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Globalization and health worker crisis: what do wealth-effects tell us?

Asongu Simplice (Research Department, African Governance and Development Institute, Yaoundé, Cameroon)

International Journal of Social Economics

ISSN: 0306-8293

Article publication date: 25 November 2014




Owing to lack of relevant data on health human resource (HHR) migration, the empirical dimension of the health-worker crisis debate has remained void despite abundant theoretical literature. A health worker crisis is growing in the world. Shortages in health professionals are reaching staggering levels in many parts of the globe. The paper aims to discuss these issues.


A quantile regression approach is used to examine the determinants of health-worker emigration throughout the conditional distributions of health-worker emigration. This provides an investigation of the determinants when existing emigrations levels matter. The author assesses the determinants of emigration in the health sector through-out the conditional distribution of HHR emigration.


The findings have been presented in two main strands: when existing emigration levels are low and when existing emigration levels are high. In the former case (when existing emigration levels are low), wealth-effects have the following implications. First, while economic prosperity is a good tool against nurse brain drain in middle income countries (MICs), health expenditure is a good instrument against physician brain drain in low income countries (LICs). Second, whereas positive demographic change fuels the problem in LICs, it mitigates the issue in their MIC counterparts. Third, savings, government-effectiveness, foreign-aid and inflationary pressures only accentuate the problem for both income groups. Fourth, corruption-control becomes a vital tool for emigration-control in both income-brackets. Fifth, while trade openness mitigates physician emigration in LICs, financial openness has the opposite effect on nurse emigration. In the latter case (when existing immigration levels are high), the following conclusions have been drawn. First, While economic prosperity fights nurse emigration only in LICs, savings is a tool against physician emigration only in their MIC counterparts. Second, health expenditure and inflationary pressures are relevant tools in the battle against physician resource flight. Third, whereas, government effectiveness is an important policy measure for mitigating emigration in LICs, human development plays a similar role in MICs. Fourth, democracy, press-freedom, foreign-aid and financial openness fuel emigration in either income strata. Fifth, population growth and trade openness are important tools in the fight against brain-drain. Sixth, the HIV infection rate is a deterrent only to nurse emigration.


This paper complements existing literature by empirically investigating the World Health Organization hypothetical determinants of health-worker migration in the context of globalization when income-levels matter. In plainer terms, the work explores how the wealth of exporting countries play-out in the determinants of HHR emigration.



JEL Classifications — D60, F22, I10, J24, O15

The author is highly indebted to the editor and reviewers for constructive comments.


Simplice, A. (2014), "Globalization and health worker crisis: what do wealth-effects tell us?", International Journal of Social Economics, Vol. 41 No. 12, pp. 1243-1264.



Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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