Post-colonial medical brain-drain

The problem of highly qualified professionals from poorer countries leaving home for greener pastures in richer countries is not a new phenomenon. While one cannot blame skilled individuals in different sectors wanting to move abroad for a better quality of life, the loss of vital human capital from poorer countries does perpetuate a vicious cycle which undermines the ability of poorer countries to progress.

The impacts of brain-drain are particularly glaring in the health sector, where resource constrained poor countries cut corners to subsidise medical education but then are unable to retain desperately needed health professionals within the country. To contend with this problem, the WHO’s Code of Practice for International Recruitment has created a red list of countries which have low universal health coverage, and where the density of doctors, nurses and midwives is below the global median which is around 49 healthcare providers per 10,000 people.

The WHO red list does not prevent individual healthcare personnel from independently applying for employment in richer countries, but it instead aims to prevent their active recruitment via recruitment agencies or specific employers. This list currently includes 47 countries, mostly from Africa, but this list also includes Afghanistan, Bangladesh, Pakistan and Nepal. Countries like the UK have endorsed the WHO’s decision and even incorporated this list into its national codes of health practice to make these 47 countries a no-go destination for British medical recruiters.

However, a recent BBC investigation has found evidence of the British public and private sector involved in the active recruitment of doctors from WHO red list countries. The BBC has named a British private company — NES Healthcare — for targeting doctors in red list countries to be hired as Resident Medical Officers (RMOs), who then serve as live-in doctors within the British private health sector. The BBC has found that 92% of these RMOs had been recruited from Africa, mostly from Nigeria (81% of them), which is also a red list country. What is more, the RMOs hired by NES Healthcare were found to be working in exploitative conditions due to excessive working hours and unfair salary deductions.

The BBC reportage on this issue has also pointed a finger squarely at the British Council, a public funded entity, for being complicit in this overseas medical recruitment process. The BBC spoke to Nigerian doctors who had been attracted to migrate to the UK via an event overseen by the British Council. Moreover, the General Medical Council in London was also found to be administering the Professional and Linguistic Assessments Board test (PLAB, Part 1), which is a prerequisite for securing a medical licence to practise in the UK, in several red list countries. The PLAB 1 is not only offered to doctors in Nigeria but also in many other red list countries, including Pakistan.

Many skilled health professionals from Pakistan have moved to the US, the UK and several Gulf states; and now China is becoming a destination of choice for them. Poorer countries like our own cannot prevent doctors, or other highly skilled professionals, from migrating to richer countries of their own volition. But the enticement of doctors from former colonies to work in under-paid and over-worked jobs is unfair and a direct violation of Britain’s national health policies and its international pledge to the WHO.

The General Medical Council, the British Council, and NES Healthcare have denied involvement in active recruitment of doctors from poorer countries. However, the fact that this expose was reported by the national broadcaster of the UK necessitates closer attention by British policymakers. One just hopes that the doctors who have allegedly been entrapped by NES Healthcare are not further victimised, and that the British government instead takes its own private and public entities to task for this irregularity. The UK must also commit to supporting healthcare in WHO red list countries which have been targeted by these apparent unethical recruitment practices.