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Africa: Brain Drains in Context
AfricaFocus Bulletin
Feb 10, 2012 (120210)
(Reposted from sources cited below)
Editor's Note
Topics linked to migration, such as remittances and brain
drains, have attracted increasing attention in discussions
of development. But such specific issues should be
considered in the wider context of the goal of reducing the
grossly unjust levels of inequality between nations. The
brain drain of medical personnel, for example, cannot be
solved simply by looking at migration flows, but by focusing
on how to provide the human and financial resources needed
for equitably assuring the right of health to all.
This AfricaFocus Bulletin contains an excerpt on Migration
and Development from a longer study by the AfricaFocus
editor published in 2011 by the Nordic Africa Institute,
"African Migration, Global Inequalities, and Human Rights:
Connecting the Dots."
A specific illustration of how issues such as the "brain
drain" need to be considered by looking at both receiving
and sending countries can be found in another AfricaFocus
Bulletin sent out today, and available on the web at
http://www.africafocus.org/docs12/bd1202a.php This contains
excerpts from a new study published in the British Medical
Journal, providing quantitative estimates of the losses to
nine sub-Saharan African countries (and associated gains to
recipient countries) from the emigration of doctors to the
United States, United Kingdom, Canada, and Australia,
reaching a cumulative total of at least $2 billion. This
raises the question of how to compensate the countries who
provided these doctors for their de facto subsidies to the
countries receiving these skilled workers.
For the full text of "African Migration, Global
Inequalities, and Human Rights," see http://www.africafocus.org/editor/nai-migration.php
For previous AfricaFocus Bulletins on migration issues, go
to http://www.africafocus.org/migrexp.php
++++++++++++++++++++++end editor's note+++++++++++++++++
Migration and Development
Excerpt from:
African Migration, Global Inequalities, and Human Rights:
Connecting the Dots
William Minter
Nordiska Afrikainstitutet, Uppsala, 2011
Full text in html available at
http://www.africafocus.org/editor/nai-migration.php
Full PDF available for download at
http://nai.diva-portal.org/smash/record.jsf?pid=diva2:442755
Although the development debate continues to focus on
macroeconomic growth, as well as on achievement of antipoverty
targets such as the Millennium Development Goals,
over two decades the annual UNDP human development reports
have encouraged expansion of the range of objectives to
consider (http://hdr.undp.org/en/reports/).
The 2009 Human Development Report, focusing on migration, laid out an
agenda to enhance human development outcomes for movers and
for countries of origin and destination. The 2010 Human
Development Report, concentrating on inequality within
countries, made the case that internal inequality in itself
impedes human development.25
This brief review of specific issues related to migration
and development offers no new policy solutions. The
objective is rather to illustrate how a human development
framework, combined with consideration of global
inequalities, can provide a broader context for policy
debate. Developing "win-win-win" policies on migration
requires building a consensus in favour of "inequalityreducing"
human development. In short, development should be
redistributive, both globally and within countries.
The challenge of measuring global inequality, or other
inequalities based on units other than countries is, of
course, substantial, since statistics are based on national
boundaries. Thus one can relatively easily generate measures
within a specific country or between countries. But finding
comparable measures for groups that overlap country borders,
such as people born in a specific country (including those
now in the diaspora), is more difficult. Nevertheless, the
first step is to call attention to the need to do so.
Migration systems and networks, as well as specific
processes such as the transfer of remittances, operate both
within and across national boundaries. In order to
understand the dynamics at work, it is important to consider
the wider set of relationships, including inequalities,
between sending countries and receiving countries. Thus,
whether in binational or multinational terms, one might
advance migration within the broader policy goals of
reducing inequalities. One might develop a measure of
inequality across the countries within a migration system,
such as Western Europe-North Africa, or within the Southern
African region, combining within-country and between-country
inequality as in the measures of global inequality discussed
above.
Or, while maintaining the focus on a particular sending
country, one could develop measures of "income per natural"
as well as "income per resident." As advanced by Clemens and
Pritchett (2008), such a measure would look at the income
for the population born in a specific country, including
both residents and migrants living outside the country. Such
a measure might indicate, as Clemens and Pritchett argue,
that migration is one of the most important means of poverty
reduction for a large portion of the developing world.
Crossing international boundaries, they argue, is not an
"alternative" to development; it is in fact one of the
components of development, significantly raising the average
income of the set of persons born in a specific country.
