This study sheds light on strategies for retaining skilled pharmacists in Pakistan's pharmaceutical sector, offering valuable insights for both academia and industry stakeholders by investigating the impact of human resource management practices, including training and development, compensation and rewards, job performance, and job satisfaction, on employee retention. It also examines the moderating role of career growth in this context. Theoretical foundations are grounded in international migration theories and social exchange theory, providing a comprehensive framework for the study. A cross-sectional survey (...) design was used to collect data from 254 pharmacists in southern Punjab, Pakistan. Structural equation modeling (SEM) was employed for data analysis. Findings reveal that training and development, compensation and rewards, job performance, and job satisfaction all have significant direct effects on employee retention. Additionally, career growth acts as a crucial moderator, strengthening the relationship between training and development and job performance, as well as compensation and rewards and job satisfaction in relation to employee retention. Theoretical implications emphasize the importance of tailored training programs, fair compensation practices, and career growth opportunities. Practical recommendations include creating a positive work environment, rewarding high-performing employees, and fostering career development. Future research directions encompass longitudinal studies, the influence of organizational culture and technology, regional variations, and additional factors affecting retention. (shrink)

This article considers one seemingly compelling justification for immigration restrictions: that they help restrict the brain drain of skilled workers from poor states. For some poor states, brain drain is a severe problem, sapping their ability to provide basic services. Yet this article finds that justifying immigration restrictions on brain drain grounds is far from straightforward. For restrictions to be justified, a series of demanding conditions must be fulfilled. Brain drain does provide (...) a successful argument for some immigration restrictions, but it is an argument that fails to justify restrictions beyond a small minority of cases. (shrink)

In her debate with Michael Blake, Gillian Brock sets out to justify emigration restrictions on medical workers from poor states on the basis of their free-riding on the public investment that their states have made in them in form of a publicly funded education. For this purpose, Brock aims to isolate the question of emigration restrictions from the larger question of responsibilities for remedying global inequalities. I argue that this approach is misguided because it is blind to decisive factors at (...) play in the problem of medical brain drain and consequently distorts the different responsibilities this problem generates. Brock’s strategy, if successful, would effectively lead to punishing emigrating workers from poor states for the free-riding and exploitation that is committed by affluent states – which is a counter-intuitive result. (shrink)

The metaphor of “care drain” has been created as a womanly parallel to the “brain drain” idea. Just as “brain drain” suggests that the skilled migrants are an economic loss for the sending country, “care drain” describes the migrant women hired as care workers as a loss of care for their children left behind. This paper criticizes the construction of migrant women as “care drain” for three reasons: 1) it is built on sexist (...) stereotypes, 2) it misrepresents and devalues care work, and 3) it misses the opportunity for a theoretical change about how skills in migration contexts can be understood. (shrink)

Many of the most skilled and educated citizens of developing countries choose to emigrate. How may those societies respond to these facts? May they ever legitimately prevent the emigration of their citizens? Gillian Brock and Michael Blake debate these questions, and offer distinct arguments about the morality of emigration.

Next SectionAccess to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ’locally relevant medical training’—teaching primarily locally endemic diseases (...) and practice in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. (shrink)

Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed (...) to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics. (shrink)

In this paper I first argue that when answering the question of whether or not governments may restrict emigration, Brock and Blake are staking out positions not astronomically far from one another. Despite the ostensibly large philosophical gap between the two, both think that certain governments may restrict emigration when such restriction is agreed to in a morally binding contract. Secondly, both authors think that there are specific “circumstances” or “conditions” under which a contract that restricts emigration can be morally (...) binding. This second part of the paper will pose some questions that explore these various circumstances or conditions. The ultimate aim of the paper is to help point the debate in the right direction so as to further develop an answer to the question of whether or not governments may restrict emigration. (shrink)

This chapter criticizes policies that aim to restrict the emigration or immigration of skilled workers, analyzes the ethics of recruitment, and proposes basing an ethics of skilled migration based on the violation of negative duties not to uphold unjust institutions.

