Brain Drain: Painting a
Picture for Africa

Divine Ikenwilo

ATPS SPECIAL PAPER SERIES No. 34

Published by the African Technology Policy Studies Network, P.O. Box 10081, 00100
General Post Office, Nairobi, Kenya.

© 2007 African Technology Policy Studies Network (ATPS)

PUBLISHED BY ATPS COMMUNICATIONS DEPARTMENTABOUT THE AFRICAN TECHNOLOGY POLICY STUDIES NETWORKThe African Technology Policy Studies Network (ATPS) is a multi-disciplinary network of researchers,
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European Union and the Royal Dutch Government.

Acronyms

BMJ
EU
FDI
GDP
ILO
IOM
NHS
NIDO
NYSC
OECD
UK
UN
UNO
UNECA
USA
WHO

British Medical Journal
European Union
Foreign Direct Investment
Gross Domestic ProductInternational Labour Organisation
International Organisation for Migration
National Health Service
Nigerians in the Diaspora Organisation
National Youth Service Corp
Organisation for Economic Cooperation and Development
United Kingdom
United Nations
United Nations Organization
United Nations Commission for Africa
United States of America
World Health Organization

Table of Contents

1.

Introduction

1

2.

Literature (theories of migration and causes of migration:
push-pull factors)
2.1 Human capital and life cycle migration models
2.2 Household migration models
2.3 Asymmetric information migration models
2.4 Network migration models

2
2
2
3
3

Facilitators of migration and brain drain (creating theenabling environment)

6

4.

Evidence of migration and brain drain (some statistics)

7

5.

Effects of migration and brain drain on Africa

116.

What can be done about migration and brain drain?

14

3.

References

17

Introduction

According to a United Nations estimate, by early 2005, there would be between 185 and 192 million
migrants around the world (UN, 2004). A substantial proportion of these people are Africans who havesettled in other countries and continents and among these are highly skilled health care workers andprofessionals. Research has established the link between international migration and brain drain(Adams, 2003). African doctors, qualified nurses and allied health care professionals have been
migrating in their stride to either seek training opportunities or simply to seek opportunities to practicetheir professions.
The problem of brain drain has recently been a cause for concern for most African governments andorganisations because of the apparent affects on health care service delivery, among other negative
effects. Many possible causes of brain drain have been advanced, couched in terms of push, pulland facilitating factors and other theories of migration. From real, nominal as well as perceived
wage differentials between source countries in Africa and destination countries, to non-economic,
social, political and cultural factors, the effect of globalisation, improved communication and targeted
migration, have all contributed in exacerbating the problems of the drain of African health care
professionals.
This paper revisits the causes of migration, recognises the existence of brain drain and seeks to
explore the extent of the problem, and finally proffer possible solutions to ameliorate the effects,
drawing largely from both theory and empirical work.

1

2.

Literature (theories of migration and causes of
migration: push pull factors)

Migration is a process that responds to a variety of stimuli and has a variety of consequences(Hirschman, 2005). Usually, people move from areas of labour surplus (characterised by low wages
and high unemployment) to areas of labour shortage (characterised by low unemployment and highwages). Economics-based theories of mobility have typically concentrated on micro-level
explanations of individual or household migration decisions, or macro-level theories focusing on
income or labour market differentials between source and destination countries. Economists haveproposed various models in explaining the process of movement of labour from one place to another.
Four such models of migration are worthy of note: the human capital and life cycle models, thehousehold migration models, the asymmetric information models, and the network models of
migration.
2.1 Human capital and life cycle migration models
The human capital model assumes that migration is non-permanent and that workers seek toacquire skills in foreign lands. Such acquired skills will have a long-term effect on lifetime earnings,
as the new skills will help the individual to earn more in his career or profession. This sort ofmigration will eventually have a positive effect on productivity in the long run. The individual is
assumed to make only one move in the course of a lifetime, their choice depending on location as
well as on activities. The overriding objective, like with human capital and most other forms of
migration, is to improve on lifetime earnings. A rational individual would expect to gain from moving,hence he is driven by the desire to maximise utility. For example, assuming an individual who ispresently located in Africa A would obtain the income stream yk (t) in an Organisation for Economic
Cooperation and Development (OECD) country with location E, the present value of his gain frommoving permanently to E would be;
Where cAE is the cost of moving from Africa to the OECD country, r is the discount rate and T is theindividual’s remaining years of working life.
2.2 Household migration models
This model assumes that households may be faced with more than one labour market problem andwill spread their risk by working in different labour markets; for example, the wife may be working in
Africa while the husband works abroad. The husband, working abroad, will therefore make remittances
to the family in Africa. Such remittances will undoubtedly have a major positive economic impact athome, either in terms of improving the family’s purchasing power or their investment potentials.

