Turning brain drain of health professionals into brain gain: Strategies for harnessing the potential of skilled diaspora for Pakistan
By Dr. Wajiha Rizwan and Dr. Noor-i-Kiran
“Brain drain” is the migration of skilled professionals to improve their quality of life and living standards, where better salary packages, advanced learning opportunities and a healthier working environment are considered major driving forces. The phenomenon of brain drain of health professionals from developing countries to developed nations for a greener future has been a matter of serious concern for almost last two decades. Around 56% of all international immigrant doctors from developing countries are relocating to four high-income countries out of which 45% of immigrant doctors are from three countries, including Pakistan, India and the Philippines. This immigration leads to a severe shortage of medical expertise in their home countries. There is a need to explore the underlying existing factors leading to doctor immigration in Pakistan.
Pakistan is a developing country that is the sixth most populous country in the world. The Health Care Delivery System(HCS) of Pakistan has always been subjected to many political, cultural and socioeconomic challenges. The political instability as well as interference, poor funding, a very insufficient budget reserved for the health sector and improper management of resources are major factors that hamper the development of Pakistan’s HCS.1 According to the health workforce profile of Pakistan published by WHO in 20202, Pakistan faces a serious shortage of healthcare staff, including nurses, paramedics and doctors. The doctor-to-patient ratio in Pakistan is 1:1300, much less compared to WHO WHO-suggested ratio of 1:1000. 3,4 This shortage eventually leads to poor healthcare access and delivery, overburdened health facilities impairing quality of care and loss of productivity, having a negative impact on the economy due to increased illness rate among the workforce. It also adds to the dissatisfaction of patients as well as health professionals.
According to an estimate, in Pakistan around 32,879 physicians graduate annually and 40% of these graduates go abroad to avail better professional opportunities citing low income, long hours of job, and inequality as the main reasons5. As reported by Bureau of Emigration and Overseas Employment, only 10 to 15 percent of physician, who leave country, come back.6 This immigration unfortunately involves the most intellectual genius doctors who possess the ability to bring major reforms in health sector through innovative ideas. In 2022, around 832,339, skilled personal headed abroad. It shows that every day 2312 Pakistanis left their homeland during the recent year. This included 2,464 (0.29%) doctors, and 1768 (0.21%) paramedics and nurses.7
Factors Leading to Brain drain of health professionals and Possible Solutions: Addressing the following factors and implementing policies related to solutions can help mitigate the brain drain of doctors from Pakistan and encourage them to stay and contribute to the country's healthcare system.
Brain drain among healthcare professionals in Pakistan is driven by several key factors, each requiring targeted solutions. A major issue is limited career opportunities, which can be addressed by expanding healthcare facilities and creating jobs through public and private sector collaboration. Ensuring that these opportunities are merit-based would help retain talent. Additionally, low salaries and benefits discourage doctors from staying in the country. Offering competitive salaries, comprehensive benefits, and performance-based incentives can enhance retention.
Security concerns also play a significant role in brain drain. Ensuring the safety of healthcare professionals by improving security in hospitals and surrounding areas, as well as developing specialized protection measures, is essential. Moreover, political instability creates an unpredictable environment for professionals. Promoting political stability and encouraging medical associations to advocate for reforms would contribute to a more secure and appealing workplace.
Another significant challenge is the lack of Continuing Medical Education (CME). Establishing CME programs and financially supporting doctors to attend workshops and conferences can keep them updated and professionally satisfied. The issue of corruption and red tape also hampers efficiency in healthcare institutions. Enforcing strict anti-corruption policies and streamlining administrative processes can reduce bureaucratic barriers and foster a more transparent system.
Improving the quality of life for healthcare professionals and their families is crucial. This includes better living conditions, access to quality education, and housing schemes. Moreover, the lack of professional recognition and respect can demotivate doctors. Acknowledging their contributions through awards and fostering a culture of respect can significantly improve morale.
Addressing inadequate job satisfaction is also important. Conducting regular job satisfaction surveys, creating platforms for healthcare professionals to express concerns, and involving them in decision-making can make them feel valued. Developing telemedicine infrastructure can also allow doctors to serve broader populations and increase their sense of purpose.
Furthermore, limited research opportunities discourage academically inclined professionals. Allocating funding for research, building research centres, and encouraging international collaboration can help address this gap. Lastly, the availability of limited specialization options pushes many to seek education abroad. Expanding specialty training within Pakistan would encourage doctors to pursue advanced careers domestically, thus reducing brain drain.
Policies to convert “Brain Drain” into “Brain Gain and Regain”:
There are certain benefits like remittances sent home and collaboration in education, innovation and research that migration of health professionals may lead to “financial and intellectual gain.” The government of Pakistan must establish effective policies to at least minimize the negative impact of brain drain to promote the development of health sector and economic stability in country.13
Pakistani foreign faculty hiring programs: The government through publicprivate partnerships can offer permanent or short term employment to skilled diaspora in various medical institutes of Pakistan. These programs can help in “Brain Regain” bringing back those competent professionals and researchers who gained expertise and skill and can now transfer their knowledge and skills to Pakistani faculty and students.12 The overseas Ph.D scholars can be attracted to return to homeland by establishing postdoctoral centers.14
Brain Circulation: The Government needs to create financial incentives and attractive career pathways for doctors to stay in Pakistan yet offer opportunities for international collaboration and experience without requiring permanent relocation.14
Utilization of Remittance: Remittances from skilled health professionals living abroad adds to foreign revenue for many developing countries. The policies to ensure the proper transfer of remittances can lead to the generation of revenues that could be invested in the social and economic development of the Pakistan. This can only have impact if this revenue is properly utilized in development through education and research. If our foreign faculty can be allowed exemption in tax and provided with some other incentives, they are willingly investing in innovation and research in Pakistan it will help to utilize the foreign remittance effectively.9
Conclusion: Skilled diaspora who have emigrated for various reasons are recoverable assets and can play vital role in development of homeland. However, this “Brain Regain” requires the opening of various creative conduits and supportive environment. Foreign trained health professionals should be encouraged to contribute to areas of national priorities for research and development.9 Ultimately, involving health professionals who are living abroad in creating opportunities at homeland can help in retention and repatriation of national medical graduates
Dr. Wajiha Rizwan (MBBS, FCPS) is Associate Professor, Pediatrics, University of Child Health Sciences Lahore & Dr. Noor-i-Kiran Naeem (MBBS, FCPS, MSc. MEd), is Assistant Professor, Medical Education, ABWA Medical College, Faisalabad.