Healthcare professionals are the backbone of every country and developed countries’ governments do everything within their power to keep them happy. Sadly, such is not the case for Pakistani healthcare workers. Time and again, the government has displayed little regard it holds for the esteemed professionals. The entire community is overworked, underpaid, threatened, understaffed, and exploited at every level. It is no surprise that most of the workforce dreams of a life in other countries that offer them security, privileges, rights, livable conditions, and fair pay.
What is Medical Brain Drain?
The migratory phenomenon of medical professionals moving to developed countries for better prospects is called medical brain drain. It is mostly observed in workers from underdeveloped or developing countries. The reasons behind the phenomenon are called “push and pull factors”. The reasons for medical graduates and professionals immigrating into developed countries are stable medical infrastructure, low unemployment ratio, attractive remuneration packages, and an aging population.
Some factors of emigration are the increasing rate of unemployment in the market, barely available opportunities, lucrative and new recruitment agencies, and worsening state of healthcare in developing countries. Other factors behind Pakistani medical graduates emigrating were outlined by Dr. Zarmeneh Aly, “the long-standing belief of young doctors and their parents who train outside their home country is superior and a mark of achievement. The expectation of bigger incomes. The lure of high-tech training and super-specialization. A reaction against the Pakistani government’s poor management of the education system, and the corruption associated with this management, in favor of what are perceived to be the more merit-based medical training systems of the West.”
Migration is impacted by a number of factors such as restrictions upon visas in the health labor market, degree recognition, tax system towards the migrants, availability of permanent resident status, and points-based system.
Pakistan’s Medical Brain Drain
Ministry of Overseas Pakistanis and Human Resource Development’s data shows that until March 2019, around 40,000 Pakistani doctors were living and working in the USA, the UK, and many European countries. According to the statistics published by the Bureau of Emigration & Overseas Employment (BE & OE) of the Government of Pakistan for 2022 (up till June), 985 doctors, 883 nurses, and 28 pharmacists registered for employment abroad through the Overseas Employment Corporation and BE & OE.
Nursing is an often overlooked part of the healthcare industry, and in Pakistan, nurses and midwives are not given their due share. As per the recommendation of the Pakistan Nursing Council, the nurse-to-patient ratio should be 3:10 yet the current ratio is 1:40. The Pakistan Economic Survey 2020-2021 showed that in 2020, only 116,659 registered nurses were working for a population of over 200 million people in the country. The battle against the pandemic was fought by nurses as much as Pakistani doctors. Acknowledging the hardships faced by the workers, Professor Rozina Karmaliani, Dean of Agha Khan University’s School of Nursing and Midwifery said, “Nurses have grown used to double shifts, no days offs, and living at hospitals during the pandemic to keep the public safe… They are also working at vaccination centres, hosting capacity building drives for their colleagues, volunteering at field isolation centres, as well as managing tele-clinics, hotlines, and home-health initiatives. Despite being stretched, they are striving to do their best.”
When the pandemic engulfed the country, healthcare workers were the first and most important line of defense. Despite it, the workforce’s safety and health were neglected by the government. Dr. Zaeem Zia, District Health Officer in Islamabad said, “When COVID-19 started spreading in the country, our duty as healthcare workers was to buckle down and get to work, helping tackle the influx of patients affected by the new virus… Supplies of PPE were low, but we still had a job to do. It was scary. Many of our colleagues, who did not have protective equipment, were getting infected.”
PMA Joint Secretary Dr. Salman Kazmi pinpointed the problem when he said, “The government on the one hand claims to invest in health and education, and on the other, it does nothing to stop the brain drain.” He added, “The government announces a pay package for doctors and nurses only when they go on strike or take to the streets. This is no solution. The government needs to develop a structure otherwise we may run out of doctors.”
Is Brain Drain Justifiable?
Pakistan significantly depends on its labor export to boost its GDP. In a document published by the Ministry of Overseas Pakistanis and Human Resource Development, in 2019, the total foreign remittances sent by migrant workers back to Pakistan was around $21.84 billion or nearly 8% of the country’s GDP. Most of the Pakistani migrants are settled in Qatar, Kuwait, Oman, Saudi Arabia, Bahrain, and the United Arab Emirates.
To strengthen the economy and international ties with other countries, every reigning government often enters into agreements to export medical professionals. In 2020, to meet one of the top twenty Sustainable Development Goals (SDGs) set by the Economic and Social Council (ECOSOC) of the UN, AFCO-Private Limited, Pakistan, a local employment recruitment bureau and the MMC-Health Care Limited, UK signed a memorandum of understanding (MoU) to provide 150,000 medical sector jobs in the UK. The agreed-upon numbers were 80,000 to 10,0000 nurses, 25,000 doctors, 10,000 pharmacists, and 20,000 allied paramedics.
Kuwait restricted visas for Pakistani nationals in 2011 over security conditions but in 2020, the restrictions were lifted to allow skilled personnel from Pakistan into the country as part of Kuwait’s Vision 2035. Initially, the agreement cited the immigration of 600 healthcare workers but the allotted numbers were increased by 2022. Ayub Afridi, the former prime minister’s aide, said, “Pakistan has sent more than 3500 doctors, nurses, and technicians to Kuwait during the pandemic and 3000 more are in the pipeline, while at the same time, KSA (Kingdom of Saudi Arabia) is recruiting hundreds of medical professionals too.”
The prospect of moving onto greener pasture is certainly alluring but the SELMA study showed that the healthcare needs of Pakistani migrants are neglected. The study highlighted many Pakistani migrants living in squalor, subjected to overcrowding in their accommodations, at the mercy of various health problems, and more. Speaking of the reasons behind such negligence, Fauziah Rabbani, professor at AKU and one of SELMA’s principal investigators, said, “Why has the protection of the health of migrants fallen through cracks? Among the reasons is the political framing of labour migrants as a source of economic revenue or replaceable labour. In particular, the sending states like Pakistan are deemed to be in a relatively weaker position to demand enforcement of global guidelines because their economies are so dependent on remittances.”
