We’ve all heard the term “brain drain”. This phrase is used to describe the phenomenon of bright, educated people from developing countries moving to the developed world, lured by prospects of more money, more respect, and a higher standard of living. As the daughter of two physicians who were educated in India but now work in the U.S., I have long pondered the pros and cons of this type of brain drain. However, it is only recently that I became acquainted with a new term: “internal brain drain”.
In contrast to the international focus of the old term, the new “brain drain” refers to the movement of health professionals within a country. In an internal brain drain, physicians abandon their public sector jobs to work in more lucrative posts offered by non-governmental organizations (NGOs). As author Michael A. Cohen points out in his article, “The New Colonists,” the internal brain drain creates an “outsourcing” of medical care to health-focused NGOs, and cripples the national healthcare system by siphoning away these much-needed health care professionals. As a result, developing countries come to rely on NGOs for their health care needs.
You may ask yourself, “Who cares?” If governments can’t provide adequate medical care to their citizens, what is the harm in NGOs taking over this role? The problem, as Cohen points out, is that these NGOs often lack a system of accountability and fall prey to the scourge of Corruption (with a capital C), ultimately creating what Cohen derisively names, a “new colonialism”. Also, many of the NGOs focus on problems that are funding darlings, such as HIV/AIDs, and thus fail to provide basics such as obstetrics/ gynecology services or preventative health care. As Donna Barry, advocacy director withPartners in Health points out, the result is a “fragmented and inequitable health system, where we can count HIV loads, but a woman dying in childbirth cannot get a cesarean section”.
It is difficult to imagine that well-intentional NGOs are contributing to such a sordid affair. Indeed, some people call foul and claim that other issues such as a lack of health professional schools contribute to the problem. However, the drafting of an “NGO Code of Conduct” on May 29, 2008, implies that NGOs do admit to some of the blame. This “Code of Conduct” has elite signatories such as Oxfam UK and Physicians for Human Rights and aims to strengthen public health systems by avoiding hiring health workers from the public sector and advocating for fairer salaries. Will this Code help solve the problem of internal brain drain? Or will it create a whole new set of problems? Only time will tell. In the meantime, we can use the “internal brain drain” example as a reminder to stay vigilant in their own international work, keeping in mind that all good intentions can lead to unforeseen, unwanted consequences.