Internal brain drain and donor-induced distortions of human resource allocation

Background: Human resource inadequacies are key constraints to building strong primary care health systems in many countries, including Mozambique. Anecdotal evidence suggests that internal brain drain, that is, the flow of key health personnel from the public sector to the donor or NGO sector, occurs frequently as a result of well-intentioned donor and NGO recruiting. This study attempts to quantify the extent to which internal brain drain exists in Mozambique and some of the characteristics of physician job movement in-country.

Design/Methods: All Mozambican national graduates of the Mozambique medical school from 1980-2004, and Mozambican nationals who graduated of Cuban and Russian medical schools from the same time period were identified. Current workplace of those graduates was assessed by officials of the Human Resources Department of the Ministry of Health and verified by key informants. Categories included MOH (clinical and management), NGO, bilateral donors (PEPFAR as an independent category), multilateral organizations, private sector, and no longer in country. Movements from category to category have been documented. Key informant interviews and focus group discussions explored reasons for flow of human resources.

Results: Final results will be available by March 2008. Preliminary data suggest that there has been an increasing movement of physicians from public sector to NGO and donor sector since 1990, with a notable increase in flow from the public sector since 2000. The principal recipient of physician flow has been international NGOs working in Mozambique. Salary differentials and conditions of work have been reported as major drivers of internal brain drain. Repeated trainings, seminars, and workshops also contribute to unexpected work absences. A relatively small proportion of physicians who leave the public sector have returned to date.

Conclusions and application to improve implementation: Donor and NGO-induced internal brain drain is a serious problem in human resource poor countries of sub-Saharan Africa. Sustainability of HIV programs and primary health care in general is threatened by this phenomenon. Moreover, resentment and low morale may be a result of the forces that drive the flow of physicians. A code of conduct for NGOs is being developed by a group of NGOs to help reduce the inequities that underlie internal brain drain.