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The consequences of poor access and quality of healthcare services in developing countries are widely recognised by international agencies such as WHO.1 Moreover, with the HIV/AIDS pandemic wreaking havoc in sub-Saharan Africa, availability of trained physicians is essential for providing antiretroviral treatment to large numbers of individuals.2 Owing to emigration of physicians and nurses from developing countries, WHO has suggested codes for recruitment of health personnel by developed countries.3 The biomedical and social science issues surrounding the benefits of healthcare uptake for health outcomes are complex. It is therefore puzzling that Javier Hidalgo in his article4 dismisses the need for meticulous health policy formulation. Instead, he contrives a ‘defence’ for the practice of recruitment of healthcare workers by developed countries through a misleading interpretation of the evidence from country-level data presented by Bhargava and Docquier.5 It would be useful to proceed by outlining some methodological difficulties in investigating the links between physician emigration and population health outcomes.
Some methodological issues in assessing impact of physician emigration on health outcomes
The use of healthcare services is ubiquitous in most societies and is concentrated among pregnant women and infants, children and adults suffering from infectious diseases, and adults with chronic diseases. It is, however, difficult to assess the benefits of timeliness and quality of healthcare services on health outcomes without elaborate data following individuals over several years. Because such data are seldom available, it is necessary to investigate the impact of physician emigration on health outcomes in developing countries using alternative approaches. For example, physician emigration is likely to lead to an attrition of the most qualified personnel thereby lowering quality of services; basic healthcare services may be denied in rural areas where working conditions are unattractive due to a lack of amenities such as electricity.
The evidence on adverse effects of physician emigration on health outcomes is likely …
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