The departure of trained professionals from poorer countries is conventionally described as a .
The carries an assumption that deserves examination rather than repetition.
It assumes that the training would have produced the same output had the person stayed.
In several documented cases that assumption fails, because the domestic system could not employ the graduates it produced.
complicate the accounting further and are frequently larger than the cost of the training.
A doctor abroad may fund the education of four siblings at home.
The prospect of emigration also raises , since more people train than eventually leave.
Economists call this the , and its size varies enormously by profession and by country.
None of this holds for health workers in the poorest systems, where the departure is simply a loss.
A country training nurses at public expense for a wealthier country's hospitals is that country.
Codes of practice discourage active recruitment from listed countries, and compliance is voluntary and partial.
agreements that fund training in exchange for a defined period of service have worked better.
They are also politically awkward, since they attach a condition to a person's movement.
The deeper policy question is rarely reached in public argument.
People leave systems that are badly funded, badly managed and professionally .
Salary matters less than the absence of equipment, supervision and any prospect of advancement.
Retention policies that address only pay therefore fail in a pattern that is documented and repeated.
A profession that cannot be practised well is not retained by being paid slightly better.