Stemming the Brain Drain of Medical Graduates From Developing Countries: Controversies and Solutions

Brain drain is a term used to describe the migration of highly skilled or educated people from their home country to other locations across the world. One of the existing strategies to combat the brain drain of medical students and graduates from poorer countries is the practice of conditional or bonded scholarships. Conditional scholarships have been relatively successful in stemming brain drain and have been implemented all over the world, even in developed nations such as the USA, Kuwait, and Australia, although this perspective focuses on Nepal and Malaysia as developing countries. While bonding has proven to be effective in reducing the emigration of medical graduates from poorer to wealthier countries, it is not a perfect solution. In this policy review we argue on ethical grounds that it may not be truly justifiable to limit the freedom of movement of medical graduates. Another problem associated with bonding schemes is that they further widen the gap between rich and poor in developing nations. Most countries that implement this compulsory service following graduation allow a means to escape the bond through monetary payments, which may be equivalent to the cost of their undergraduate medical education. The problem arises when wealthier graduates can pay this cost and emigrate to countries with better resources, salaries, and opportunities, while poorer students remain in their home countries. An analysis of the factors that push medical graduates away from their home countries and pull them to countries abroad is provided.