1. Medical Brain Drain
Prof . Mahmoud El-Meteini

2. 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.

3. 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 % of their Tertiary educated individuals to immigration
(Docquier&Marfouk 2006)
A cause for worry for policymakers in developing countries ………..

5. 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)

6. 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)

7. 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

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

9. 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 ………

10. 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

11. 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

12. 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

13. 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

14. 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.

15. Egypt
Case Study

18. 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

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

21. Enrolled Doctors in Egypt Medical Syndicate

22. 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)

23. 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

24. 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

25. Thank You