Africa’s brain drain

on May 27, 2005
Category: Immigration Europe, Africa

A worrying story in today’s Independent as once again Africa’s precious resources are being exploited by the West. This time it is human resources as

"rich countries of the West are systematically stripping the developing world of their doctors and nurses in one of the worst acts of global exploitation in modern times"

The story focuses on Ghana (but it is happening throughout the continent) where medical staff have been "lured" away to work in the US and Britain thereby crippling Ghana’s health service.

Its training school turns out almost 100 nurses a year - to be sucked up by the West, lured by the ten-fold salaries. Almost 1,000 nurses and 150 doctors have left Ghana for the UK in the past six years, and the flow is accelerating. Hundreds more have gone to the US, Australia and other countries in a mass migration fuelled by the worldwide demand for medical staff.

According to the Lancet more than 30% of doctors and nurses in the UK were trained outside the country. This compares with France and Germany where the figure is only 5%. Half of the 16,000 medical staff recruited in Britain come from outside of Europe. In Ghana the entire class of 2001 medical students have left or are preparing to leave the country. A top consultant in Ghana earns £7,500 a year and a nurse £2,000. In Britain and elsewhere in the West their salaries would be 10 times higher. Even allowing for the difference in cost of living, it is easy to see why so many are tempted to emigrate.

The point is that the loss of large numbers of medical staff is compromising local health care provision. And it is not just medical professions who are leaving. Thousands of highly skilled professionals emigrate every year after completing their education in their home countries. The numbers of those leaving has risen steadily over the past 30 years and is now estimated to be on average 20,000 per year.

Some countries are trying to at least introduce some sort of regulations around brain drain whilst others are trying initiatives to reverse the trend. South Africa is
trying to reduce the numbers of teachers leaving annually by working
with the Commonwealth Group on Teacher Recruitment which is developing
guidelines on how teachers are recruited including non-discriminatory
recruitment (race and gender) and outlawing the exclusion on the basis
of HIV status. Also in SA The IOM (International Organisation of Migration) has introduced a scheme "Migration for Development" "aimed at bringing diaspora skills and capital back to the region in order to promote sustainable development." The programme will allow Africans working abroad to contribute to development at home without having to give up their Western salaries and will involve three possibilities. Temporary return, virtual return and economic return.

Under the temporary return programme, a qualified and experienced Zambian doctor working in Canada, for example, would be assisted to return home to teach, perform operations or share skills for a finite period. Virtual return involves skill-sharing, teaching, mentoring and even marking exam papers via the Internet.

Eritrea is considering introducing a series of schemes aimed at "encouraging" those sent abroad for training to return home. For example, introducing a $15,000 bond to guarantee return, withholding qualifications until return and sending students to "less attractive" countries to study rather than US or Europe. I am not sure if these schemes have actually be introduced and if so whether they are actually working. I fully understand the rationale behind the schemes but am not sure that this is the best way to go.

On a positive note it should be remembered that remittances from Africans living in the West to their home countries is billions of US$ ($75 billion globally which is larger than foreign investment or aid.) For example in Uganda remittances exceed national income from coffee and is more than gold and cocoa in Ghana. These remittances do not totally compensate for the loss of highly skilled professionals especially doctors and nurses but they do go a long way to ease the burden on family at home working like an informal social security system. Unlike aid, remittances sent home are targeted to meet the needs of individuals and families and the monies are used more efficiently and there is no middle person or corrupt official to steal away the funds.

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15 Comments so far

1. Brian

May 27th, 2005 at 3:53 pm

It’s tricky. I totally agree with you that brain drain is a huge problem for Africa. On the other hand, considering the lamentable state of many universities, medical facilities and other ‘brain-related’ infrastructure in many parts of Africa, is it any wonder that professionals want to go somewhere they can actually practice their profession in reasonable conditions?

As I said, I totally agree with you. The question is how to fix it. The Eritrea bond idea is interesting. But like I said, I think governments need to focus on building and MAINTAINING good infrastructure. I’d be willing to bet that many African professionals would be willing to accept a smaller salary in order to remain in their home country provided they were assured decent working conditions.