2

BRAIN DRAIN: PAINTING A PICTURE FOR AFRICA

3

Such remittances would also go a long way in educating the children as well as other members of
the extended family, which invariably improves their future earning potentials.
2.3 Asymmetric information migration models
The perfect market model assumes perfect information, both on the supply and demand side.
However, the market is said to fail when there is asymmetry of information. Asymmetric information
models assume that migrants know what their own skills are, but do not know what employers’ needs
are. In the same way, employers know their needs but cannot determine migrants’ skills accurately.
2.4 Network migration models
Here, migrants follow former migrants from the same source regions. For example, it is known that
Nigerian migrants from a specific part of the country tend to move to a specific part of the UnitedStates of America (USA), while migrants from another part of Nigeria tend to migrate mostly to theUnited Kingdom. In this instance, there is improved information about the destination countries,
such that potential migrants know where they are going and what to expect. This type of migration
could potentially improve employers’ knowledge, having already employed people from similarcountries or regions.
However, there are economic as well as non-economic reasons for migration, usually couched interms of push, pull and facilitating factors. We discuss the push-pull factors here as well as thefacilitating factors.
Some of the economic push pull factors are related to labour market conditions in either the source
country or destination country or both. Large-scale unemployment and underemployment in Africa issaid to be a major cause of out migration. In some cases, the few medical staff remaining within
African countries have to work more because health care facilities are understaffed. Heavy workloads
and increasing pressure on the remaining staff leads to low morale, which may eventually causesome health care professionals to leave their countries. In a number of cases in Africa, specificallyin Nigeria, qualified doctors and nurses have been known to seek jobs in other fields such as
banking and some have engaged in trading because they cannot find jobs in the medical professions,in what may be correctly termed brain waste. In 2003, Liberia (an African country) was in the Guinness
World Records as the country with the highest rate of unemployment, with 85% of its labour force notin paid employment. Generally, Africa is known to be among the countries with the highest rates of
unemployment in the world, according to the International Labour Organisation (ILO). Unemployment
figures from the ILO (in Figure 1) show that unemployment rates in sub-Saharan Africa haveconsistently been higher than the global averages since 1993 and well above averages for Asia
during the period.
On the other hand, the changing age distribution of populations in developed countries, which has
seen people living longer, has meant increasing demand for health care and qualified medical
professionals. Added to this is recent OECD estimates that the labour force in the European Union(EU) is expected to contract by 5.55% by the year 2020. A short-term solution to this increasing

ATPS SPECIAL PAPER SERIES NO. 34

4

demand is to recruit already qualified health care professionals from abroad. The United Kingdom(UK) for example, is known to recruit 30% of its NHS workforce from abroad, with a substantial
14

12

unemployment rate (%)

