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Brain Drain and Health Workforce Distortions in Mozambique

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  • Kenneth Sherr
  • Antonio Mussa
  • Baltazar Chilundo
  • Sarah Gimbel
  • James Pfeiffer
  • Amy Hagopian
  • Stephen Gloyd

Abstract

Introduction: Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector. Methods: An observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980–2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties. Results: Of 723 qualifying physicians between 1980–2006, 95.9% (693) were working full-time, including 71.1% (493) as clinicians, 20.5% (142) as health system managers, and 6.9% (48) as researchers/professors. 25.5% (181) of the sample had left the public sector, of which 62.4% (113) continued working in-country and 37.6% (68) emigrated from Mozambique. Of those cases of internal migration, 66.4% (75) worked for NGOs, 21.2% (24) for donor agencies, and 12.4% (14) in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% (41/113) of internal migration cases had previously held senior-level management positions in the public sector. Discussion: Internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they seek to strengthen.

Suggested Citation

  • Kenneth Sherr & Antonio Mussa & Baltazar Chilundo & Sarah Gimbel & James Pfeiffer & Amy Hagopian & Stephen Gloyd, 2012. "Brain Drain and Health Workforce Distortions in Mozambique," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-7, April.
  • Handle: RePEc:plo:pone00:0035840
    DOI: 10.1371/journal.pone.0035840
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    References listed on IDEAS

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    1. Pfeiffer, J. & Johnson, W. & Fort, M. & Shakow, A. & Hagopian, A. & Gloyd, S. & Gimbel-Sherr, K., 2008. "Strengthening health systems in poor countries: A code of conduct for nongovernmental organizations," American Journal of Public Health, American Public Health Association, vol. 98(12), pages 2134-2140.
    2. Buse, Kent & Walt, Gill, 1997. "An unruly mélange? Coordinating external resources to the health sector: A review," Social Science & Medicine, Elsevier, vol. 45(3), pages 449-463, August.
    3. S. Akbar Zaidi, 1999. "NGO failure and the need to bring back the state," Journal of International Development, John Wiley & Sons, Ltd., vol. 11(2), pages 259-271.
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    1. Lena Dohlman & Matthew DiMeglio & Jihane Hajj & Krzysztof Laudanski, 2019. "Global Brain Drain: How Can the Maslow Theory of Motivation Improve Our Understanding of Physician Migration?," IJERPH, MDPI, vol. 16(7), pages 1-13, April.
    2. McPake, Barbara & Russo, Giuliano & Tseng, Fu-Min, 2014. "How do dual practitioners divide their time? The cases of three African capital cities," Social Science & Medicine, Elsevier, vol. 122(C), pages 113-121.
    3. Dirk-Jan Koch & Jolynde Vis & Maria van der Harst & Elric Tendron & Joost de Laat, 2021. "Assessing International Development Cooperation: Becoming Intentional about Unintended Effects," Sustainability, MDPI, vol. 13(21), pages 1-26, October.
    4. Pillay, Timesh D. & Skordis-Worrall, Jolene, 2013. "South African health financing reform 2000–2010: Understanding the agenda-setting process," Health Policy, Elsevier, vol. 109(3), pages 321-331.
    5. Pfeiffer, James & Gimbel, Sarah & Chilundo, Baltazar & Gloyd, Stephen & Chapman, Rachel & Sherr, Kenneth, 2017. "Austerity and the “sector-wide approach” to health: The Mozambique experience," Social Science & Medicine, Elsevier, vol. 187(C), pages 208-216.
    6. Alejandro Vega-Muñoz & Paloma Gónzalez-Gómez-del-Miño & Juan Felipe Espinosa-Cristia, 2021. "Recognizing New Trends in Brain Drain Studies in the Framework of Global Sustainability," Sustainability, MDPI, vol. 13(6), pages 1-27, March.
    7. Holdaway, Jennifer & Levitt, Peggy & Fang, Jing & Rajaram, Narasimhan, 2015. "Mobility and health sector development in China and India," Social Science & Medicine, Elsevier, vol. 130(C), pages 268-276.

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