Theorists concerned about the distributive effects of skilled emigration (brain drain) often argue that its harmful effects can be justly mitigated by restricting emigration from sending countries or by limiting immigration opportunities to receiving countries. I raise moral and practical concerns against restricting the movement of skilled migrants and contend that conceptualizing the moral issue in these terms leads theorists to neglect the moral salience of institutions that determine the distributive effects of migration. Using an analogy to skilled (...) migration in a domestic context, I argue for locating brain drain in a more holistic, institutional context that includes the reform of global institutions and of policies affecting migration. (shrink)

In this essay, we focus on the moral justification of a highly controversial measure to redress medical brain drain: the duty to stay. We argue that the moral justification for this duty lies primarily in the fact that medical students impose high risks on their fellow citizens while receiving their medical training, which in turn gives them a reciprocity-based reason to temporarily prioritize the medical needs of their fellow citizens.

When skilled individuals emigrate from developing states to developed states, they leave a burdened state behind and bring their valuable human capital to a state that enjoys vast advantages by comparison. Most of the normative debate to date on this so-called ‘brain drain’ has focused on the duties that skilled emigrants owe to their home state after they emigrate. This article shifts the focus to the question of whether their host state acquires special duties toward their home state (...) and argues for an affirmative answer to that question. After identifying the conditions under which ‘exploitative free-riding’ can occur, the article shows that the brain drain is a case of exploitation that gives rise to special duties of compensation for developed host states. (shrink)

Politics, Philosophy & Economics, Ahead of Print. When skilled individuals emigrate from developing states to developed states, they leave a burdened state behind and bring their valuable human capital to a state that enjoys vast advantages by comparison. Most of the normative debate to date on this so-called ‘brain drain’ has focused on the duties that skilled emigrants owe to their home state after they emigrate. This article shifts the focus to the question of whether their host state (...) acquires special duties toward their home state and argues for an affirmative answer to that question. After identifying the conditions under which ‘exploitative free-riding’ can occur, the article shows that the brain drain is a case of exploitation that gives rise to special duties of compensation for developed host states. (shrink)

Politics, Philosophy & Economics, Volume 21, Issue 3, Page 249-268, August 2022. When skilled individuals emigrate from developing states to developed states, they leave a burdened state behind and bring their valuable human capital to a state that enjoys vast advantages by comparison. Most of the normative debate to date on this so-called ‘brain drain’ has focused on the duties that skilled emigrants owe to their home state after they emigrate. This article shifts the focus to the question (...) of whether their host state acquires special duties toward their home state and argues for an affirmative answer to that question. After identifying the conditions under which ‘exploitative free-riding’ can occur, the article shows that the brain drain is a case of exploitation that gives rise to special duties of compensation for developed host states. (shrink)

The global migration of physicians and nurses produces serious shortages in the developing world, exemplifying one of the ways that global capitalism sets up dynamics of surplus extraction from periphery to global wealth centers. This paper focuses specifically on the Ghanaian situation, and argues that an ethics of care framework offers a way of approaching the problem productively. Recognizing the various commitments and relationships that tie us together allows for a response that protects individual freedom while responding to the need (...) to maintain adequate numbers of trained health-care workers. (shrink)

The moral debate about open borders needs to go beyond focusing on the interests of the migrant versus the interests of the hosting state and its original citizens to focusing more on the interests of the countries that migrants are leaving. I hint at the long-term insufficiency of so-called economic remittances to the development of migrant-sending states when compared to domiciled skilled labor. But most importantly, I identify the irrelevance of current empirical research on brain drain to an (...) open borders scenario. I hint at the potential scale of brain drain in such a scenario, and I raise a moral question about the propriety of proposing open borders with a focus on the wellbeing of the individual migrant if such a focus is determined to be at the expense of the wellbeing of the migrant’s home country. I add that a preamble to opening borders would be to significantly address gross global economic disparities, world poverty, and political injustices. (shrink)