10

8
1993
2002
2003
6

4

2

0
World

Latin America& Caribbean

East Asia

S.E. Asia

South Asia

Mid. East & N.
AfricaS.S Africa

Transition
economies

Industrialised
economies

regions

1: Unemployment trends (1993-2003)
Source: Global trends in employment, productivity and poverty, ILO (2004-2005)

proportion of these coming from African countries. According to the Daily Mail, the UK National
Health Service (NHS) has saved an estimated £2.7 billion by recruiting medics trained overseas,rather than training home grown staff.
Real and nominal, as well as perceived differences in wages between source and destination
countries have also been blamed for the apparent migration of health care professionals from Africa.
Skilled workers are attracted to rich and booming regions (Giannetti, 2003). For example, Hamilton
and Yau (2004) report that while physicians’ monthly salaries were US$50 and US$1,242 in Sierra
Leone and South Africa respectively, their counterparts in Canada and Australia earned at least fourtimes those in South Africa.
The need to acquire skills and in some cases, to use these skills, have been known to cause
emigration of Africans. The highly skilled are more responsive to productivity differentials when
taking migration decisions (Giannetti, 2003). Some African health care professionals have trained inhighly skilled and technical professions and find it hard to be employed in their home countries. The
only option for such people is to work abroad and hope that one day they would become employablein their home countries. Other reasons that have been advanced for emigration include the paucity
or complete lack of professional support. Most health care facilities in Africa are poorly equipped

BRAIN DRAIN: PAINTING A PICTURE FOR AFRICA

5

and poorly managed, and sometimes, basic equipment like CT scans are not available. The
healthcare sector is dogged by limited organisational capacity, poor or less accommodating work
environments and unrealistic workloads, which invariably lead to low staff morale. In Malawi, forexample, the doctor-population ratio is 1:49,118 (the highest in the world), while in Uganda, one
doctor is responsible for treating 24,700 patients (The World Bank, 1994). Also Niger is reputed in the
Guinness World Records to be the country with the fewest hospital beds per population with 0.1 per
1,000 people between 1990 and 1998.
Non-economic factors instigating outward migration and brain drain from Africa include politicalinstability (which lead to wars and other forms of unrest), socio-cultural as well as religious factors.
In some African countries, it is socially acceptable to travel abroad. Some people travel abroad
simply because their neighbours or relatives have previously travelled abroad, a phenomenon which
the network migration model seeks to explain. People from French-speaking African countries havepredominantly travelled to France and other French-speaking countries in the OECD while thosefrom English-speaking African countries have migrated to the UK, USA and other English-speaking
OECD countries. Others have travelled to countries where they expect to find people of similar
cultures or religious affiliations. For example, Christians and Muslims travel to areas of religious
importance such as Israel and Saudi Arabia, where they expect to stay close to the roots of theirreligious beliefs.

3.

Facilitators of migration and brain drain(creating the enabling environment)International telephone communication has become easy. More so, improvements in transportation,
especially in air travel, have made it easier to travel between countries and between continents,
especially following the introduction of huge and faster aeroplanes like the Boeing 777 or the Airbus
A380. The Internet revolution has also made it easier for potential employers to advertise jobs as well
as for potential job seekers to access these jobs online. One of the effects of improved communicationis the fact that the world is fast becoming a global village. Globalisation also makes it easier for
people to move from place to place and consequently, labour supply becomes more geographicallymobile. Added to this is the fact that it is easier now to obtain travel visas and work permits. Most
OECD countries are engaged in targeted migration in a desperate bid to recruit much-needed
professionals from overseas. Examples of these targeted migration include the Diversity Immigrant
Visa Program (otherwise known as the Green Card lottery) in the USA, the point systems in Australia,
Canada, New Zealand and the UK, to name a few, as well as the Fresh Talents Initiative in Scotland.
African health care professionals are not left out in these targeted migrations. We present someevidence of migration and brain drain in the next section.

6

4.

Evidence of migration and braindrain (somestatistics)

