by W.D.S. Madhavi
Brain drain is recognized as a global issue and the term conveys the immigration of highly educated and knowledgeable individuals to other nations. At present brain drain is a trending tragedy in the developing world. According to the Human Flight Brain Drain Index (2022), the majority of developing countries are grappling with this problem, and every country in South Asia is ranked among the top ones in worldwide. In South Asia, Afghanistan has been identified as the third worst-affected nation, while India is ranked twenty-second. In the Sri Lankan context, the brain drain value is 7.6 index points by 2023, and Sri Lanka is ranked 20th globally while holding the 9th place position in the South Asian region. Brain drain as a national threat that presents a generation hungry for massive success of which we just heard and are yet to experience.
Moreover, National security has been reinterpreted by non-traditional threats that go beyond traditional challenges. The concept of security was brought into rostrum in the 1994 Human Development Report, emphasizing security with people is most ideal rather than territories as well as development rather than weapons. Therefore, the current disclosure addresses security challenges related to every aspect in the society including economy, health, environment and etc. According to Katheryn and Elta (2020) health is a sort of security components, which is a vital to establish security well-being in a country. As a new pillar of national security, health security has been brought about the threshold on national insecurity due to health disasters in modern world and health changes such as brain drain of healthcare professionals.
Doctor’s Brain Drain in Sri Lanka
There is a significant brain drain out of Sri Lanka today and it affects practically every sector including the educational sector and the health sector. However, it heavily has contributed to Sri Lanka's health sector's collapse. According to the Annual Health Bulletin for 2020, Sri Lanka has 150,273 healthcare workers, including lab technicians, radiographers, therapists, and medical attendants. Amongst the total, 2730 medical specialists, 21,450 doctors, 1564 dentists, 46,385 nurses, and 8525 midwives. Statistics from the Ministry of Health (MOH) show that in 2018, 240 medical experts who had been educated during the previous two years returned to Sri Lanka, whereas 267 potential specialists had left the country to pursue their education abroad. In terms of the year 2019, 290 future medical professionals had left Sri Lanka for overseas training, whereas 262 of them had returned after their training had taken place just one or two years earlier. Thus, 191 potential medical specialists had also left the country. This poses a serious threat to Sri Lanka's state of health. According to Ministry of Health (2023) when a doctor travels abroad, they engage into an agreement that after getting their foreign training, they would return to Sri Lanka to serve for four years for each year of their overseas training. If the foreign training lasted two years, the professional would have to serve the nation for eight years. Doctors who travel abroad without notifying their patients must face costs. A doctor will receive a Vendor on Premise (VOP) notice and be blacklisted if they quit the practice unexpectedly. Considering data, this contract did not actually take effect. As a result, according to the Ministry of Health, the exodus of medical professionals has had a substantial influence on the healthcare sector in Sri Lanka.
Dr. Ashoka Gunarathne of the Specialist Doctor's Association reportedly stated at the press conference (2023), Sri Lanka now employs only 2,000 consultants, or 50% of the number required. The ideal number of consultants in Sri Lanka would be 4,000. According to Government Medical Officers Association (GMOA) data in a year, (period 30.08.2022 – 30.08.2023) 526 medical officers on long term foreign leave, 200 doctors reportedly left without informing relevant authorities, 197 medical officers who left the job and 71 medical officers retired. The medical workers who left the country without informing the appropriate authorities have prompted the Sri Lankan health ministry to take action. It’s should be all eye are open for this matter, otherwise it could seriously threaten the public's health security in Sri Lanka.
Push and pull Factors
According to Young (2020), brain drain can occur due to geographic, organizational, and industrial factors and there are several pull and push factors for doctors to leave the country. However, in Sri Lanka, the circular and repetitive distress incurred in the past due to various situations such as the 88/89 rebels, the 30-year internal war, and terrorist assaults have resulted in a harmful brain drain. Hence, the severe and significant brain drain occurring in Sri Lanka right now, is primarily due to political and economic factors like the country's economic downturn, political unrest, human rights violations, bureaucracy, lack of national development policies, bribery and corruption, lack of employment opportunities, generally at low levels of social freedom, high-income tax, lack of future vision, high energy prices, and a lack of jobs in their chosen fields. The country's hyperinflation has prevented medical pay from rising, making it difficult for doctors to make ends meet. Additionally, the government's policies and plans have let doctors down in every aspect.
As an example, salary is a major factor in keeping healthcare workers. The Former President of the Sri Lanka Medical Association (SLMA), Prof. Karunathilake claimed that while there is a misunderstanding that doctors have profitable private practices, the truth is that less than 30% of them do so, and not all of them are financially successful. Doctors are now even more financially disadvantaged as a result of the latest tax amendments. The former President of Sri Lanka Medical Association (SLMA) stated that it is critical to address these financial issues in order to recruit and keep skilled medical specialists. Due to the significant income disparity, tax system, socio-political context, people are becoming increasingly frustrated and looking for opportunities elsewhere.
Not only the destination country’s favorable salary rates, predicted increased quality of life, freedom or independence but also the growing need for workers in the host country for a better future is a common attitude and a dream among many educated adolescents from urban and rural background. Moreover, several pull factors are also suggested by the World Health Organization (WHO) to address the issue of doctors leaving the country. WHO suggests a multidimensional strategy that includes financial, non-financial incentives, and legislative measures. Addressing macro-level factors such as the political and economic climate, safety, and security is necessary to create an environment that motivates doctors to remain and serve.