2. Kima

May 28th, 2005 at 6:36 pm

In 2004, Kenyans abroad, just as an example, remitted at least $600 million to their friends and relatives through official channels such as Western Union. This is only the tip of the ice-berg as a lot more money is sent through other channels. When people call for the governments that have made peoples lives in Kenya untenable and thus forced them to seek greener pastures abroad to be responsible for regulating and “encouraging” less ‘brain drain’ I am forced to laugh bitterly. The Kenyan state routinely devalues and destroys peoples’ initiative - with its high taxes, stealing and enmity to the small business person - such that it acts more like a colonial state than a democratic one. People have to leave. My mother was a nurse in the UK for 9 years. It is how my siblings got an education, my grandmother’s farm was bought, several nieces and nephews were schooled, funerals paid for, HIV medicines bought and businesses started. Is that a brain drain or would you rather she is earning $150 a month at a hospital that requires you to give a bribe to get good care. I am tired of this brain drain argument. It belongs to people in donor and NGO conferences, it is relentlessly statist - never choosing to appreciate that people’s lives belong to them - and it ignores reason. And if the response to this comment is that African governments paid for the training of health professionals so that these people ‘owe’ something to the system, this is my response: it was never government money but rather belonged to the people. Those who’ve gone abroad as professionals have often worked at home for years and sometimes decades before deciding to move on. They have paid their share in taxes and professional contributions. Finally: the brain drain argument is beloved by a kind of middle class paternalism that is of the opinion that without them everything will fall apart - it is nonsense of the worst kind. Sorry for the long comment, but I was just hoping to take this discussion in a slightly different direction.
Regards.

3. american black

May 28th, 2005 at 7:32 pm

AB Four (Prince, Babies, And A Solution To The Mississippi Problem)

We all know about Africa’s precious resources are being exploited

4. Clair

May 28th, 2005 at 7:41 pm

I live in East Sussex UK where we have a very high proportion of elderly retired people so our health services are fully stretched relatively speaking. Yesterday I went to my GP with what I thought was a minor eye irritation. That was at 12.00 noon. At 16.00 I was being seen by an eye specialist at Eastbourne General Hospital. The eye specialist was from Tamil Nadu. Ths is health care that would be universally acknowleged as first class. In fact it is free to the user. But what is the hidden cost and what proportion of the world has access to this this kind of medical care?

5. owukori

May 28th, 2005 at 8:11 pm

Kima - I completely agree with everything you say. I know many Nigerians who have supported whole families through education, housing and healthcare by remittances sent home including my own family. I also compeltely agree with you that our “home” countries devalue professionals and the work they do. My brother and cousin both went home as architects. They both found that their fellow citizens constantly undervalued their work and would in fact rather pay an expatriate three times as much than even employ their services. In the end they both returned to the UK where they have worked successfully ever since AND been able to support family at home.

The post I made was just reporting the facts. You should note that I mentioned that remittances were the social security system that African countries do not have and unlike aid, remittances are targeted to individual needs and projects such as the farm for your family and so on. My closest friends daughters support their mother who has worked as a nurse for over 30 years and has nothing to show for it. Through their remittances they have been able to set her up in a nursing agency, refurbish her house so now she has a decent place to live, her health needs are taken care of and now she has her own transport so does not have to go to work on a motorcycle taxi speeds its way through the streets of Lagos.

It is also a fact that healthcare in most if not all African countries is in a critical state and the loss of medical professionals can only add to the further disintegration of healthcare. So even if we are able to send money home what good is it if there are no doctors to treat patients?

However the onus is not on the doctors and nurses to choose to stay or leave. It is on the governments to provide these professionals with decent salaries and working environments so they will not leave in the first place.

6. Kimani

May 28th, 2005 at 9:12 pm

Owukori,
we are in agreement. I just wrote a post on my blog which you can take a look at and will try and get it into a newspaper this coming week. The health system in Africa it is true is in a crisis. In Kenya however, most people are getting their care from private clinics which are often quite bad. The health profesional will stay - they want to desperately - if they are given further opportunities to set themselves up independently without all the problems the government put in their path. The salaries are bad because an inordinate amount of tax money is used to pay for bloated bureacracies that extend patronage. The people have too little money because the state is determined to manage every last bit of the economy. Of course doctors and nurses should stay, and they want to. So whose fault is it? Not the patients and the carers, it is the middle man: our governments.

