As Sri Lanka slowly recovers from successive crises, the migration of its highly-skilled professionals such as doctors and engineers is increasingly becoming a concern.
Sri Lanka’s human capital flight, wherein educated or professional individuals depart from the country in search of better professional opportunities and higher standards of living, has become acute following its unprecedented economic crisis.
The mass exodus of working professionals is unlikely to bode well for the crisis-hit island, with most stakeholders pointing out that it spells bigger troubles ahead.
Experts point out that this wave of migration will have a detrimental effect on Sri Lanka as it will deprive the country of its skilled workers, leaving it with very few capable of developing and contributing to the economy.
According to figures released by the Sri Lanka Bureau of Foreign Employment (SLBFE), more than 300,000 Sri Lankans left the country with secured jobs overseas in 2022 – the highest in history. An SLBFE spokesperson told The Sunday Morning that a total of 172,932 individuals had migrated from 1 January until Thursday (3).
As per the Central Bank of Sri Lanka (CBSL), total departures for foreign employment increased in the first quarter of 2023, recording 76,098 departures compared to 39,445 in 2020 and 75,027 in 2022.
According to University of Peradeniya Faculty of Dental Sciences Chair Professor of Community Dentistry Prof. Dileep de Silva’s findings based on data from the University Grants Commission for 2020, the recurrent cost borne by the State to produce a doctor (five-year programme) is Rs. 4.18 million while it costs Rs. 8.62 million to produce a dental surgeon (five-year programme).
Moreover, the training of a specialist costs the State around Rs. 11-13 million. “However, this sum can vary, since those who go for non-paid jobs/attachments are paid a living allowance when they go abroad for one year. They are paid in foreign currency, so depending on the exchange rate the amount that is spent will change,” said Prof. de Silva, who is also a Specialist in Health Management and former Head of Health HR in the Ministry of Health.
As such, these doctors migrating constitutes a significant loss for the country. Prof. de Silva observed: “It’s a significant loss in terms of time because we have trained them free of charge for 13 years in the school system, another five years at the medical faculty, and another seven to eight years to become a consultant. You train them for 25 years and they leave without returning.”
While the departure of medical professionals occupies a larger share of the public consciousness, other professions such as engineering are likewise affected. According to Prof. de Silva’s calculations, it costs the State Rs. 2.24 million to produce an engineer.
Alarm bells in the health sector
The Sunday Morning spoke to Government Medical Officers’ Association (GMOA) Spokesman Dr. Chamil Wijesinghe, who said that the GMOA had issued warnings of the impact of the brain drain since last year.
“We are yet to see the worst-case scenario of this situation,” he said. “It will take about one or two years to witness the full-blown effect of this brain drain; we are still in the midst of it since it will take about a year to realise that there are no replacements for those who have left.”
According to him, among the reasons driving this mass exodus of medical specialists is the economic situation, where doctors are not receiving a sufficient salary to manage increased costs such as taxes.
“The starting salary of a consultant is Rs. 88,000. After toiling away at an MBBS and a postgraduate degree, their careers will often start in areas such as Kilinochchi or Mullaitivu. This cannot be justified.”
Outlining the other reasons prompting migration, Dr. Wijesinghe pointed to the prevailing uncertainty in the country, concerns over their children’s education, unhealthy working environments due to tax policy, etc., issues such as transport faced by those working in difficult stations, and more.
Accordingly, he noted that a significant drop had been observed in those taking part in the postgraduate selection exams. Moreover, these last few years had seen the most numbers of individuals sitting for examinations required for practising medicine overseas.
Sri Lanka Medical Association (SLMA) President Dr. Vinya Ariyaratne expounded on the gravity of the migration of doctors, although precise statistics were unavailable.
“No one is able to give a correct picture because the Health Ministry is also unable to give the numbers. However, what can be said is that this is a serious issue. There are certain specialities and subspecialties where the numbers are anyway very low, such as paediatric nephrologists. We are facing an acute shortage in specialised categories. The referral system is also not functioning because specialists aren’t available.”
Dr. Ariyaratne noted that this was a problem that had been exacerbated by the crisis: “Even before the crisis, we had a maldistribution of doctors, with specialists being more concentrated in urban areas, etc. This has become aggravated now. However, it is not just the financial issues, but the working conditions as well. Those doctors who opt to stay back are frustrated due to the shortage of drugs since they can’t perform routine surgeries and patients are also inconvenienced.
“Some problems have always been there, but with the present situation, there are more push factors for doctors and other allied health staff to leave. This needs to be addressed; it’s the collective responsibility of all, including the SLMA and professional colleges. The Government should also look into ways to retain these doctors.”
Dr. Ariyaratne further pointed to the World Health Organization’s ‘Code of Practice on the International Recruitment of Health Personnel,’ which categorically discourages active international recruitment from countries already facing shortages of healthcare workers.