Despite the greater difficulty of collecting data that goes
beyond the framework of national borders, placing internal
and international migration within the same framework is a
logical next step in examining such current topics as
remittances, brain drains/gains, and the role of diaspora
populations within overall human development strategies.26
Remittances
Since the World Bank's focus on the issue in Global Economic
Prospects 2006, remittances have become part of the
mainstream discussion on development. The most recent
estimates from the World Bank (2010) note that recorded
remittances to developing countries worldwide will recover
to $325 billion in 2010, up from $307 billion in 2009, and
may even exceed $370 billion by 2012. Despite declines due
to the world economic crisis, remittances were more
resilient than other financial flows, and remained almost
three times greater than official development assistance
(ODA) to developing countries.
Flows to Sub-Saharan Africa were estimated at a stable $21
billion a year from 2008 to 2010, and projected to increase
to $24 billion in 2012. In contrast to the global picture,
totals for recorded remittances to Africa were not greater
than flows of ODA. According to the World Bank, the top five
remittance-receiving countries were Nigeria ($10.0 billion),
Sudan ($3.2 billion), Kenya ($1.8 billion), Senegal ($1.2
billion), and South Africa ($1.0 billion). In terms of
remittances as a percentage of gross domestic product (GDP),
the top five were Lesotho (24.8%), Togo (10.3%), Cape Verde
(9.1%), Guinea-Bissau (9.1%), and Senegal (9.1%). In North
Africa, grouped with the Middle East in World Bank data, the
top remittance-receiving countries were Egypt ($7.7
billion), Morocco ($6.4 billion), Algeria ($2.0 billion),
and Tunisia ($2,0 billion). As a percentage of GDP,
remittances were highest in Morocco (6.6%), Tunisia (5.3%),
Egypt (4.0%), and Algeria (1.4%).27
There is a growing consensus in current research and policy
debate that remittances should not be seen as substitutes
for other sources of national financing, such as development
assistance or foreign investment. Their economic
contribution, channelled principally to direct family needs,
is valuable in its own right, not only for the individuals
and households receiving it but for national economies. As
part of their mixed strategies for survival and advancement,
households often combine international remittances with
those from family members working in urban areas in the home
country.28 It follows that attempts to tax remittances or to
channel them into development projects are likely to be less
effective, from a national development standpoint, than
helping households access and invest these remittances for
their own survival and betterment, including in health and
education.
The costs of sending remittances, which go principally
through money transfer operators rather than through the
banking system, are high. Although transmission costs have
decreased somewhat worldwide, from 9.8% for a $200 transfer
in last quarter of 2008 to 8.9% in the first quarter of
2010, the reduction was principally in the U.S./Mexico
corridor, with rates remaining high in Africa.29 Substantial
savings could be achieved by introducing greater competition
into the system, and a Global Remittances Working Group
initiated by the G8 countries in 2008 has called for
reducing the cost by 5 percentage points over five years. By
requiring providers of remittance services to be more
transparent about fees, the Wall Street Reform and Consumer
Protection Act, signed into U.S. law in 2010, has the
potential to give greater leverage to remitters. But the
global remittance market is still dominated by large players
such as Western Union and MoneyGram, which face little
competition in many smaller markets.
While greater competition may bring about incremental
reductions in remittance costs, the extent of competition
also depends on the size of the national markets and the
extent of government initiatives specifically aimed at
promoting lower costs. According to the World Bank, SubSaharan
Africa has the highest average cost among regions,
at 11.57% in the third quarter of 2010.
A promising advance in some African countries is the
introduction of money transfer via mobile phone, beginning
with M-Pesa in Kenya. This trend is likely to continue. But
it has as yet had little impact on transfers across national
borders. If regulatory barriers could be overcome, this
technology could have a very substantial competitive impact
on lowering international remittance costs as well,
particularly between neighbouring countries within Africa.
With continued emphasis from the World Bank and related
agencies, remittances are likely to receive sustained
policy attention. However, it is still important to
contextualize these financial flows with respect to other
flows, in order to evaluate their potential impact on
development. These other flows include not only foreign
investment, official development assistance, and trade
balances, but also the very substantial illicit financial
flows, which are even less well tracked than remittances and
only now beginning to attract more systematic international
attention.30
The reforms needed for accurate reporting of data of illicit
financial flow are daunting. They include transparency on
country-by-country accounts of multinational corporations,
documentation of the true residence of beneficiaries of
banking accounts, and exchange of tax information between
governments in the case of suspicious transactions. In
contrast to remittances, however, the amounts involved in
individual transactions are likely to be substantial. In
looking at the results for inequality within and between
countries, and among those born in a country (including
diasporas), such flows should also become an essential part
of the migration and development debate.
