Pakistani physicians and the repatriation equation

Diaspora engagement: a scoping review of diaspora involvement with strengthening health systems of their origin country

BACKGROUND

Diaspora communities are a growing source of external aid and resources to address unmet needs of health systems of their homelands. Although numerous articles have been published, these endeavors as a whole have not been systematically assessed.

OBJECTIVE

Examine the available literature to assess activities through which diasporas engage with the health system in their origin country and what barriers they face in their interventions.

METHODS

This is a scoping review from 1990-2018 using the PRISMA-Scr framework to examine both peer-reviewed and gray literature on (1) specific activities through which diasporas contribute to the health system in their origin country; (2) major health needs diasporas have tried to address; and (3) barriers faced by diaspora healthcare efforts.

RESULTS

The initial search identified 119 articles, of which 45 were eligible after excluding non-relevant studies. These were case studies of diaspora contributions to health systems in their origin country (13), interviews (13), literature reviews (9), general articles on the topic (4), and correspondences or presentations (6). The healthcare needs diasporas have sought to address include health workforce emigration ('brain drain') (10), capacity building for research and training (10), inadequate infrastructure (5), and finances (4). Specific activities included short-term missions (11), establishing partnerships (9), emigration back to country of origin (8), specific research and training programs (8), and financial remittances (5). Specific barriers identified were most commonly financial need within the origin country (8), lack of sustainability (6), communication issues (6), lack of intention to return to the origin country (5), infrastructure (4), and political concerns (3).

CONCLUSION

Further research on how to expand the scope of and reduce barriers to diaspora engagement is needed to optimize the effectiveness of diaspora contributions to their origin countries. Metrics and standards should be developed for assessing impact of diaspora engagement and interventions.

Willingness of Lebanese physicians in the United States to relocate to Lebanon

BACKGROUND

We recently proposed that Lebanon could become a regional 'academic hub' through the repatriation of emigrated Lebanese physicians who would then provide clinical services in the Arab Gulf region on a locum tenens basis. The objectives of this study were to assess the willingness of Lebanese medical graduates practicing in the United States of America to relocate to Lebanon and the Arab Gulf region and to explore the factors associated with this willingness.

METHODS

In 2009 we surveyed Lebanese medical graduates practicing medicine in the United States. The questionnaire included questions about their willingness to relocate to Lebanon and to the Arab Gulf region and the associated timeframes. The questionnaire also included questions about family factors. We linked responders' answers to their personal, educational, and practice characteristics provided by the American Medical Association Physicians' Dataset. We conducted both descriptive and regression analyses.

RESULTS

A total of 286 physicians participated in the survey (57% response rate). A majority (61%) was willing to relocate to Lebanon (51% possibly, 10% definitely). A third (33%) were willing to relocate to the Arab Gulf region (31% possibly, 2% definitely). About half (54%) were willing to relocate to Lebanon as a base for clinical missions to the Arab Gulf region (49% possibly, 5% definitely). Willingness to relocate to Lebanon was independently associated with Lebanese citizenship and the birthplace of the spouse being Lebanon, and inversely associated with US citizenship. Willingness to relocate to the Arab Gulf region was independently associated with being board certified, and inversely associated with being married, the age of the oldest child, and practicing in direct patient care. Willingness to relocate to Lebanon as a base was not independently associated with any factor.

CONCLUSIONS

The findings of this study support the feasibility of the proposal of Lebanon becoming a regional 'academic hub'. Future research should explore other factors important for the feasibility of the proposal as well as actual relocation.

Health Care Management Training Needs in Pakistan

The management of health care organisations (HCOs) significantly determines the quality and efficiency of health care delivery in developing countries like Pakistan. HCO managers are needed to plan and execute expansion and corporatisation of private HCOs and to transform public sector charity hospitals to self-sustaining efficient organisations and private clinics into profitable ventures. The objective of this study was to assess the need for health care management training in Pakistan using semi-structured interviews of key informants in different cities. We asked experts about the existing HCO management training opportunities, demand for such skills and its impact on the future of health services delivery. Unanimous support for HCO management training emerged in the wake of dissatisfaction with limited opportunities for such training in the country. The participants agreed that trained HCO managers can help introduce modern management practices in health care service delivery, thereby making the HCOs more efficient and effective. We conclude that well-reputed management schools would be performing an important service to the improvement of the health sector in Pakistan if they can design and offer effective management training programmes for HCOs.

Healthcare workers and the brain drain

The brain drain of health workers occurs mostly from low- and low/middle-income countries to resource-rich countries and from rural to urban areas. Shortage and uneven distribution of healthcare workers aggravated by the brain drain from Africa, Asia, and Pacific countries has contributed to impaired reproductive and sexual health services and the high rate of maternal and newborn mortality and morbidity in these counties. Brain drain impedes maternal, neonatal, and child health and the fight against HIV/AIDS, and translates into loss of potential employers, teachers, and role models. Source countries spend US$ 500 million each year to educate health workers who leave their home countries for North America, Western Europe, and South Asia. A code of practice on international recruitment of health personnel is needed. Improving the health workforce database, wages, health resources and working conditions, task shifting, pay-back from recipient countries and migrant health professionals, securing additional investment in the health workforce, and the development of locally relevant medical training and research are useful measures to combat this problem.

Quality of medical training and emigration of physicians from India

BACKGROUND

Physician 'brain drain' negatively impacts health care delivery. Interventions to address physician emigration have been constrained by lack of research on systematic factors that influence physician migration. We examined the relationship between the quality of medical training and rate of migration to the United States and the United Kingdom among Indian medical graduates (1955-2002).

METHODS

We calculated the fraction of medical graduates who emigrated to the United States and the United Kingdom, based on rankings of medical colleges and universities according to three indicators of the quality of medical education (a) student choice, (b) academic publications, and (c) the availability of specialty medical training.

RESULTS

Physicians from the top quintile medical colleges and of universities were 2 to 4 times more likely to emigrate to the United States and the United Kingdom than graduates from the bottom quintile colleges and universities.

CONCLUSION

Graduates of institutions with better quality medical training have a greater likelihood of emigrating. Interventions designed to counter loss of physicians should focus on graduates from top quality institutions.

Why Pakistani medical graduates must remain free to emigrate

What is forgotten in the debate on brain drain, say the authors, is that some doctors who emigrate to the West have every intention of returning after their higher-level training overseas.