The greatest problem involved with studying migration and brain drain is the paucity or complete
absence of reliable data. The issue of brain drain is a potentially politically sensitive one both for thesource country (because it opens up issues about the inadequacy of jobs and the enabling
environment to keep their nationals) and for the destination country (which is more often accused of‘poaching’ or ‘stealing’ workers from countries who have invested huge sums of money and time intraining and developing them). United Nations figures (Figure 2 and 3) showed substantial increases
in total number of migrants from various regions in Africa in 1990 and 10 years later. Migrants from
West Africa recorded the largest increases in the 10-year period. There was a substantial decreasein the number of migrants from East Africa and a slight decrease in migrants from North Africa.
Migrant populations from Southern and Central Africa increased in 2000, relative to 1990. Regarding
the proportion of the population migrating, Southern, Eastern and Western Africa recorded the highest
proportions respectively in 1990. However, in 2000, the proportion of the population of migrants in all
regions, except Western Africa, fell. More and more people from Western Africa have been leaving
the continent than from any other region in Africa, and their destinations are usually the OECD
countries. The flow of African migrants is usually to the countries that had previously colonised them.
For example, migrants from English-speaking African countries usually migrate to the UK and other
English-speaking countries, while their French-speaking counterparts usually migrate to France
and some parts of Canada. A significant proportion of these migrants are skilled and highly skilled
professionals, a large proportion of who are medical personnel. Recent evidence from the WorldBank suggests that even though the absolute number of African migrants in the OECD countries issmall compared to those from other continents, the proportion of skilled migrants from Africa to thesecountries is among the highest, relative to other continents (Figure 4). By the year 2000, there weremore skilled African migrants in the USA, than there were in the EU. For example, there were moreskilled emigrants from Nigeria than there were from any other country in Africa or from Brazil, Ukraineor the Philippines (Figure 5).
“There is a global shortage of health workers and Africa is one of the key suppliers” (IOM, 2005: 38).
It is not difficult to understand how health care professionals from the continent will fill this shortage
since Africa is reputed to be the continent with the most mobile population in the world (Curtin, 1997).
The British Medical Journal (BMJ) estimates that 23,000 health care professionals emigrate annuallyfrom Africa, a figure which the South African Institute of International Affairs corroborates (SAIIA,
2003). There are more African scientists and engineers in the USA than in Africa (IDRC). According
to the United Nations Commission for Africa (UNECA), some 127,000 highly qualified African

7

ATPS SPECIAL PAPER SERIES NO. 34

8estimated number of African migrants (1990 & 2000)
total migrants 1990

total migrants 2000

18000
16000
14000

total migrants ('000)

12000
10000
8000
6000
4000
2000
0

Southern Africa

Central Africa

Northern Africa

Western Africa

Eastern Africa

Total Africa

total migrants 1990

1454

1464

2336

4884

6087

16225

total migrants 2000

1544

1490

1945

6782

4515

16276

regionFigure 2: Estimated number of African migrants (1980-2000)
Source: Population Division, Department of Economic and Social Affairs, United Nations (2004)

African migrants in 1990 & 2000
(estimated migrants & percentage of populations)
18000

4

16000

3.5

14000

3

12000
2.5
10000
2
8000
1.5
6000
1

4000

0.5

2000

0

0
Southern Africa

Central Africa
total migrants 1990

Northern Africa
total migrants 2000

Western Africa% of pop 1990

Eastern Africa% of pop 2000

Figure 3: African migrants in 1990 & 2000
Source: Population Division, Department of Economic and Social Affairs, united Nations (2004)

Total Africa

9

BRAIN DRAIN: PAINTING A PICTURE FOR AFRICA

immigration stock in OECD countries (2000)
rate of immigration % total

rate of immigration % skilled

20
18
16

% of immigrants

14
12
10
8
6
4
2
0
Sub-SaharanAfricaAfricaAmerica

EuropeAsia

Oceania

Eastern
AfricaCentralAfricaNorthern
AfricaSouthern
AfricaWestern
AfricaregionFigure 4: Immigration stock in OECD countries (2000)
Source: Extracted from International migration, remittances and brain drain. Ozden C and Shiff M (eds.). The World Bank
2005.
share of emigrants to EU and USA (people with tertiary education, 2000)
destination E.U.

destination U.S.A.

90

80

70

share of emigrants

60

50

40

30

20

10

0
Egypt

MoroccoEthopia

Ghana

Kenya

NigeriaSouth Africa

Brazil

UkrainePhillipinescountry

Figure 5: Share of emigrants to EU and USA (people with tertiary education, 2000)
Source: extracted from International migration, remittances and brain drain. Ozden C and Schiff M (eds.). The World Bank
2005.