7. clarius ugwuoha

May 28th, 2005 at 11:33 pm

We cannot expect any better of the situation. The pool of emmigrants would otherwise have been wasted in their ‘third world’ countries, as jobless, under-equipped practitioners or outright societal misfits. The massive brain drain, a form of neo colonialisation, is a sad and sordid reality that has to be reversed, not by fiats or edits but by masses-oriented and economy-friendly policies.

8. owukori

May 29th, 2005 at 3:46 pm

The Guardian reports (African research angers lecturers) on a TUC (Trade Union Congress) and government funded study into the effects of the “brain drain” on higher education in developing countries. The teachers unions, Nafthe and AUT are calling for the government to restrict Black Africans from taking up jobs in British universities and colleges.

“The Natfhe report calls for a new restrictive protocol on the recruitment of academics. It says: “Protocols should include minimum acceptable standards and ensure that collective bargaining and the relative position of academic labour in the UK is not disadvantaged by international recruitment.”

AFrican lecturers are quite rightly accusing the government and the trade unions of

“using their benign concern about the brain drain as a cover for “a racist, discriminatory policy” against skilled black Africans”.

9. Ms. World

May 29th, 2005 at 4:08 pm

Great post! I’m still formulating ideas about it. Thanks so much for keeping me informed.

10. Alex

June 29th, 2005 at 5:21 pm

Owukori draws attention to a discussion paper that I wrote for AUT/Natfhe which has attracted some very negative comment from people who chose to read one paragraph out of the 70-some pages in the report completely out of context. In fact the report is largely concerned with the circular problem of underdevelopment - a term I am not entirely comfortable with and elsewhere am critical of - which is the cause of skilled migration as people make rational choices to employ their skills where they can be put to use. In fact then my report is fully in line with the comments that you yourself make. It also concentrates heavilly on the remmittance issue, which it argues is problematic rather than insignificant - ie yes the scale of remmittances is staggering and more than aid, but accrues unequally and from an economics point of view can have undesired effects on national economic development (ie import dependency etc). However, this is presented as a highly complex issue and one of my suggestions was to look at ways that remmittances could be channelled to the sort of developmentally orietnted uses you highlight.

Finally, the report is clear that the UK (read wider developed world) benefits massively from skilled migration from developing countries, and that developed economies are seeking to gain further by designing differentiated immigration policies to attract the skilled (and this is associated with neo-colonialism) while rejecting others - who in fact might have a greater NEED to migrate. This criticism is though muted as the aim of the document was to inform lobbying with govt, who would not necessarilly listen to a rant against existing policy. The point is though that it was in no way part of the sort of immigration agenda that those who have criticised the work have tried to claim it is. In fact, the report also makes clear that the UK HE system needs immigration to fill skills gaps and that existing levels of immigration from the least developed countries are insignificant in terms of teh scale of the UK labour force, though not necessarilly in terms of developing country labour forces.

Not sure why I bothether to contribute to this list but I did think it worth putting the record straight.

11. owukori

June 29th, 2005 at 10:09 pm

I assume you are referring to my last comment on the Guardian reports rather than the intial post? However I am not sure what exactly you are trying to say here? Your report may well be 70 pages long but if only one two or three paragraphs refer to the Guardian report then I stand and I believe so too would the African lecturers by the final paragraph

“AFrican lecturers are quite rightly accusing the government and the trade unions of “using their benign concern about the brain drain as a cover for “a racist, discriminatory policy” against skilled black Africans”.

With regard to remittances why is it that people always assume that they consist simply of monies sent to individuals or families. Much of the remittances monies are actually used for start up busineses, such as factories, farms, shops, professional services, services and so on thus creating jobs and having a positive affect on the local economy. I personally know of many such businesses in Nigeria alone. Another example is the Moroccan town of Beni Mellal in the central Middle Atlas which I visited just two months ago. The town is prosperous and booming all due to the remittances sent home by its citizens mainly in Italy but a few in Spain over the past 15 years.

