Medical Brain Drain Prof . Mahmoud El-Meteini

Definitions Brain Drain: - The process by which a country loses its most educated& talented workers to other countries through immigration - The loss of academic & technological labor force through moving of human capital to more favorable geographic, economic, or professional environments Medical Brain Drain:Migration of highly trained and skilled physicians & scientists from underdeveloped countries to countries that offer better working conditions and /or lifestyles This trend is a problem …. because the most highly skilled&competent individuals leave the country, and contribute their expertise to the economy of other countries. The country they leave suffer economic hardships because those who remain don't have the 'know-how' to make a difference.

Problem Size “It’s Big” The magnitude of this phenomenon increased during the 1990s, and all evidence suggests a continuation of this trend. Examples: 1- Individuals withTertiary Degrees make up only 3% of the sub- Saharan African population, 43% of their immigrants have this level of education 2- Most Caribbean nations lose between 61- 89 % of their Tertiary educated individuals to immigration (Docquier&Marfouk 2006) A cause for worry for policymakers in developing countries ………..

3 main concerns to drained countries First: These countries lose individuals who are important for the delivery of crucial public services such asHealthcare & Education Sectors Second: Immigrants are among those most capable of contributing to progressivePolitical & Socioeconomic Changes in a given country Third: The significant cost of training these individuals has been primarily covered by the public sector and is now not recoverable in taxes these individuals would have paid and services they would have provided to the community Zero return upon investment ……. (IOM 2005; Ozden and Schiff 2006)

Receiving Nations In contrast, receiving nations gain by “filling in gaps” by skilled personnel at a lower cost than they would have otherwise paid for, &gaining in the different knowledge&insights that the immigrants bring It has been estimated that a reduction in visas for graduate students&skilled immigrants to the United States would result in a reduction in both patent&grant applications (Chellaraj, Maskus&Mattoo 2006)

Brain waste Brain waste is a concern, raising the question of whether the receiving countries are efficiently using the skilled immigrants they receive ?? From the data available it appears that a large number of skilled immigrants often end up in jobs for which they are significantly overqualified This can be the result of language or cultural barriers or lack of understanding of how to interpret qualifications from different educational institutions

Causes of Brain Drain “Push and Pull factors” Economic factors Cultural factors Political factors Personal/ Social / Organizational

Unemployment & Political Instability Causes of Brain Drain Push Factors: are negative characteristics of the home country that forms the impetus for intelligent people migrating from Lesser Developed Countries (LDC). Unemployment & Political Instability some other push factors are: economic underdevelopment, employment discrimination, absence of research facilities, poor working conditions & lack of intellectual freedom ………

Higher paying jobs & a better Quality of Life Brain Hunting Pull Factors: are the positive characteristics of the developed country from which the migrant would like to benefit Higher paying jobs & a better Quality of Life Superior economic outlook, prestige of foreign training, relatively stable political environment, a modernized educational system to allow for superior training, intellectual freedom; All in a rich cultures

Effects of Brain Drain on the Home Country Developing country with prevalent brain drain negative repercussions on the economy: Loss of Tax Revenue Loss of potential Future Entrepreneurs Shortage of skilled workers The exodus may lead to loss of confidence in the economy, which will feed the desire to leave rather than stay Loss of innovative ideas

Any Benefits ?? Brain drain is usually described as a problem that needs to be solved However, there are might be some benefits that can be derived from the phenomenon When people move to developed countries, they acquire new skills & expertise, which they can utilize to the advantage of the home economy once they return Another benefit is remittances; the migrants send the money they earn back to the home country, which can help to stimulate the home country's economy

Possible Actions to Curb Brain Drain Drawbacks of brain drain outweigh the benefits ……….. Moves that governments can make to reduce mobilization of highly educated&skilled workers Stimulate Economic activity To ensure that citizens feel safe Higher wages Creating a better educational system Enhancing working environment

Brain Tax A thought-provoking proposal addressing a number of concerns, initially proposed by Bhagwati and Hamada (1974) A proposed tax to be imposed on the émigrés and the funds collected administered by an international organization such as the United Nations Development Programme (UNDP) for development in less industrialized countries Strength of this proposal: It does not interfere with an individual’s right to migrate, but by taxing the individual it recovered some of the cost&positive externalities that the sending country had lost. It also marginally reduced the incentive to migrate by reducing the post-tax income of émigrés.

Egypt Case Study

Statement numbers of graduates   2012/2013 2013/2014 2014/2015 Cairo University 950 844 719 Alex. University 1101 924 973 Ain Shams University 629 837 AsuotUniversity 366 987 Tanta University 730 642 476 Al-MansouraUniversity 968 785 665 Al-ZagazigUniversity 517 589 905 Al-MinyaUniversity 384 387 455 Al-MonoufwaUniversity 411 391 655 Suez Canal University 184 123 98 South Valley University- Quena 107 152 191 BanySouiefUniversity 142 187 188 Al-FauoumUniversity 140 168 176 BenhaUniversity 369 436 636 SohagUniversity 227 280 361 Kafr El-Sheikh University 226 303 Port Said University 41 100 Aswan University 79 83

Enrolled Doctors in Egypt Medical Syndicate الاطباء المسجلين بالنقابة 250000 طبيب (45%) 112500 طبيب غير مستدل عليهم (45000 طبيب) ترك المهنة (33750 طبيب) طبيب حر (33750 طبيب) (55%) 137500 طبيب وزارة الصحة (61875 طبيب) مديريات الشئون الصحية (56720 طبيب) مستشفيات جامعية (8320 طبيب) تأمين صحي (4535 طبيب) معاهد تعليمية (6050 طبيب) 32%

Enrolled Doctors in Egypt Medical Syndicate

54 % of students who travel abroad to study do not return home 5% of Egypt-born physician and 1% of Egypt-born nurses are working in USA & UK (Michelle Clemens, 2009) Disadvantage: They are in the most productive phase of life They have no place to return to In Egypt, returning migrants tend to have higher levels of human capital than non-migrants, and are likely to be more entrepreneurial the longer they have worked abroad (McCormick and Wahba 2001; Wahba 2007)

Diversified Incentives That’s what India understood “ Case Study” In 2013: The world’s biggest reverse brain drain due to its strong economic growth The return of highly skilled migrants will produce benefits for their home countries only if migrants return before the end of their working lives Diversified Incentives That’s what India understood *Large numbers of physicians from low&middle income countries are currently registered in the UK, USA, New Zealand&Australia, with concomitant impact on the physicians / population ratio in their origin countries *A creative international policy may be needed to ensure that individual migration rights of health professionals do not compromise societal population rights to health, and that there are public&fair agreements between countries within an internationally agreed framework

Likewise, a 4% OF GDP allocated to Healthcare sector Solutions Financial High Wage Health care funding Support research Providing places to return, research Social Develop working conditions Improve the infrastructure: transport, hospitals, dorms Increase social protection and prestige of doctors Organizational Allow exchanges Increase interaction & communication between health professionals Transform service structures from client-based to client-focused Tele-consultation Recently: 1% of the GDP to be allocated for scientific research according to an item mentioned in the 2014 Constitution Likewise, a 4% OF GDP allocated to Healthcare sector

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