Health Policy 70 (2004) 1–10 “Brain drain” of health professionals: from rhetoric to responsible action Tim Martineau a,* , Karola Decker b , Peter Bundred c a International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK b International Politics, Department for Political Science, University of Hamburg, Germany c Department of Primary Care, Liverpool University, Liverpool, UK Received 22 September 2003; accepted 14 January 2004 Abstract The question of the “brain drain” of health professionals has re-emerged since last exposed in 1970s. This paper is based on exploratory studies in Ghana, South Africa and the UK, a literature review and subsequent tracking of contemporary events. It reviews what is currently known about professional migration in the health sector and its impact on health services in poorer countries. The relevant responsibilities at the global level and source and recipient country levels are then reviewed. It is concluded that that the situation is more complex than portrayed by some of the rhetoric and that meaningful dialogue and consideration of responsibilities is needed. In addition, better information is needed to monitor migration flows; source countries need to improve staff attraction and retention strategies; and recipient countries need to ensure that they do not become a permanent drain on health professionals from the developing countries. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Migration; health professionals; recruitment; retention strategy 1. Introduction There are an estimated 35 million people work- ing in the health sector worldwide [1]. This essen- tial global resource is not equitably shared between countries, largely due to the extent of international migration of health professionals. ‘Brain drain’, as professional migration is some- times called, in the health sector is not a new phe- nomenon. Concerns over the international movement * Corresponding author. Tel.: +44-151-705-3194; fax: +44-151-705-3364. E-mail address: t.martineau@liv.ac.uk (T. Martineau). of health workers were expressed at Edinburgh Com- monwealth Medical Conference in 1965. In the 1970s the World Health Organisation was prompted to exam- ine the global stocks and flows of doctors and nurses in what is the only study of its kind [2]. This report made little impact and migration of health profes- sionals has gradually increased over the years [3–5]. As the large scale movement of health professionals from developing countries is now impacting on the health systems of those countries it is imperative to develop a meaningful dialogue among stakeholders in the search for urgently needed solutions. This paper focuses on the responsibilities of import- ing or ‘recipient’ countries and exporting or ‘source’ 0168-8510/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2004.01.006