ATPS SPECIAL PAPER SERIES NO. 34

10

professionals left the continent between 1960 and 1989. According to the International Organisation
for Migration (IOM), over 300,000 African professionals reside outside Africa, while the continent has
been losing 20,000 professionals each year since 1990. Ethiopia, for example, lost 75% of its skilledworkforce between 1980 and 1991 (IOM).
Recent figures released by the IOM showed that between 1993 and 2002, Ghana lost 630 medical
doctors, 410 pharmacists, 87 laboratory technicians and 11,325 nurses to international migration
and brain drain (IOM, 2005). More than a quarter of foreign nurses registered in the UK in the year
1999-2000 came from South Africa (Figure 6). According to Migration Watch UK, South Africa isamong the three countries supplying the largest number of overseas nurses to the UK (the others are
The Philippines and India). Other African countries such as Nigeria, Zimbabwe, Ghana, Kenya,
Zambia and Malawi are among those countries whose qualified nurses have emigrated and havebeen practising in the UK since 1998/99. To date, Africa remains a significant source of muchneeded nurses for the UK NHS. In 2003, 43% of nurses registering in the UK, for example, were
foreign trained, compared to 10% a decade earlier (Buchan et al. 2004).

60

50

%
of 40
all
for
eig
n
nur 30ses

1998-99
1999-00
2000-01
2001-02
2002-03
2003-04
2004-0520

100South Africa

Nigeria

Zimbabwe

Ghana

Kenya
country

Figure 6: Foreign nurses in the UK (1999-2005)
Source: Nursing and Midwifery Council, UK (www.nmc-uk.org)

ZambiaMalawi

India

Philippines

5.

Effects of migration and brain drain on Africa

There is hardly any African country whose health system is not facing a crisis, not least the increasing
incidence of diseases such as HIV-Aids, malaria and other communicable diseases. Added to these
problems is the growing number of health care professionals that leave their home countries insearch of greener pastures abroad. Every country requires the collective combination of the factorsof production (land, labour, capital and enterprise) in their development efforts. For one, the problemof brain drain negatively affects labour, capital and enterprise. The United Nations (UN) opines thatemigration of African professionals is one of the greatest obstacles to Africa’s development. Emigration
leads to loss of fiscal income. For example, who will pay taxes that are required to provide funds forthe provision of basic services and infrastructure, if there are no professionals working within theircountries of origin in Africa?
The effects of brain drain are varied and mostly negative on the continent and on the individual
source countries. It leads to loss of much needed human resources and puts pressure on those who
remain. It also leads to loss of return to investment on the education of young health care professionals,
including doctors, nurses and allied health professionals. South Africa had 600 of its medical
graduates registered in New Zealand (Bundred and Levitt, 2000) and it costs South Africa an estimated
US$37 million to train these 600 medical graduates who have been lost to brain drain.
Another result of the problem of brain drain is that African countries continue to depend on loans,gifts, grants and expatriate labour from the OECD, to fill the human resources gap created by brain
drain. This costs a lot of money either in terms of paying such expatriate workers (for work that could
have been done by African professionals) or to repay loans that were secured for these purposes.
Evidence suggests that Africa employs up to 150,000 expatriate professionals at a cost of US$4
billion a year (Tebeje, 2005).
Brain drain of health care professionals leads to under provision of vital health care services and also
to immense pressures and workload demands on those who stay. A total of 38 out of 47 sub-SaharanAfrican countries fall short of the minimum World Health Organization (WHO) standard of 20
physicians per 100,000 people in the year 2000. Malawi is in the Guinness World Records as thecountry with the lowest per capita doctor population, while 1 in 5 doctors and 2 in 5 nurses from
Malawi are emigrating to the UK every year. According to the WHO, in 2000, the Zambian Medical
Council registered 800 doctors, while 1,500 were needed. The short fall was a result of brain drain.

