The emigration of highly trained and qualified people from their home country – also known as “brain drain” – continues to negatively impact diagnostics in low- and middle-income countries (LMICs). Alongside already pressing concerns of limited access to essential services, laboratory professionals in LMICs are struggling to manage increasing caseloads.
Here, we speak with Sipho Kenneth Dlamini, Associate Professor of Infectious Diseases at the University of Cape Town, South Africa, about the importance of tackling brain drain before it’s too late.
Images for collage sourced from Adobe Stock
How would you describe the current landscape of diagnostic capacity in LMICs?
Diagnostic capacity in LMICs is currently too limited to meet the health needs of their populations. Access to testing is poor, and diagnostic systems are often underfunded and unsupported. As a result, infrastructure is weak, leading to serious gaps in healthcare. This contributes to health inequalities both within and between countries. The COVID-19 pandemic made these problems even more visible from a diagnostic point of view.
How does the limited number of trained pathologists in LMICs affect core diagnostic services?
Shortages of trained healthcare workers leads to delays in diagnosis and treatment, which harms patient care and health outcomes. For example, limited diagnostic capacity makes it harder to effectively treat diseases like tuberculosis. It also weakens antimicrobial stewardship programs, which rely on diagnostics to fight antimicrobial resistance (AMR). Other conditions affected include HIV, malaria, cancer, and chronic illnesses like heart and kidney disease.
Many programs aim to train pathologists and laboratory professionals in LMICs. In your view, how successful have these efforts been in retaining talent locally?
According to published reports and the 2023 World Health Assembly, many countries have committed to improving diagnostic capacity. However, progress has been slow and varies by country due to different challenges. Some nations have made strides by creating national strategies, updating regulations, and adopting new technologies. Still, access and affordability remain major issues in LMICs.
These efforts can help retain skilled professionals, but the reasons people leave their countries are complex. A safe and supportive work environment is important, but so are broader social factors – such as quality of life and political stability – which are often key reasons for migration.
What are the primary drivers of brain drain in pathology and lab medicine?
Several key factors drive challenges in pathology and laboratory medicine:
Economic: low pay, unstable economies, and limited job opportunities
Professional: outdated infrastructure, lack of research support, burnout, and poor leadership
Social: desire for better living conditions, social unrest, and lack of professional recognition
Workplace: unsafe environments, harassment, and fear of malpractice
External pressures: active recruitment from other countries and better training or career opportunities abroad
At ESCMID Global 2025, you suggested the term “brain drain” is unhelpful – could you expand on this?
I believe we need to rethink the term brain drain because it carries a negative message. It suggests that only the most talented people leave a country, while those who stay are somehow less capable. This label isn’t used when unskilled workers migrate, nor is it applied when skilled professionals move from high-income to low-income countries. So the term can be misleading and unfair.
To what extent does international collaboration – such as fellowships or exchange programs – help to alleviate brain drain?
International partnerships that aim to improve training and reduce brain drain are helpful but often have limited impact. They can’t solve deeper problems like weak healthcare funding, economic instability, or inflation. There are also not enough training spots or fellowships to meet the demand.
For these programs to succeed, all stakeholders need to work together. Too often, exchanges or fellowships happen in isolation and focus only on the individual – not on the system they’ll return to. As a result, many professionals gain valuable skills abroad but can’t apply them at home due to poor infrastructure and lack of support.
What advice would you give to a young pathologist from an LMIC who is eager to pursue advanced training abroad but also wants to give back to their home country?
It’s important to encourage young people to pursue advanced training abroad, especially if it’s not available in their home country. Ideally, they should talk to local health leaders – at the institutional, district, or national level – before they go. This can help ensure there’s some infrastructure in place to support their skills when they return. Planning ahead in this way makes it more likely that their training will lead to lasting, meaningful improvements in healthcare for their country.
Do you think digital pathology, AI, and remote diagnostics could help address some of the workforce shortages in LMICs – or do they risk widening the gap further?
I believe technology is valuable and should be embraced – it’s a key tool that can help meet health needs in LMICs, especially where there are shortages of healthcare workers.
In your opinion, what would a sustainable, context-sensitive solution to diagnostic workforce development in LMICs look like?
In my ESCMID Global talk, my main message was to highlight that the global health workforce should be seen as a shared resource. Everyone benefits when healthcare workers are distributed more fairly around the world. Training and developing healthcare workers shouldn’t be the responsibility of individual countries alone. Instead, we should explore global training models that support workforce sharing across borders.
My concern is that if we stick with the current system, LMICs will continue to fall behind. They often lack the resources to train or keep highly skilled workers and can’t compete with wealthier countries. Sometimes, high-income countries find it cheaper to recruit workers from poorer countries rather than invest in training locally. This can lead to serious shortages in the countries that are losing workers.
That said, LMICs also have an important role to play. They need to follow through on the commitments they’ve made – especially those focused on expanding access to diagnostics and developing the health workforce. This includes improving working conditions, investing in diagnostic infrastructure, and making sure diagnostic services are well integrated into health systems. Regional and cross-country collaborations to build diagnostic capacity are already happening, and these efforts should be supported and expanded.
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