Comment on Brock and Blake: debating brain drain

Cole, Phil

doi:10.1136/medethics-2015-103164

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…The effective functioning of any health sector is highly dependent on the availability of skilled health professionals, losing these professionals will ultimately weaken the socio economic development of its country; hence the need to find ways of limiting their migration (Donoso & Mancilla, 2017;Okeja, 2017;Mlambo & Adetiba, 2017). While dealing with this requires a carefully tailored strategy, temporary restriction on the emigration of health workers has been a major recommendation (Ilić & Milosavljević, 2017;Cole, 2017;Donoso & Mancilla, 2017;Yuksekdag, 2018). Policy recommendations have also been made, like the global code of practice on the international recruitment of health personnel issued by the World Health Organization (WHO) in 2010, that directs all member states to respect the rights and needs of source countries in international migration of health personnel in order to mitigate the negative effects of health personnel migration on the health systems of developing countries; but there is little evidence that the implementation of the code has been successful or effective (Brouillette et al, 2017;Yeates, & Pillinger, 2018;Shaffer et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Critical review of the use of financial incentives in solving health professionals' brain drain

Akinto

2021

IJRBS

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This study critically reviewed the use of financial incentives in solving health professionals’ brain drain, with the view to ascertain its effectiveness. The Systematic Assessment Quantitative Technique (SQAT) developed by Catherine Pickering and Jason Antony Byrne, was used to identify and review 21 relevant peer-reviewed journal articles that investigated six forms of financial incentives in solving health professionals’ brain drain. Evidence from 66.67% of the studies showed that financial incentives are effective in solving health professionals’ brain drain through the use of improved remuneration, funded training, return subsidy and research grant. The remaining part of the studies (33.33%) did not find the use of financial health aid and bonding effective. This study recognized that financial incentives do not fully solve healthcare brain drain and other non-financial measures need to be implemented; future research work should therefore integrate other measures with financial incentives in order to gain additional insight on solving healthcare brain drain. The use of limited but high-quality academic databases means that some articles were not considered for review.

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Section: Introductionmentioning

confidence: 99%

Critical review of the use of financial incentives in solving health professionals' brain drain

Akinto

2021

IJRBS

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“…By contrast, Phillip Cole expresses significant reservations about the policies I argue are permissible under certain conditions 2. He says: ‘Health workers … should never be called upon to make the kind of sacrifices Brock is looking for’ 2.…”

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confidence: 99%

“…He says: ‘Health workers … should never be called upon to make the kind of sacrifices Brock is looking for’ 2. ‘I cannot see that it is fair and reasonable to remove the right to leave or to financially penalize those that do’ 2. He worries that health workers are not being sufficiently respected and the measures for which I argue would remove the right of workers to negotiate contracts.…”

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confidence: 99%

“…He worries that health workers are not being sufficiently respected and the measures for which I argue would remove the right of workers to negotiate contracts. His main alternative position is that ‘the international community must make sure that it does not fail in its efforts to address’2 health crises facing low/middle-income countries so that ‘the violation of fundamental human rights is never, in fact, justifiable in practice” 2. He also notes that there are many powerful players who have more responsibilities including multinational corporations, the WHO and the International Organisation for Migration.…”

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Relevant evidence, reasonable policy and the right to emigrate

Brock

2016

J Med Ethics

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In this article I respond to commentaries by Javier Hidalgo and Phillip Cole. Javier Hidalgo believes that we would be justified in restricting the liberties of health personnel if we had compelling evidence that this would bring about beneficial consequences. He is sceptical that this evidence exists or would ever be forthcoming. Hidalgo therefore supports my position, at least in theory, that where there is good evidence concerning relevant beneficial consequences for remedying important losses associated with high skill migration, we may permissibly restrict health personnel's freedom to migrate through introduction of carefully crafted compulsory service and taxation programmes. So one important issue is whether such evidence is or could ever become available in a form useful to members of government. By contrast, Phillip Cole expresses significant reservations about the policies I argue are permissible under certain conditions. He believes that health workers should never be required to comply with the sorts of taxation and compulsory services programmes I recommend. I show that the programmes for which I argue are not as onerous as Cole imagines and therefore that they can be justified. I also show that relevant evidence exists to address Hidalgo's concerns.

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Empirical Bioethics and the Health ‘Brain-Drain’: a qualitative study of the experiential and ethical landscape of compulsory community service for a group of South African doctors

Gardiner

2022

Med Humanities

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The health ‘brain drain’ (HBD) is an issue of significant global bioethical concern, resulting in severe maldistribution of healthcare workers (HCWs) and gross inequities in health service provision. The ethics of the HBD and its possible mitigation strategies are, however, complex and areas of active ongoing bioethical debate. South Africa faces a dire and worsening HBD crisis, and use a mitigation strategy of compulsory community service, or ‘comserve’, for most HCWs. While there is some literature on HCWs’ comserve experiences and the various ‘push and pull’ factors affecting their migratory decisions, there is a notable gap regarding their personal values, beliefs and ethics regarding the HBD and comserve, which, as this research supports, play a prominent role in migratory decisions. This empirical bioethics research aims to explore this among a group of South African doctors who recently completed comserve, as well as how their experiences affected their situation on the individualist-collectivist continuum. This was done qualitatively using semistructured interviews with 11 participants and analysed using reflexive thematic analysis under a methodology of critical realism. Themes identified were ‘Special Duties’; ‘Freedom and Autonomy’; ‘Justice and Accountability’; and ‘The Individualist-Collectivist Continuum’. Participants use a variety of ethical theories to discuss the HBD and oppose or support comserve, which play a significant role in their migratory decisions. Most find the policy to be theoretically ethically justifiable but note that procedures undermine this. There are also several factors that appear to affect participants’ position on the individualist-collectivist continuum, with some paradoxical effects on the HBD.

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Comment on Brock and Blake: debating brain drain

Cited by 4 publications

References 3 publications

Critical review of the use of financial incentives in solving health professionals' brain drain

Critical review of the use of financial incentives in solving health professionals' brain drain

Relevant evidence, reasonable policy and the right to emigrate

Empirical Bioethics and the Health ‘Brain-Drain’: a qualitative study of the experiential and ethical landscape of compulsory community service for a group of South African doctors

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