11

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ATPS SPECIAL PAPER SERIES NO. 34

All the above-mentioned problems go further to exacerbate the problems of disease, poverty andunderdevelopment in Africa, while at the same time widening the gap in development, science andtechnology between Africa and the West.
However, recent literature makes a case for brain-drain-induced brain gain (for example, Mountford,
1997; Stark et al., 1997, 1998; Vidal, 1998; Beine et al., 2001, 2003; Stark, 2004; Stark et al., 2004;
Docquier and Rapoport, 2004;). Researchers assume that if a proportion of skilled workers migrates
and earns a higher wage abroad, the brain drain raises the expected return on education. This inturn induces additional investment in education (brain gain) in the source country, which may resultin a net brain gain, which in turn leads to increased welfare and growth, assuming that the resulting
brain gain is larger than the initial brain drain. However, based on both static partial and generalequilibrium conditions, Schiff (2005) argues that the positive net brain gain claims might be an
exaggeration and shows that a beneficial brain drain cannot take place, since a net brain loss islikely during the transition between brain drain and brain gain.
Other researchers have preferred to argue for brain drain in terms of remittances (Figure 8), (Adams,
2003; Kuznetsov, 2005; Lucas, 2005). Remittances amount to more than $75 billion a year,
representing more than 50% of total official development assistance around the world (Kuznetsov,2005). Javorcik et al. (2004) argue that increased Foreign Direct Investment (FDI) to given source
countries from the USA were the results of having skilled immigrants from those source countries.

Figure 7: Official worker remittances (real US $)Source: Adams 2003

13

BRAIN DRAIN: PAINTING A PICTURE FOR AFRICA

annual percent change in remittances & GDP (1981/83-1998/00)
16

14

12

annual % change

108
official worker remittances
GDP
6

4

2

0
East Asia

Eastern Europe &Central Asia

Latin America &Caribbean

Middle East &North Africa

South Asia

Sub-SaharanAfrica-2
regionFigure 8: Annual percent change in remittances & GDP (1981/83 – 1998/00)
Source: Adams 2003

6.

What can be done about migration and brain
drain?

Response to the problem of brain drain in Africa is varied. The following two quotes have completely
opposing views.
“For developing countries, brain drain might be a better solution than what they call brains in the drain. In poor
countries, many bright people do not have the opportunity to fully use their capacity. If persons are bright, theyshould not be stopped from using their full capacity, be it in their own country or abroad. Africans that go abroad
may return in twenty years time and help develop their continent”. Norbert Mao, MP – Uganda (Parliamentary
Network on the World Bank committee on international trade for development, February 28, 2005).
“Every rich country can afford and should aim to train as many health care workers as it needs. To poach andrely on highly skilled foreign workers from poor countries in the public sector is akin to the crime of theft”.
Editorial, The Lancet.

At the end of the day, the problem (of brain drain) is an African one, hence its up to the Africans to dosomething about it. Destination countries (like those of the OECD) are resorting to short-term solutions
to their long-term labour force needs. In most cases, African professional health care workers havemigrated voluntarily and most of them are happy to stay away from home. These migrants always
return home at intervals, basically because of family ties. It is therefore natural to start to address the
problems of brain drain by making the situation ‘right’ at home.
The first thing African governments (affected by the problem) must do is to improve monitoring,collection and dissemination of data on qualified health care professionals (both those at home andthose who migrate). Most African governments cannot readily provide information on the number of
their qualified health care professionals who have migrated. Such information will not only help inmonitoring the flow of professionals, but will also be useful in making a case against the poaching ofsuch professionals by more wealthy countries.
Its up to the governments of Africa to make economic, social and political conditions in their various
countries better. In some cases where home supply exceeds demand, the governments should beinstituting policies that favour job creation and investments, especially in the private sector. The
National Youth Service Corp (NYSC) scheme in Nigeria provides opportunities for newly qualified
Nigerian graduates to work compulsorily in the country for at least one year before they are free tomake their own career movements. This one-year national service prepares the new graduate forthe labour market and also serves to familiarise the young graduate with the local work environment

