Matter Report

Brain Drain in Developing Countries

Background and Brain Drain Facts

Overview • In 2006, the International Labour Office reported that over 77 million
people currently live and work outside their country of origin.
• Rate of skilled migration higher than 50% in 5 African countries: Cape
Verde (67.5%), Gambia (63.3%), Seychelles (55.9%), Mauritius (56.2%)
and Sierra Leone (52.5%).
– Many more have rates of over 30%. Somalia is 32.7%.
Health
• UN Economic Commission on Africa and International Organisation for
Migration reported that 20,000 Africans have emigrated each year to
high-income countries since 1990.
• In Zambia, Zimbabwe and Ghana, over 50% of recently graduated
medical students have either already emigrated or are making
arrangements to do so (while in Ghana 42% of doctors’ positions and
25% of nursing positions remain vacant).
• According to Kenya’s Health Department, only 10% of 6,000 doctors
trained in public hospitals stay.
• South Africa, after losing some 1,338 doctors to Canada in 1998, made
an appeal to Canadian health ministers to stop recruiting in their country
(because South African doctors are so well trained, they are in high
demand). Now working with UK and Canada to control emigration and be
more mutually beneficial.
• Philippines exports largest number of qualified nurses in the world. Of the
7,000 nurses who graduate each year, 70% emigrate to higher-income
countries while 30,000 positions remain unfilled in Philippines.
African education system
• Africa spends a higher percentage of their government spending on
education, relative to the rest of the world. 25% for Ghana and about 20%
for many other African countries such as Kenya and Cameroon.
• University systems in Africa usually quite meritorious between secondary
and university – often nationwide entrance exams.
– Strong focus on public universities with low tuition fees.
– Primary school is often dependent on income.

Why it happens Pull factors from receiving countries

• Increased demand in high-income countries – in lieu of training more
workers – tendency to recruit workers from other countries.
– Main ‘importers’ = UK, US, Canada, New Zealand and Australia. Now
up to 45% of doctors who practice in some Canadian provinces, such
as Saskatchewan, were trained abroad.

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 Model

– Poor human resources planning to deal with new increase.

• Aging population of high-income countries – unprecedented increase in
long-term healthcare needs and case management.
• National healthcare professionals in high-income countries also
emigrating to other countries with better conditions – eg in Canada,
doctors moving to US.
• National healthcare workers reluctant to work in rural areas or certain
areas of specialisation. In US and Canada therefore, immigrant workers
may obtain their permanent residence status in exchange for a
commitment on their part to work in remote areas
Push factors from host countries
• Better pay: a doctor or nurse in Canada can earn up to 25 times what he
or she would earn in Zambia.
• Better conditions: Host doctors have to deal with obsolete equipment,
lack of professional development opportunities, absence of security
measures.
– Corruption and nepotism reduces likelihood of promotions.
– Low salaries also mean individuals can’t take care of needs – often
workers have to supplement income with other activities (particularly
in healthcare, eg private market, illicit resale of medication). In
Cambodia, private employment represents 90% of a healthcare
worker’s income.
• For over two decades, World Bank and IMF imposed a reduction in
human-resource investment in developing countries. Policy was a failure.

Model • World Health Organisation already produced a list of countries with a

‘Human Resources for Health’ crisis due to a lack of personnel (mainly
Africa) such as Ghana, Haiti, Pakistan, PNG and Bangladesh.
• Would create a similar list for skilled workers generally.
• Would ban the provision of work visas/permanent residence by other
countries to skilled workers from these countries.

Arguments for Individual freedom

emigration • Individuals, particularly in an increasing globalised world, have the right to
exercise their freedom of movement in a way that benefits them. Those
living in host countries often face crippling poverty and bad conditions,
and as such it is only fair that, where the state has failed to provide them
with a sufficient quality of life, they are given the opportunity to improve
their own lives.
• While it is unfortunate that states invest money into education only to lose
some skilled workers overseas, this is a calculated this that states must
face, much like their provision of any other service to any other individual
who may emigrate for whatever reason.
Host countries can’t handle population
• Often, host countries simply cannot afford to look after the population
they have or to provide employment opportunities for everyone. It is a
complete misconception, therefore, to suggest that these skilled workers
would be contributing greatly to host countries if they were not to leave
[Note: need to push this strategically in debate].
• Particularly in Pacific Island nations and some countries in Africa – high
rates of unemployment. Countries like Mauritius and Kiribati actively

