Letter from Pakistan – Brain Drain: The Exodus of Nurses to Wealthier Countries is Killing Us

Letter from Pakistan – Brain Drain: The Exodus of Nurses to Wealthier Countries is Killing Us

This is the first of several blog posts on nursing issues in the developing world contributed by MSc nursing students studying at the Karachi, Pakistan campus of the Aga Khan School of Nursing and Midwifery.

Their class assignment involved composing and submitting short research articles for publication in a recommended nursing blog or journal. The object: to help them hone their communication skills as future nurse leaders in Pakistan’s healthcare system. As their instructor put it, one of the goals of the exercise is to encourage nursing students to become “Change Agents” in healthcare settings and the world. DailyNurse thanks the instructor and all of the Change Agents who submitted articles. We hope you will find the selected posts informative and thought-provoking.

The health care systems in western and Gulf countries are well developed and established as compared to Pakistan and other developing countries. Developed countries have become magnets for qualified nurses and other healthcare personnel from developing countries—who are leaving their homes in growing numbers to seek higher pay and better working conditions in more prosperous nations.  The loss of trained, knowledgeable native healthcare workers is eroding the healthcare systems of these countries and endangers patient health outcomes. It is no coincidence that people in the United States on average live more than 10 years longer than people in Pakistan and other developing states. 

According to the Pakistan Economic Survey 2020-2021, Pakistan had a total of 116,659 registered nurses in 2020 for a population of about 200 million people (Pakistan Economic Survey, 2020-2021).  In the general wards of Pakistani hospitals, the current nurse-patient ratio is 1: 40, while the Pakistan Nursing Council recommends a nurse-patient ratio of 3:10 (Firdos, Asghar, & Ashraf, 2020). These facts and figures demonstrate the urgency of the issue of nursing shortages, and the danger they present to the public health.   

The first and most obvious effect of this brain drain is a severe reduction in the availability and quality of health care services in developing nations, particularly in rural regions and the public sector as a result of the cascade effect (Marchal & Kegels, 2003). The nursing shortage in the developing world cannot be arrested overnight, but can be mitigated by implementing the following provisions and measurers: 

  1. Identifying and eliminating factors that prompt healthcare workers to emigrate and seek positions in other countries  
  1. Providing incentives such as annual salary increments, educational expenditures for nurses’ children, free health care, retention allowances, scholarships for nurses’ higher education and professional growth, and housing allowances (Pang, Lansang, & Haines, 2002). 
  1. Providing a safe and conducive working environment for female nurses in Muslim countries as well as in developing countries, particularly in the public sector. 
  1. Mutual agreement is essential between countries to contain brain drain to a certain point, or they can negotiate to trade on a temporary basis if one country experiences a shortage of health care professionals. 
  1. World Health Organization (WHO) should intervene when inequity is observed and take initiative on ‘managed migration of health care professionals’ to avoid any health care crises. 
  1. Promoting a culture of awareness about the nursing profession to increase respect for nurses and make nursing a more attractive career choice. 
  1. Establishing worldwide ethical rules for the exodus of nurses and other healthcare professionals. 
Aga Khan School of Nursing and Midwifery, Karachi, Pakistan.
The Aga Khan School of Nursing and Midwifery, Karachi, Pakistan.

It is the right of each individual to have access to amenities of life such as shelter, good food, health, and education facilities. When affluent nations hire away our best-qualified nurses, patients in developing countries like Pakistan are deprived of native health care expertise and desperately needed care. As the world learned from the pandemic, when one country suffers a healthcare crisis, it places all countries at risk. The WHO needs to set guidelines to reduce the impact of this global injustice because draining the best talents from poor countries to serve the wealthier draws a deadly line of inequality. 

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