• Govt. investment in higher edu., clear career pathways, competitive salaries, improving nat’l systems, reimbursement arrangements, political-econ. reforms

Suggestions to address brain drain include increasing Governmental investment in higher education, establishing clear career pathways and competitive salaries, improving national systems, putting in place reimbursement-related arrangements, and political and economic reform.

These suggestions were made in a letter to the Editor of the Sri Lankan Journal of Nursing on the ’Need for change in the current crisis of the brain drain of healthcare professionals in Sri Lanka’ which was authored by A.D.U. Dharmasiri (attached to the Ratnapura Teaching Hospital) and published in the said Journal's Third Volume's First Issue, in September of last year (2024).

Brain drain refers to the emigration or migration of individuals in search of better professional opportunities or a higher standard of living in another country. This phenomenon can be driven by push factors such as adverse economic conditions, unemployment, low wages, the lack of social freedom, and unstable political governance. On the other hand, pull factors like higher wages, a better quality of life, and increased personal freedom also contribute. Sri Lanka is currently facing this critical issue, particularly in the healthcare sector, due to many of these reasons. 

How does brain drain happen?

Brain drain is a significant concern for many developing countries, with Sri Lanka ranking among the worst in terms of the immigrant-to-population ratio (B.V. Adkoli's ‘Migration of health workers: Perspectives from Bangladesh, India, Nepal, Pakistan, and Sri Lanka’). Although Sri Lanka provides free education, nearly 20,000 to 40,000 Sri Lankan undergraduates are currently studying abroad, representing a substantial loss of talent. Many of these students are from leading Government schools and may never return to the country. Most are between the ages of 25 and 39 years, meaning a significant portion of those who benefited from free education are now employed abroad, leaving Sri Lanka with a low human resource capacity (A.P. De Silva, I.K. Liyanage, S.T. De Silva, M.B. Jayawardana, C.K. Liyanage and I.M. Karunathilake's ‘Migration of Sri Lankan medical specialists’). According to World Bank data from 2018, Sri Lanka faces a shortage of skilled healthcare professionals, with only 1.004 doctors and 2.18 nurses or midwives per 1,000 patients. Each year, around 60 doctors leave for the United Kingdom (UK), Canada, or Australia for their one-year compulsory training, and many don’t return, leading to a growing crisis in local healthcare services. Between 1993 and 1996, 13% of doctors left Sri Lanka, and from 1997 to 2000, the figure rose to 28%. Initially, many nurses migrated to Middle Eastern countries, but, they have since shifted to the UK, Canada, and Australia due to the higher demand and salary rates in these developed nations. “Despite the extensive benefits of free education, the current economic crisis and political instability have led many healthcare professionals to prioritise personal advancement over contributing to their homeland,” Dharmasiri claims.

How does this affect healthcare in Sri Lanka?

Sri Lanka, a middle-income country, dedicates 4% of its Gross Domestic Product to healthcare and, like many other countries, faces a shortage of healthcare workers. Recently, the Ministry of Foreign Affairs has launched various programs encouraging Government professionals to migrate and earn foreign currency to help solve the country's United States Dollar crisis. The Government has extended the two-year leave period to five years to facilitate migration and has spent public funds for training health professionals, urging them to earn foreign currency and send remittances back to Sri Lanka. However, this short-sighted approach is worsening the brain drain, as most trainees don’t return when their services are needed. Sri Lanka has the highest proportion of older adults in South Asia, with 12.3% of its population aged 60 years or older. By 2030, this figure is expected to rise to over 25%. This ageing population will lead to increased retirements, reduced workforce numbers, lower productivity, and decreased tax revenue and savings. The growing demand for geriatric care services and the strain on free healthcare will require significant investment by the Ministry of Health to maintain quality care by 2030. Developed countries are actively hiring Sri Lankan nurses to work in critical care and geriatric care roles for their ageing populations, creating a pull factor for migration. While this provides international job opportunities for Sri Lankan healthcare professionals, it leaves the country with unmet needs for specialists and resources to care for its own ageing population. The Government may not be able to meet the rising healthcare costs. Additionally, many experienced healthcare professionals in specialised fields are migrating to meet the demand abroad, leading to a decline in the quality of local healthcare. As senior professionals leave due to economic burdens, only a few remain to guide junior staff. However, every profession requires senior expertise to mentor newcomers and uphold ethical standards in the professional practice, as noted in Y.A. Masau, N. Al-Sadat and A.B. Gerei's ‘Brain drain and healthcare delivery in developing countries’. The extension of the retirement age to 63 has also negatively impacted the younger generation, limiting their opportunities for promotions, training, and salary increases, Dharmasiri argues. Although the number of healthcare professionals trained each year falls short of the country’s needs, the Government has not implemented adequate measures to retain them, he further claims. “Currently, there is a severe shortage of essential drugs and medical resources throughout Sri Lanka, with the Government seeking assistance from foreign countries. At the same time, Sri Lanka is marketing its healthcare professionals overseas as a short-term solution to its foreign exchange problems. In the near future, the country may face a crisis where its most talented professionals are not contributing to its healthcare system,” Dharmasiri elaborated.

Suggestions to address brain drain

The lack of access to quality training and fewer opportunities for advanced education are key factors driving brain drain. The Government should focus on creating strategies to retain skilled professionals by offering better employment opportunities and facilities.

Both Government and private healthcare training institutions should establish clear career pathways, with competitive salaries that reward hard work, teamwork, and innovation. Rapid promotions should be available by the time individuals reach their 40s.

The quality of education, healthcare, and the economy in Sri Lanka must be improved through appropriate reforms.

“The Government should mandate reimbursement from professionals who leave the country after receiving free education,” Dharmasiri emphasised. Clear employment regulations should also be established for all healthcare workers.

Strengthening political and economic systems is crucial to discouraging emigration. The Government must enhance governance, reduce corruption, and ensure political stability.