There is a consensus that the effects of medical brain drain, especially in the Sub-Saharan African countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue—while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In (...) the first step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves would hold responsibilities to assist with respect to vital needs of their compatriots. These are fair reciprocity, duty to support vital institutions, and attending to the unintended harmful consequences of one’s actions. While the first two are explained and also largely discussed in the literature, the third requires an explication on how and on which basis skilled workers would have a responsibility as such. In this article, I offer a vulnerability approach with its dependency aspect that may account for why the health workers in underserved contexts would have a responsibility to attend to the unintended side effects of their actions that may lead to a vital risk of harm for the population. I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility. (shrink)

This essay asks if a cosmopolitan—who we take to be generally supportive of freer international migration—should worry about the adverse effects on those remaining behind in poor countries.

According to the brain drain argument, there are good reasons for states to limit the exit of their skilled workers (more specifically, healthcare workers), because of the negative impacts this type of migration has for other members of the community from which they migrate. Some theorists criticise this argument as illiberal, while others support it and ground a duty to stay of the skilled workers on rather vague concepts like patriotic virtue, or the legitimate expectations of their state (...) and co-citizens. In this article, on the contrary, we suggest that the liberal conception of states’ legitimate political authority demands, and not just permits, that developing states from which migration of skilled workers occurs set up contractual mechanisms. These mechanisms will ensure that state-funded training in the health sector is provided against a commitment on the part of future professionals to reciprocate with their services for the benefits obtained. If one of the conditions for the state to maintain legitimate political authority is to provide basic services such as healthcare to its subjects (while respecting at the same time their autonomy and freedom), then this is what developing states affected by the brain drain ought to do. What we call the authority-based approach to the brain drain also helps to clarify the obligations that other states have not to interfere with these contractual mechanisms when they exist, and not to profit from their absence. Inspired by FIFA’s legal instruments of training compensation and solidarity mechanism for the transfer of players, we conclude by suggesting a plausible global policy to complement this authority-based approach. (shrink)

One of the characteristics of the relationship between the developed and developing worlds is the ‘brain drain’– the phenomenon by which expertise moves towards richer countries, thereby condemning poorer countries to continued comparative and absolute poverty. It is tempting to see the phenomenon as a moral problem in its own right, such that there is a moral imperative to end it, that is separate from (and additional to) any moral imperative to relieve the burden of poverty. However, it (...) is not clear why this should be so – why, that is, there is a moral reason to stem the flow of expertise in addition to seeking to improve welfare. In this paper, I examine three explanations of the putative moral aspect of the brain drain. (shrink)

The American Journal of Bioethics, Volume 12, Issue 5, Page 42-43, May 2012.

This paper proposes a novel use of tax policy to address one of the most pressing issues arising from economic globalization and international migration, that of “brain drain” – in particular, the migration of certain skilled and highly trained or educated professionals from less and least developed countries to wealthy “western” countries. This problem is perhaps most pressing in relation to doctors, nurses, and other medical professionals, but exists also for teachers, lawyers, economists, engineers, and other highly skilled (...) or trained professionals. While there have been other proposals in the past to use tax policy to address brain drain (most famously versions of the so-called “Bhagwati Tax”, a form of exit tax), in this paper I provide an account of and justification for using tax credits, modeled loosely on the foreign tax credits U.S. citizens receive in certain situations for taxes paid in other countries. My proposal avoids several of the pitfalls of other methods of using tax policy to ameliorate the harms of brain drain, as it does not subject people from the developing world to potentially onerous double taxation, and does not depend on sophisticated tax collection capabilities within developing countries, capabilities which are often lacking. Additionally, my proposal also leads to fewer morally problematic restrictions on the liberty of citizens of less and least developed countries than do non-taxed based alternative proposals, such as temporary bans on migration. While the proposal cannot hope to completely solve the problems that arise in relation to brain drain – no approach can do this – it does provide a straightforward way to ameliorate the problems that arise from it without placing significant financial or liberty burdens on already less advantaged people from the developing world. -/- (This paper may be downloaded for free from the link to my SSRN page below). (shrink)

