectively, will be able to address majority of the health problems that they face. More over, these nations have talented and intellectual health professions whom some are underutilized or frustrated and therefore retaliate to enabling/conducive environments. most of the developing countries are characterized by corrupting, nonfunctional health policy, political instabilities, lack of basic health services, poor working conditions, expensive post graduate training among others which much most of our health professions to other the private sectors locally and abroad.

3.
The MOH in developing countries need to mainstream and restructure their health systems including policy and practice. There is need for transparency and accountability in the health systems. Professionalism needs to the way of life both among the big shots and the small fishes in the system. Funding agencies can invest in health delivery services e.g building and equipping primary health facilities especially in the marginalized areas. the government needs to provide physical security and incentives like post graduate training, attractive remunerations, more training slots for undergraduates, employment for all those who have been trained by government funds and partnering with international bodies in the provision of health services in the public health facilities.

George Dzombo

[fkombe]

1. Is the issue of brain drain in the health sector an ethical issue at all?

The issue of brain drain becomes an ethical issue when we add in the issue of some avoidable deaths occurring as a result of brain drain. Where this happens, it becomes unethical for anyone trained by the government to abandon their country and let people die as they search of greener pastures. On the other hand, where the local atmosphere is not conducive for the local health workers to improve their living standards, it becomes intertwined with another issue of sacrifice. In other words, should an individual sacrifice their better future in order to save the lives of other individuals? This poses an ethical dilemma which our health workers have to contend with. I believe ethics should always balance between benefits and risks. In this case, the individual risk will be minimal than the benefit. However, the community risk appears higher. The question one may have to ask is whose benefits and risks are important in ethics-individual or community? The response may be cyclic and depends on the viewpoint taken but whatever it is, it leaves an important issue for ethical consideration.

2. Which school of thought do you agree with and why?
I agree with the third school of thought. I think it is the responsibility of the developing world to offer attractive package to their medics. It is unfair to expect health personnel to remain in their countries when there are no prospects for a better future. Ethics is about balancing the risks and benefits and I believe individual benefits will sometimes take precedence however selfish this may sound. Developing counties should create a conducive atmosphere to motivate their health workers to remain in their countries.

3. Suggest practically feasible ways of addressing brain drain in the health sector.
Let developing counties create a conducive working environment to ensure health personnel are motivated to work in their countries.

[NanaAkua]

The issue of brain drain has become a canker in sub-Saharan Africa, and really deserves every attention as an ethical issue. With reference to the school of thought that i associate myself with, it is quite dicey.
Brain drain stems from different angles. Giving the argument put up by the first school of thought, and the third one. I think I will go in for both. Why? Because it is true that many resources have been put into training health professionals and they need to be kind enough to pay back to the society; to whom much is given, much is expected.
On the other hand, I quite agree with the fact that Health workers do not have all the resources that they need to work with. Talk of essential drugs, laboratory equipment, for clinical diagnosis, to mention but a few. It is very frustrating to watch a patient dying slowly not because the doctor can do nothing, but because there are no resource for him to work with. The feasible ways of addressing this is that, health workers should try to give back to society what society has given them. They should be concientised about their civil responsibilities. However, I do agree absolutely that, health professionals have families to cater for and therefore deserve better remuneration.
The governments of African countries should endeavour to make health care a major priority with the scarce resources at their disposal. This could go along way long in minimizing the brain drain canker in sub-Saharan Africa.


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Ellen Abrafi Boamah
Research Officer
Kintampo Health Research Centre
Ghana Health Service
P. O.Box, 200, Kintampo,
Brong Ahafo Region
Ghana.
Mobile:+233 243 910032
Tel. +233 61 38869
+233 61 38871

[elhassan]

The issue is seemingly not ethical, the fact that every personnel is free and this is personal trend and it has got nothing to do with patriotism. Yet it is a problem, the fact that most of my class colleagues are working abroad.
The developing countries is at zero station in gripping health personnel as consistent to the third school.
The globalization of knowledge down to the earth of the developing countries making it at hand in form of knowledge, attitude and performance to the whole health providers will shift the brain drain backward to reduce morbidity and mortality.
I personally try to acquire the drained brains knowledge to implement it in my country.
Our mother earth became a very small village. Finally the resident health providers including doctors need to be supported by their governments and it is not a dream.

