BY ANNABEL WOODWORTH
While migration in healthcare is normally discussed in terms of patient access, the movement patterns of healthcare providers are critical in building viable global health systems and delivering equitable care. Since the emergence of the term ‘Brain Drain’ in the early 1960s, the migration of highly skilled professionals, particularly in healthcare, has been characterized as a direct depletion of the home country’s human capital and training capabilities. Brain Drain describes the pattern of emigration from low- and middle-income countries (LMICs) to high-income countries (HICs), with 10-50% of highly skilled professionals leaving their origin country in search of better economic opportunities and a higher quality of life.1 Recent studies have shown, however, that this phenomenon can be better described as ‘Brain Circulation,’ with both LMICs and HICs experiencing indirect economic benefits, as well as incentive effects in the home country that facilitate increases in those pursuing professional medical training. This positive effect is further amplified through bilateral frameworks that support labor mobility and ethical recruitment. While the migration of healthcare professionals is traditionally regarded as extractive and exploitative, formal bilateral agreements between HICs and LMICs like Global Skill Partnerships facilitate a mutualistic relationship, strengthening economic stability and raising the global standard of care.
The possibility of foreign migration creates an ‘incentive effect’ that encourages individuals from LMICs to pursue professional training in skilled fields. This is especially apparent in healthcare. Although 26,835 nurses migrated from the Philippines to the U.S. between 2000 and 2006, the country licensed 113,775 new nurses within that same period—a net gain in human capital in the Philippines of 86,940 nurses.1 This illustrates that migration prospects can expand the capacity and infrastructure for healthcare training within an LMIC. These educational incentives in LMICs extend beyond the healthcare industry; according to a 2012 study, 20% of top students in Tonga and 32% in Ghana who ultimately remained in-country reported taking specific actions, such as private lessons, language study, or test preparation courses, to improve their prospects of working or studying abroad.2 Even outside of the incentive effect, the benefits of migration are still evident through remittances; emigrated professionals send money back to their home country, acting as a form of developmental aid and increasing access to local medical services.
Despite the long-term benefits of labor mobility between high- and low- income countries, departure of essential labor can create immediate healthcare crises in LMICs if proper measures are not taken to ensure ethical and reciprocal recruitment of nurses and physicians. While the global health workforce shortage is decreasing, it remains a significant obstacle in creating equal access. Although data from a BMJ Global Health assessment for the health workforce indicate that the shortage is expected to drop from 15 million in 2020 to 10 million by 2030, this still poses a profound risk to the stability of healthcare systems around the world.4 Physician migration places a large strain on already fragile healthcare systems; one survey study in Nigeria reported that 43.9% wanted to emigrate while only 13% of Nigerian physician respondents were satisfied with their current work situation.5 Without proper support, LMIC health systems are vulnerable to widespread healthcare shortages that would further exacerbate issues of patient access.
A remedy for this issue of extractivism and exploitation lies in the implementation of a formal bilateral agreement between the origin and destination countries. Global Skill Partnerships (GSPs) facilitate this by having HICs provide financial support to LMICs that allows them to strengthen their domestic training capacity and grow the in-country health labor force.3 Trainees choose between a ‘home track,’ contributing to the local economy, or an ‘away track,’ moving abroad with a skill set in high demand in the HIC. Although still existing on a limited scale, GSPs have proven successful at building up human capital overall and increasing labor mobility. The Australia Pacific Training Coalition, a GSP established in 2007 and operating in ten countries in the Pacific, has yielded over 21,000 graduates and an 84% employment rate in high demand fields like healthcare, hospitality, construction, and engineering.6 GSPs prevent extraction by ensuring that both LMICs and HICs reap the benefits of the program. Despite this success, the United States has yet to formally adopt this model. In order to invest in long-term public health, it is critical that we hold ourselves accountable and take action toward a mutually beneficial solution.
Issues in global health cannot be solved through isolationist policies. In order to shift the narrative from ‘Brain Drain’ to ‘Brain Gain,’ it is necessary that wealthy countries like the United States move towards mutualistic frameworks that prioritize raising the global standard of care and advancing public health systems worldwide.
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References
- Batista, C. & Han, D. Brain drain or brain gain? Effects of high-skilled international emigration on origin countries. Science 388, (2025).
- Gibson, J., & McKenzie, D. (2012). The economic consequences of “brain drain” of the best and brightest: Microeconomic evidence from five countries. The Economic Journal, 122(560), 339–375.
- GSP. Migration that Works for Everyone. Global Skill Partnership https://gsp.cgdev.org/ (2026).
- Boniol, M. et al. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? BMJ Global Health 7, (2022).
- Onah, C. K. et al. Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system. 20, 85.
- Our Performance. Australia Pacific Training Coalitionhttps://aptc.edu.au/our-performance (2024).
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