Terming the present situation as an “exodus” of medical personnel, he said: “Certain countries have used this international understanding to bar medical staff from leaving and readily getting employment in other countries, particularly in the West. However, some of these medical staff go for jobs where the qualification requirements are less [than their status] out of desperation.”
Settling for less
While these highly-skilled and trained professionals depart seeking greener pastures abroad, the reality is that they often have to settle for less.
As Prof. Dileep de Silva noted: “These doctors who migrate are going into a situation of underemployment, meaning a position which requires far less skills than what they were trained for. For instance, our consultants go as locum consultants, where they are given a job only for a year, after which they have to find another job.”
Another significant “trigger” which may have added to the wave of migration, Dr. Ariyaratne believes, is the Government’s public administration circular issued allowing five years of leave without pay for public officers in Sri Lanka looking to go abroad for foreign employment, with no prejudice to their seniority or pensions.
“The most qualified people will leave first, because it is beneficial for them. They know they can return after several years and enjoy all retirement benefits.”
Public service in trouble
Meanwhile, Point Pedro Institute of Development (PPID) Development Economist Dr. Muttukrishna Sarvananthan noted that the migration of professionals was natural in a country with such a debilitating economic crisis, especially with the Government’s five-year no-pay leave plan. However, he pointed out that with the departure of qualified professionals, Sri Lanka’s public service would deteriorate.
“In the future, our public service will be even more corrupt and inefficient as a result,” he said, noting that the Government should have instituted measures to ensure that higher level professionals could not take advantage of the process while lower level employees, of whom there was a surplus, were able to leave.
Losing significant numbers of the health workforce will also affect service delivery. Even prior to the crisis, Sri Lanka has faced significant inequities in the distribution of healthcare workers, especially vis-à-vis urban and rural areas. Accordingly, the impact of migration will invariably have a disproportionate impact on the peripheries of the health system.
“Peripheral hospitals and even the teaching hospitals outside Colombo are significantly affected,” Dr. Ariyaratne said, noting that there was a shortage of specialists in district general hospitals and teaching hospitals.
Prof. Dileep de Silva revealed that since 2021 to date, around 10% of consultants have migrated.
“At present, about 220 consultants have migrated, along with a large number of specialist trainees. This is roughly about 10% of the total number of consultants, which is 2,300,” he noted.
He explained that there was already a loss of about 10-12% from among those who went abroad for postgraduate training in medicine. “In order to become board-certified as a consultant, they are sent abroad for a mandatory training of one year. Over the last 10-15 years prior to the crisis, only about 88 out of 100 returned, which is a 12% drop,” he said, noting that this drop was much greater post-crisis.
However, he noted that the system was still able to withstand the turbulence it was undergoing. “Health training is a capital expenditure, which is a long-term process, therefore it will take a longer time to stabilise the system should there be turbulence such as doctors leaving.”
Fortunately, however, Sri Lanka’s healthcare system is still able to manage as things are yet to arrive at a threshold of destabilisation, Prof. de Silva explained. He assured that the departures would plateau within the next four months or so, following which the numbers would start declining.
However, Prof. de Silva pointed out a potential concern in the migration patterns which could destabilise the healthcare sector – the ongoing feminisation of Sri Lanka’s healthcare system.
According to his findings, by 2030, 74% of medical school students will be women. Should women migrate, however, they are unlikely to return, due to cultural factors which lead to them being followed by their family. However, if a man migrates, there is a higher likelihood of him returning after earning, the study finds.
Meanwhile, the impact of the brain drain on other sought-after professions is also being felt, although the potential impact does not appear to be immediately apparent.
Speaking to The Sunday Morning, Chamber of Construction Industry of Sri Lanka (CCI) Immediate Past President Eng. Maj. Ranjith Gunatilleke said that the brain drain of engineers could be attributed to the push and pull theory.
“As per this theory, the country is pushing engineers out, while at the same time other countries are pulling them in. The push factors for engineers in Sri Lanka include non-availability of employment, underemployment, wherein engineers are poorly compensated, lack of indirect benefits such as housing, etc., and corruption.
“When it comes to pull factors, one is that almost all countries that engineers migrate to have less or no corruption. In addition, they have the option of better education for their children and high salaries. However, the family members in the country could constitute a pull factor to remain in Sri Lanka.”
However, Gunatilleke noted that despite these circumstances, the construction industry was not affected by the migration of engineers. “We have an oversupply of engineers in this country. Moreover, at the moment the country’s requirement is also minimal, since the Government has declared that there are no funds for capital development, meaning no infrastructure or building development is taking place. Yet, universities continue to supply engineers.”
He further stressed that although this was an important issue, the gravity of the situation was not immediately apparent unlike in the medical sector.
While Sri Lanka continues to lose its trained professionals due to shortages, inflation, and uncertainty, this exerts an additional strain on an already struggling State mechanism which will no longer see its investments into the country’s human capital materialise.
Reducing the country’s brain drain will require an approach that creates opportunities for skilled professionals to remain and contribute to the country’s development, especially as the State cannot afford to invest its already thin resources into diminishing returns.