14

BRAIN DRAIN: PAINTING A PICTURE FOR AFRICA

15

and work culture. Governments should also make efforts to provide and improve enabling
environments for professional development by creating opportunities for training, as well as providing
basic infrastructure such as quality roads, electricity, and drinking water. Some level of political andsocial stability will also go a long way to reduce the problem. Some African countries have been
known to be politically unstable within the last 10 years; for example, Rwanda, Sudan, Angola, Coted’Ivoire, Sierra Leone, Liberia, and Democratic Republic of Congo.
Kuznetsov and Sabel (2005) view migration of skills as a ‘win-win’ for all countries involved, from aperspective of new industrial policy, making use of open migration chains and Diaspora networks tomaximise benefits for both source and destination countries. Ellerman (2004) reviewed some policy
options for the source country, aimed at reducing the effects of brain drain. These included reinforcing
the logic of commitment to lessen the brain drain, as well as re-involving the Diaspora back in theirhome countries. African governments could create better links with Diaspora organisations, which
could help encourage qualified African health care professionals (among others) to identify with thedevelopment of their countries of origin, especially if they are given a sense of belonging andresponsibility in their various countries. Examples of such networks exist in Africa (such as Nigeriansin the Diaspora Organisation – NIDO, as well as in South Africa. Other Diaspora organisations havebeen set up in Asia (for example, India, China, Korea, Taiwan), in South America (Mexico) or in
Europe (.for example, Globascot in Scotland). The Globascot network initiative seeks to harness
Scottish expertise housed in leading businesses around the globe and mobilise that expertise as ameans to economic betterment within a global knowledge economy. That is, it seeks to tap from theenormous intellectual potentials of the Scottish Diaspora. Alternatively, governments could takeadvantage of the creation of virtual participation (Brown, 2000), which would encourage health care
professionals abroad to contribute to knowledge sharing (with those at home) by mobilising highly
skilled medical expatriates through the Internet.
In some cases, trade in services could be encouraged, so that the source countries in Africa reap
some reward (from destination countries) for their health care professionals working abroad. Kuznetsov(2005) predicts that the brain drain will continue to increase both from developed and developing
countries. African countries could institute bilateral as well as multilateral agreements to manage
migration flows effectively. The government of the Philippines already has an arrangement with the
UK NHS to supply nursing labour, while Ghana also has a similar arrangement with the NHS for
certain nursing specialties.
Destination countries (like those of the OECD) should be encouraged to develop more innovativeideas in training more medical personnel, as a long term solution, to meet rising home demand forservices in their various countries. They should also be encouraged to reimburse (better) countries
whose nationals are working in their countries. Their efforts at arrangements with countries such as
the Philippines and Ghana are laudable, but there is also scope to do more and better. Destination
countries could also encourage remittances by African expatriates by providing easier and cheaper
options to transfer money to Africa. Alternatively, they can help by reducing the taxes that are paid by
African migrants in their various countries (Bhagwati, 1976; Bhagwati and Wilson, 1989). This will

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ATPS SPECIAL PAPER SERIES NO. 34

help boost emigrants’ disposable income and increase the amount of money available for remittances
to their home countries.
We could also appeal to these destination countries to be more ethical about poaching healthcare
professionals from African countries that are already seriously suffering from the effects of brain
drain. In this regard, some authors have shared very strong views:“…from an ethical point of view, selective and targeted ‘raiding’ of developing countries’ medical workforce bywealthier countries is not acceptable” Dauphinee, 2005.
“..the ethics of national policies which allow countries to recruit en-masse the most qualified physicians, at no
cost or penalty to themselves, should now be challenged” Bundred and Levitt, 2000

The role of international organisations such as the United Nations Organization (UNO) and theInternational labour Organisation (ILO) to create and enforce rules of engagement is also sacrosanct
as arbiters in migration of skilled health care professionals between nations. These organisations
could also be encouraged to develop and monitor compensation arrangements for trade in theservices of skilled medical workforce between source and destination countries.

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17

18

ATPS SPECIAL PAPER SERIES NO. 34

Mountford A. 1997. Can brain drain be good for growth in the source economy? Journal of
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