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 Arguments for emigration

export workers because they know they can’t provide jobs for them.
• This free flow of emigration also allows local governments to focus on
providing services to the most needy, without having to deal with such a
strong overpopulation problem.
Brain circulation
• Often workers will go for a brief period of time and then return, or
otherwise keen strong ties to their native country. Many retain dual
residency.
• Most tangible benefit is that individuals return with higher incomes and
greater spending power.
• Also return with greater training and access to more knowledge. Diffusion
of knowledge and ideas an important component of growth – as it
requires entrepreneurs and individuals able to engage in global markets
(particularly given that is where the bulk of demand will be coming from
for developing countries). Ghana, for example, has set up an academic
exchange with NYU for this purpose. Similarly, many African
independence leaders (such as Kamuzu Banda and Jomo Kenyatta)
were all part of an initial brain drain who met and strategised in the UK
and USA and then returned to fight for independence.
Economic benefits to host country
• Emigration allows small nations to break into global marketplace.
– Small island nations like Mauritius and Kiribati actively train their
workers for the global marketplace – because they don’t have much
else to export.
– Kiribati trains seafarers for the global marketplace. Being a small
island nation of approximately 100,000 and located from major
markets means job creation is difficult. Therefore export their people.
• Remittances
– Most emigrants remit a considerable portion of their wages to families
and communities back home.
– Remittances for Tonga, Samoa and Kiribati in 2005 accounted to
39%, 26% and 15% of GDP and the largest source of foreign
exchange earnings.
– Suggestion that Ghana remittances are about $400M per year – 25%
of foreign exchange earnings and similar to foreign aid receipts.
– Often used to build houses, etc, preparing for their return.
– Such a phenomenon that in many parts of Mexico, now have special
mortgage financing to migrants to enable them to complete their
houses while abroad. Mexico also reduced transaction costs for
remittances.
– Note: According to International Organisation for Migration and
International Labour Office – cash infusions don’t come close to
assuaging disastrous effects of emigration on services. Don’t replace
the initial investments made to health systems by countries of origin.
Prospect of emigration encourages individual investment in human
capital
• ‘Training and trapping’ workers may actually discourage workers from
going through the trouble of training up.
– Opportunity cost, particularly in developing nations, of a university
education is particularly large. Most students therefore go into it with
the hope of being able to earn higher incomes abroad.
– Given marginal benefit of being skilled in a developing nation is

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 Arguments against emigration

relatively slimmer (and sometimes just objectively slim), individuals

may actually just not bother if they know they will be trapped.
• This would decrease the stock of human capital in the world generally.
• Would also decrease ability of host countries to make the most of skilled
workers – by enjoying the benefits of those who decide to stay at home,
or who return home after a brief period abroad.

Arguments against Right of developing states to return on investments

emigration • On a principled level, developing governments invest a significant amount
of money into their education sector with the hope of creating much-
needed skilled workers, and as such deserve the benefit of that
investment.
• This is particularly so in nations such as those in Africa, where a
significant portion of GDP is allocated to education, and as such
constitutes a serious investment by the government.
Short term harms (eg to health system)
• Reduction in quality and quantity of skilled services being provided.
– Particularly problematic as you need a certain weight of professionals
to be able to build developed industries and attempt to grow.
• Also leads to severe shortages in important social services.
– When a Canadian institute recruited one of only two anaesthetists
from the Boxburg Centre for Spinal Injuries in Johannesburg, the
Centre had to shut down because no replacement was available.
– Many African nations are also losing university professors, which
harms their ability to train future generations.
• Creates a vicious cycle – as more workers leave, the workload becomes
worse for those who stay, which also encourages them to leave.
• In health industry, this is compounded by the AIDS crisis.
– Recent efforts to more patients on anti-retrovirals, and to manage
HIV-related diseases such as cancer and tuberculosis places
increased strain on health workers.
– Health workers also dying from AIDS themselves – HIV/AIDS is
responsible for 19% to 53% of deaths among government workers in
Southern Africa. In Zambia, the mortality rate among nurses
represents nearly 40% of losses among trained personnel.
Discourages education spending in Africa
• Training for each tertiary-educated individual is often many times GNP
per capita – usually between 2 and 3.
• Significant financial burden – estimated at least $4 billion per year in
Africa in loss of public investments.
• Creates a cycle where developing countries, whose income is scarce due
to their limited economy, are incentivised to decrease investment in their
educational structures.
• Particularly in Africa, many governments face public pressure to decrease
funding to tertiary education, as impoverished citizens recent the idea of
paying for others’ tickets to Europe or the US.
Skilled workers’ skills often go to waste in developed nations
• Individuals are often lured to developed countries with the hope of a
better future when in fact there are no jobs for them.

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 Other issues

• Problem is that gamble not only harms themselves but their nation.
Marginal benefit of skilled workers remaining in developing nation
significantly higher.
– For example, in Canada – very strict bureaucratic requirements for
immigrating doctors, which means many can’t work in their area of
specialisation. Means Canada is taking doctors from desperate
developing countries without being able to use them to even meet
their own employment needs.

Other issues Compensation instead?

• Currently no high-income country currently prepared to commit to it.
• Monetary compensation would provide developing governments with the
fair benefit of their investment whilst encouraging maximum freedom and
efficiency.
• In South Africa, in 2000, the cost of training alone was higher than the
entire amount of bilateral and multilateral aid earmarked for education.
• Arguments against:
– Host countries have no right to the benefit of their citizens.
– Receiving countries cannot be expected to pay for something they
cannot fully control or is not an active policy.
– Can you calculate loss suffered by collapse of entire health systems?
– Create moral hazard for governments to train specifically for purpose
of receiving compensation?
Alternative suggestions
• World Health Assembly in 2004 adopted resolution urging member states
to ‘establish mechanisms to mitigate the adverse impact on developing
countries of the loss of healthcare personnel through emigration’.
• Increase wages and conditions for healthcare workers in developing
countries.
– World Bank helped raise salaries in Ghana by 15% to 35%.
• Improve primary and secondary education.
– Malawi introduced remedial courses to compensate for shortcomings
of secondary education – increased annual number of medical school
applications from 20 to 60.
– In Cuba – access to health related field at uni dependent on student’s
willingness to remain in public sector for specified number of years.
• North needs to adopt more ethical recruitment practices.
– Currently, school principals and university deans in Africa receive
bonuses so that they will encourage highly skilled graduates to
emigrate to North America and Europe.
• North needs to improve own human resource programs and policies.

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