With the increased rate of the Turkish medical brain drain (MDB) in recent years, there is a need for more comprehensive studies to elucidate its vague migratory factors. The aim of this paper is to try to narrow that gap by analyzing present impacts of the MDB in Turkey and to evaluate if these aspects were driven by professional ethical values, and if so, what ethical principles they were based on. In-depth interviews were conducted with 19 doctors from (...) various backgrounds, followed by a thematic analysis. The MDB in Turkey demonstrated a multifactorial structure, with prominent push factors that are intertwined at macro-meso-micro levels. The effort to maintain the principles of beneficence, non-maleficence, and protecting professional autonomy were the most important in the context of professional ethics. Only deep-rooted regulations might ensure the prevention of the MDB in Turkey and the prospect of doctors returning in the future. Conclusively, the recent criticisms the MDB has been garnering may inspire improvements in deteriorating human and health rights in Turkey. (shrink)

Recent reports published by the United Nations and the World Health Organization suggest that the brain drain of healthcare professionals from the developing to the developed world is decimating the provision of healthcare in poor countries. The migration of these key workers is driven by a combination of economic inequalities and the recruitment policies of governments in the rich world. This article assesses the impact of the healthcare brain drain and argues that wealthy countries have a (...) moral obligation to reduce the flow of healthcare workers from the developing to the developed world. (shrink)

Health-worker migration, commonly called "medical brain drain", refers to the mass migration of trained and skilled health professionals from low-income to high-income countries. This is currently leaving a significant number of poor countries, particularly in sub-Saharan Africa, with critical staff shortages in the healthcare sector. A broad consensus exists that, where medical brain drain exacerbates such shortages, it is unethical, and this review presents the main arguments underpinning this view. Notwithstanding the general agreement, which policies are (...) justifiable on ethical grounds to tackle brain drain and how best to go about implementing them remains controversial. The review offers a discussion of the specific ethical issues that have to be taken into account when deciding which policy measures to prioritise and suggests a strategy of policy implementation to address medical brain drain as a matter of urgency. (shrink)

This article focuses on two questions regarding the movement of persons across international borders: (1) do states have a right to unilaterally control their borders; and (2) if they do, are migration arrangements simply immune to moral considerations? Unlike open borders theorists, I answer the first question in the affirmative. However, I answer the second question in the negative. More specifically, I argue that states have a negative duty to exclude prospective immigrants whose departure could be expected to contribute to (...) severe deprivation in their countries of origin. Countries have a right to unilaterally control their borders, but their exercise of this right is constrained by the demands of morality. (shrink)

In Debating Brain Drain, Gillian Brock and Michael Blake both draw on a liberal moral- political foundation to address the issue, but they come to different conclusions about it. Despite the common ground of free and equal persons having a dignity that grounds human rights, Brock concludes that many medical professionals who leave a developing country soon after having received training there are wrong to do so and that the state may place some limits on their ability to (...) exit, whereas Blake infers that there is neither any wrongdoing on their part, nor rightful restrictions placed on them. In this article, rather than sort out which has the better interpretation of what liberalism entails, I consider the medical brain drain in light of an alternative normative framework, one informed by ideals of communion salient in the sub-Saharan moral tradition. I argue that a principle of prizing communal relationships more naturally entails Brock's conclusions than does her appeal to liberalism. (shrink)

Clinical Ethics, Ahead of Print. The migration of health-care professionals has often produced morally charged discussions among ethicists, politicians, and policy makers in the migrant-sending and migrant-receiving countries because of its devastating effects on the health of those left behind in the countries of origin.This movement of skilled professionals – their decision to leaving their countries of origin in search of better work environments – has created a phenomenon that has been described as brain drain. Although the migration (...) of health workers continue to bring prosperity to millions of people around the world, they have also evoked hopelessness in many more people. Thus, questions of global justice manifest themselves when it comes to the matters of brain drain and the just distribution of health and healthcare professionals. (shrink)