[fousseyni]

Dear Dr Aceme,
1) Yes I think the problem of brain drain is a serious ethical concern. The developing countries should benefit from their major investments made on training high skill people.
2) Third school of though
3) The Government from developing countries should make all the efforts to retain their people by attractive rule.

[Ernree Bee]

1. Is the issue of brain drain in the health sector an ethical issue at all?
The issue of brain drain in the health sector may be considered an ethical issue when looked at from several points of view. First and foremost, the issue of health care delivery is a matter of partnership between the health care practitioner, and the government. Each of these stakeholders have a responsibility to perform and if one party decides to neglect or ignore his or her responsibility, which is considered unethical in nature, may also directly serve as a catalyst for the other party to behave unethical.

Brain drain is prevalence in developing countries especially in Sub-Saharan Africa that suffer heavy disease burden and poverty. Majority of the population in sub-Saharan Africa live below the poverty line and are caught in a poverty trap that perpetrate from one generation to the next. Based on these facts health care practitioners who live in these developing countries and are abreast with the heavy disease burden their people suffer, have a responsibility to perform. If and only if they neglect these responsibilities by saving the lives of their people and migrate to develop countries in pursue of greener pasture, such behavior may not only be considered unethical but history will judge them.

The second point is that, it is the right of the government of developing countries to create the conducive environment and to provide those basic social services that will attract the medical practitioners and reduce the brain drain. In Africa it is not that resources are not enough to benefit the people but, bad governance and corruption have contributed to the massive migration of health professionals to developed countries. A government that practices bad governance and corruption is also acting unethical.

2. Which school of thought do you agree with and why?

I agree with the first and third schools of thought that attributes brain drain to lack of patriotism and the governments of developing nations not providing the conducive environment to retain its health personnels. Although most of these health personnels leave their countries for greener pastures which is unethical and not being patriotic, they mostly do so out of frustration on the part of the government. The government should take responsibility for the health and welfare of its people. By that, a conducive environment needs to be developed that will attract or motivate health practitioners to stay in these low income countries and improve their performance to the fullest.

3. Suggest practically feasible ways of addressing brain drain in the health sector.

Some practical ways in addressing brain drain in the health sector are:
• The creation of awareness by local governments to students in the health sector especially on Public scholarship that after being trained they will definitely be needed to serve the country for certain number of years as a way of showing patriotism. By that, an agreement will be signed by the students and the government before being train.
• There is a need for motivation of health personnels by the governments of the developing nations. More resources should be put into improving the work and
• training conditions for health personnels in developing countries. By this, health personnels would be discouraged to seek greener pastures when indeed they are already satisfied in their countries.
• Health sector salaries should be increase with the provision of incentives (both financial and non-financial) to qualified health personnels.
• Health personnels seeking sponsorship for global training should be given the opportunity with the provision of incentives as well.

~~Ernree Muku Bee~~
UL-PIRE, Africa Center-Liberia

[Constance Agwang]

1. The issue of brain drain is an ethical issue, because the developed countries know that the developing countries are where there’s disease burden and hence need a lot more medical personnel to handle the burden of disease. They still go ahead and woo these personnel hence depleting the country that trained these personnel of both man power and resources used in their training.
2. I agree with the 1st and 3rd schools of thought. This is because if some one has a heart for their country which spent money to train them, then they would be obliged to work for their fellow country men. On the other hand the government should also put in effort to retain the trained personnel by giving them good pay which is timely, and also offer training opportunities which in most cases these people are chasing after out there.
3. Like I mentioned above, this issue can be addressed by the developing countries offering what these people are often looking for in developed countries, things like good pay and opportunities for further studies to enable them develop their careers.
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Constance Agwang
Med Biotech Laaboraories
P.O Box 9364
Kampala, Uganda
Mobile: 256-77-257791