The Foreign Placement Coordinating Centre in Sri Lanka
Author: Dr A De Silva, Dr T De Silva,Dr Kumalatilake , Dr Pradep
Country: Sri Lanka
Migration of health workers contributes to the shortage of healthcare workers in developing countries since most migrate from developing to developed countries, which jeopardizes the provision of quality healthcare in these countries. The government of Sri Lanka has identified this as a problem and has created measures to address it.
The Foreign Placement Coordinating Centre (FPCC) was initiated with the objective of arranging foreign placements for specialists, non-specialist medical officers and postgraduate trainees. The main objectives of the FPCC are to find placement for Sri Lankan doctors at overseas medical institutions in the context of a “knowledge economy” to:
- conduct medical expert exchange programmes to facilitate international collaboration and research activities,
- expose local medical professional to the advancement of medical science achieved by other nations, and facilitate further postgraduate training for Sri Lankan doctors.
In Sri Lanka the main measure to bring back postgraduate trainees is the bond, which is a contract they sign with the government of Sri Lanka guaranteeing their return upon completing their foreign training. Two witnesses sign to state that they will pay the trainee’s cost of training if they do not come back. The trainee will work for the government for 4 years for each year abroad. If the trainee leaves government service before the bond service period is over they will have to settle the bond. Active measures to purse legal action for those who have left before completion of the bond period has helped to recover the money spent for the overseas training of these specialists. However other measures such as allowing private practice, pension schemes and provision of living facilities may also be helpful in retaining specialist medical officers. FPCC is a novel concept to promote temporary migration while retaining the required human resources in-country.
In the two years since the start of FPCC, four countries have been approached to participate and all four have agreed to participate. They have signed a memorandum of understanding with the government of Sri Lanka for the FPCC. The medical officers who have registered with the FPCC were directed to the countries which they requested.
From the inception of the Postgraduate Institute of Medicine PGIM in 1980 to June 2009, a total of 1,915 specialists were trained and Board Certified as Consultants. Out of the above, 215 (11.2%) postgraduate trainees have not returned after foreign training or have left the country without completing the specified bond period. The total bond value of these specialists who have left without completion of the bond period was approximately Rs. 215,475,884.76 (US$ 1,958,871). Among those who have left before completion of the bond period, 148 (68.8%) have settled or started settling the bond. A further 67 (3.4%), of the total trained will be liable via legal action for the outstanding value of the bond. The total amount due from these individuals (since 1980) is Rs. 97,659,002.70 (US$ 887,809).
The bond has assisted with the retention of skilled medical professionals in the country; also, the low numbers of bond defaulters are testament to its efficacy. The FPCC has, in its 2 years of existence managed to send participants to their training destinations of choice which is a promising start from the program.