12. imnakoya

June 30th, 2005 at 1:52 am

I’m a little late jumping in, but I will regardless. Yes, the government has a role to play in all this. But what is the role of the private sector? Check out India, the country is palgued with a lot of problems like many African nations, however, they have been able to entice foreigners to come to India for medical treatment, at a cheaper cost and yet make impressive profit. See my post Medical Tourism in Nigeria http://grandioseparlor.blogspot.com/2005/06/medical-tourism-in-nigeria.html
You may also read: The Fortune at the Bottom of the Pyramid By CK Prahalad.
It is unfortunate that we can no longer expect the government to do everything, in fact this is no longer feasible in some parts of Africa.

13. owukori

June 30th, 2005 at 10:57 am

Yes it is true that India has managed to create a lucrative medical tourist industry. It is just a shame that it has not been able to provide adequate medical care for the majority of its citizens. Furthermore it is also a fact that organs sales are rampant in India whereby the poor are encourage to sell their organs (generally kidneys). Now who buys these organs? Israelis are apparently the number one purchasers of Indian organs followed by other Western nations. Funny how things go!

14. alex

June 30th, 2005 at 11:07 am

Ok, this is my last attempt at this, as replying to people that haven’t actually read what I wrote is starting to eat up a lot of time.

The point I was making is that the paragraph in question was taken totally out of context - in the rest of the report remmittances are considered, the reasons for migration are considered etc etc, the whole issue is presented as highly complex. Also restrictions on migration are rejected out of hand and a range of measures, including reparations from rich to developing countries (and explicitly not a tax on migrant labour), measures to increase the useful contribution of remittances, measures to increase international research networks, to share (on non-commercial terms) teaching materials and access to research facilities, to promote exchanges etc etc are all also suggested as areas for debate. In fact all the suggestions are not policy reccomendations but suggestions for debate. Conveniently the person that was quoted in the Guardian chose not to mention these things, leading in my opinion to a gross misrepresentation of the actuality, the tone and the argument of the whole report.

The point about protocols is not raised in the report as protectionism other than expansive protectionism of everyone, and trade unions standing in solidarity. Other suggestions include supporting the upholding of core labour standards, of mutual trade union recognition agreements, and supporting developing country trade unions through sharing membership fees etc. All this comes from a secondary review (i was never asked or given the resources to conduct primary research - the whole thing was ten days work) of literature produced mainly by African academics writing on the issue - look at the websites in SA and Zimbabwe in particular.

It is also explicitly stated that the numbers of foriegn nationals woirking in UK HE are insignificant in terms of the UK labour market - and that UK HE needs these workers, because of skills gaps in HE and an ageing workforce. The whole thrust of the report is that the UK benefits enormously from skilled (and indeed other migration). Protocols are suggested for debate as a means of leverage to try to enhance the benefits that could accrue to developing countries from the ‘brain drain’. I now recognise that this paragraph can be taken out of context and substantially misinterpreted - this is what the Guardian column does, and this is what I object to. As such that paragraph has been redrafted to ensure full clarity and that it cannot be taken out of context and misrepresented. However, the basic point is that the report was never about “a racist, discriminatory policy” against skilled black Africans”" as you say. It was about international solidarity and reflecting the concerns raised by African trade unions through Education International.

As I say, I have no intention of carrying on this debate as it seems clear that there is no way of making somebody believe the intentions behind the report and the material in it, if this is not what they want/choose to hear. However, (not that I suppose it matters) I would though point out that I find it absolutely objectionable/offensive/hurtful to be misrepresented in this way when such views are completely opposite to my own. I also think that it is highly dangerous to jump on anything that mentions migration and label it as right wing and racist - this risks vacating all that ground to the right - something that posts higher up in this thread seem not to want.

Finally, I think we are on the same side(!), and it is an enormous shame that unity in opposition to the racists who comment regularly on migration issues is fractured in this way.