OUT-MIGRATION OF HEALTH PROFESSIONALS FROM BANGLADESH

Abstract

We have gone from lamenting health professional out-migration from the developing world to welcoming it, recognizing that there is substantial potential for promoting health sector development in the developing world via the transfer of financial and social capital from health professional diasporas. In the case of Bangladesh, actualizing this potential requires changes both abroad and at home. Diaspora health professional organizations have to significantly expand their membership base and systematically identify members with appropriate skill sets and match them with Bangladeshi institutional partners. On the Bangladeshi side, what is required is (i) strategies to change prevailing attitudes about brain drain and significantly increase the size of the health professional diaspora and (ii) a clear articulation of gaps and needs, coupled with the active recruitment of diaspora professionals by the provision of positive incentives and the removal of bureaucratic and legal hurdles that constrain effective cooperation and collaboration.

Keywords:

• Bangladesh
• diaspora
• health professionals
• out-migrants

Notes

1. Diasporas have been defined as ‘transnational groups of immigrants living abroad but maintaining economic, political, social and emotional ties with their homeland and with other diasporic communities of the same origin’ (Siddiqui 2004; de Bruyn & Kuddus 2005).

2. Return migrants are those out-migrants who permanently relocate to their country of origin. Transnationals are out-migrants who move back and forth between country of origin and destination of out-migration (Development Research Centre on Migration, Globalization and Poverty 2005).

3. At present, remittances sent by migrant workers significantly exceed official development aid and are the second largest source, behind foreign direct investment, of external funding for developing countries (Stilwell et al. 2003).

4. Return migration of professional migrants in terms of permanent relocation back to the source country is still very low to negligible for most developing countries and may require significant levels of economic development (as in South Korea) as a pre-condition (Bardak 2005).

5. As a frame of comparison PPP GNI for: India US$ 3100; Pakistan US$ 2160; Nepal US$ 1470; SriLanka US$ 4000 (Population Reference Bureau 2005).

6. Bangladesh has a very low output of professionals not only in an absolute sense but also relative to India. Proportionately, India produces 1.4 times more physicians and 5.69 times more engineers.

7. These figures are almost certainly significant overestimates. In the case of the US, they report a Bangladeshi diaspora of 300,000–500,000, whereas the 2001 US census counts only about 100,000 residents of Bangladeshi origin, including first, second and third generation Bangladeshis.

8. It is worth noting here that Bangladeshi physician out-migration is significantly smaller than the analogous Indian experience, with Indian physicians migrating at four times the rate of their Bangladeshi peers (Rahman & Khan 2006). The reasons for this huge difference is not obvious but may be due to better information channels about migration due to a longer history of out migration, higher quality of medical education, better English language skills, etc.

9. From a quality perspective, however, it appears that a relatively high proportion of the best and the brightest physicians are leaving the country (Rahman & Khan 2006). While this has an impact on the quality of medical research and intellectual development at the top institutions in the country, it probably does not affect health service provision overall materially.

10. This issue is particularly sensitive in countries like Bangladesh with a shortage of healthcare facilities and a highly unfavorable doctor/patient ratio. Governments have usually discouraged professional out migration, and even taken measures to hinder it, as a means of getting popular support by taking advantage of the catchy ‘brain drain’ theory. It is therefore imperative for any future positive policy steps in this area that this politics of populism is supplanted by one of rationalized discourse.

11. South Africa has effectively used web technology to mobilize its professional diaspora in the form of a virtual network called SANSA (Bardak 2005).

12. In Africa, IOM has started doing this by ‘circulating a questionnaire through diaspora communities, health-related organizations, Embassies, higher education institutions, professional associations, hospitals, etc. and documenting the records in a database’ (IOM 2003). The database can be viewed by country of origin, country of residence, or by professional qualifications of candidates.

13. Bangladesh already provides NO VISA REQUIRED stamps for Bangladeshi citizens who have emigrated.

14. This is already possible for citizens of US, Canada, UK, Australia, and other selected countries. This list should be expanded. Absentee voting should be allowed.

15. Bangladesh has established a separate Ministry of Expatriate Welfare and Employment (MEWOE) but it lacks logistic and financial capacity (de Bruyn & Kuddus 2005).

16. India has instituted regular up of ‘Pravasi Bharatiya Divas’ or Non-Resident Indians (NRI) Day, to recognize the positive impact of the diaspora.