Brain drain and health workforce distortions in Mozambique

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.     

Forest health status in Europe

Forest health status in Europe is assessed by the International Cooperative Programme on Assessment and Monitoring of Air Pollution Effects on Forests (ICP Forests). Established by the Convention on Long-Range Transboundary Air Pollution (CLRTAP) under the United Nations Economic Commission for Europe (UNECE), the ICP Forests has been monitoring forest condition in close cooperation with the European Commission (EC) for 20 years. The present paper describes the latest results of the deposition measurements on permanent monitoring plots and of the extensive defoliation sample survey. The findings reveal marked spatial patterns in bulk and throughfall depositions of nitrate (N-NO3(-)), ammonium (N-NH4(+)), and sulfate (S-SO4(2-)), as well as an obvious decrease in bulk and throughfall deposition of sulfate. Latest analyses of defoliation data confirm previous results, indicating a high correlation with weather extremes.