Additionally, other advantages such as better housing, suitable educational opportunities for their children, and better transit options in remote regions must to be offered. Further, legislative procedures must be put in place to guarantee the fair and impartial hiring and placement of doctors in the public sector. However, due to this unrestricted migration of doctors, Sri Lanka's health sector and overall health security are currently in a very critical state therefore, the government needs to address this crisis. The push and pull elements should first be determined by the government and should take the lead in putting policies into place that will lessen push factors. Otherwise, Sri Lanka's healthcare system will be gradually decimated.
Pros and cons
Brain drain leads to both pros and cons in a country in various ways. The gravity of positive and negative consequences varies from nation to nation due to development disparities and other sorts of domestic issues in the mother country. In considering the benefits to the countries, such as the reduction of unemployment, the remittances that help developing nations, and the skills and contacts that migrants bring back with them. When seen generally in a country like India, migration always has positive economic, political, and social effects. Indians and persons of Indian origin hold significant positions, like Satya Nadella, Kamal Harris, and Rishi Sunak etc. It assists them in maintaining their nation’s name as a brand name. Nevertheless, great Indian cultural effects are currently generalized worldwide due to the shared culture of migration of Indians in various parts of the globe where evidentially, yoga and Indian cuisine could be taken as examples. Further, the dispersion of Indians around the globe would definitely assist the government of India to enhance diplomatic relations and impose modest strategies to develop ties with other countries. Thus, Singapore could be taken as an example of diplomatic ties maintained with Modi’s Look-East strategy which houses a large number of Indians in the country.
When it comes to the Sri Lankan healthcare sector, there are a number of positive impact of doctors migrating, such as it will help promote the Sri Lankan brand by showcasing the expertise of our country's medical professionals when they offer their services to other nations. Additionally, Sri Lankan medical education can enhance its reputation worldwide.
Today, there is a growing trend among doctors in Sri Lanka not to return after studying abroad. The ratio of doctors returning to Sri Lanka is only 4:1. Therefore, it can be noted that there is a real danger of Sri Lanka losing its massive number of doctors, which would have a significant impact on its health sector. Not just one field but all fields are suffering greatly from the current brain drain in Sri Lanka as most of the sectors are interconnected. In the current context, medical faculties in universities are in danger of closing their department as a result of the shortage of professors.
The Rajarata University, Faculty of Medicine, Dean Dr. P.H.G Janaka Pushpakumara emphasized, that nowadays academic activities are grappling with many challenges because of the shortage of lectures. Further, according to the Christian Science Monitor news organization, doctor's migration has a direct impact on the quality of medical education in Sri Lanka. Senior doctors with decades of experience in the medical field, guided medical students previously and transmitted their skills to students. However, more experienced doctors are leaving the country at the moment and raising an issue of who is going to teach the future medical professionals because we can't produce doctors overnight. Another drawback of it is that the health sector has suffered significantly due to uncontrolled departure of doctors, and as a result, the medical professionals in this country are also struggling tremendously. However, while experts and officials struggle to come up with solutions, a large number of doctors and other professionals are now departing the country. The consequences will be felt for years to come if Sri Lanka is unable to stop the migration or replenish its supply of medical professionals. Further, this also raises doubts about Sri Lanka's ability to control it due to the lack of doctors in the country if it were to face a situation such as the Covid epidemic again. In addition to that, the shortage of doctors affected directly patients. Patients are having to wait longer for appointments, fill out more paperwork, go to more clinics for treatment, and pay more money, all of which result in less quality treatment since doctors are overworked. As an example, the Anuradhapura Teaching Hospital recently had to close temporarily. Sixty patients can be treated at once, but because nine of the hospital's doctors, including four pediatricians, have left the service, patients who were there at the time had to be transferred to other hospitals.
Considering the aforementioned information, a significant question regarding Sri Lanka's medical education and quality of health in the future appears. The government should take action prevent this situation because always prevention is better than cure.
Solutions and Recommendations
There is a great necessity to develop a mechanism to provide alternatives for push factors related to doctor’s brain drain. Doctors should be kept from leaving the country in the first instance in order to avert the disaster. Prior to offering effective solutions, the factors that have affected it must first be accurately identified. However, the government has made a number of efforts to make things better situation thus far. The Ministry of Health recognized the grave nature of the circumstance and the demand for immediate action. According to MOH, the Government has taken measures to improve the intake of doctors and plans to send about 1,500 doctors to rural districts starting on July 27. In addition, until a Cabinet decision, the age of retirement for doctors in medicine has been temporarily raised to 63 years. According to agreements with the International Monetary Fund (IMF), the Minister pledged that recruitment efforts will continue after September. The severe lack of healthcare personnel would be addressed by the creation of a comprehensive national programme. Further, there is no doubt that medical education in Sri Lanka is widely recognized throughout the world. Therefore, Sri Lanka should be capacitated to enroll and train foreign students in medicine while also making an enormous profit. Although Sri Lanka keeps running these programs, they still need to be expanded. The university infrastructure should also be enhanced in comparison to that. The authorities must do anything necessary to keep the high standard of free healthcare that existed in Sri Lanka from collapsing. Finally, the government must work more efficiently to manage the current situation of limitless migration of doctors and implement the necessary actions to strengthen Sri Lanka's healthcare system without collapse.
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Published on Colombo Telegraph on 03rd November 2023.
* Ms. W.D.S. Madhavi is an Intern (Research) at the Institute of National Security Studies (INSS), the premier think tank on National Security established and functioning under the Ministry of Defence. The opinion expressed is her own and not necessarily reflective of the institute or the Ministry of Defence.
-The Ministry of Defence bears no responsibility for the ideas and views expressed by the contributors to the Opinion section of this web site-