Brain Drains and Gains
The "brain drain," or loss of skilled workers through
emigration, has long been the subject of policy debate and
development research. It has also received significant
attention in the media. The migration of health workers is
particularly visible, with large numbers of foreign doctors
and nurses working in developed countries while health
crises grip African and other developing countries.31
Nevertheless, despite a significant body of research,
reliable data are elusive, and effective solutions even more
so.32 For Africa, where the total rate of emigration was
1.8% in 2000, the rate of emigration of high-skilled workers
was more than five times greater, at 10.4% (Marfouk 2007:
17). Twenty-five African countries had high-skilled
emigration rates of 15% or more. The top ten were Cape Verde
(67%), The Gambia (63%), Mauritius (56%), Seychelles (56%),
Sierra Leone (53%), Ghana (47%), Mozambique (45%), Liberia
(45%), Kenya (38%), and Uganda (36%). The largest absolute
number of high-skilled emigrants came from countries with
larger populations, including South Africa (168,000),
Nigeria (149,000), Egypt (149,000), Morocco (141,000), and
Algeria (86,000).
The losses to sending countries from emigration of skilled
emigrants, particularly in the cases of smaller and least
developed countries, are clear. In recent years, some
scholars have also pointed to "brain gain" effects, such as
remittances, return migration of migrants with added skills,
diaspora contributions to development, and the effect of the
opportunity for overseas education and employment in
increasing incentives for professional education in sending
countries. It is generally agreed, however, that these
positive effects are unlikely to be sufficient to compensate
for negative effects in most developing countries.33
The most extensive policy debate on skilled migration has
dealt with health workers. However, there is now a growing
consensus that the principal responses to date have been
ineffective.34 These include measures to prohibit migration
of skilled workers (not only ineffective but also in
violation of the rights of migrants themselves) or to pay
incentives for return (of limited effectiveness). Most
widely discussed has been the development of voluntary codes
of conduct, culminating in the World Health Assembly's
adoption of the "WHO Global Code of Practice on the
International Recruitment of Health Personnel" (WHA63.16, 21
May 2010).
Even when voluntary codes are adopted, however, they face a
policy climate in developed countries which systematically
encourages the immigration of skilled labour. Moreover,
professionals continue to be attracted by the higher
salaries and generally better working conditions in the rich
countries. In the health field, it is unlikely that brain
drain issues can be addressed effectively without broad
international cooperation to reduce inequality in health
systems and health outcomes between countries. The shortage
of health personnel in developed as well as developing
countries needs to be met through an expansion of education
and training capacity, both overall and in the most
disadvantaged countries in particular. Global health budgets
need to be provided with sustainable financing from both
national and international sources, including new innovative
financing mechanisms such as those being developed by
UNITAID.
In short, the perspective needs to shift to the development
of health systems rather than focusing only on the migration
of health workers. The supply of health workers is just one
of multiple factors affecting health systems equity.
Promoting quality health systems both requires and attracts
skilled health professionals. If that is accepted as the
shared goal, both at national and international levels and
by health institutions and professionals themselves, then
distribution of personnel to meet the needs can be
addressed not only by encouraging return of skilled
professionals to their countries of origin, but also by more
flexible forms of temporary assignment and collaboration
across national lines.
International coordination in planning for human resources
in health, including these and other measures, has recently
taken significant steps forward with the first Global Forum
on Human Resources for Health, held in 2008 in Kampala,
Uganda, and the second, which took place in Bangkok,
Thailand, in January 2011. The forums are managed by a
multi-stakeholder Global Health Workforce Alliance
(http://www.who.int/workforcealliance/en/). They aim to
address the worldwide shortage of health workers, estimated
at 4.2 million, with 1.5 million needed in Africa alone. The
Alliance has identified 57 countries that urgently need
additional human resources to meet health crises, of which
39 are in Africa.
In other areas of the economy, as in health, actions on
brain drain should not be aimed at reducing mobility but
rather at flexibly integrating professional development and
employment within broader development strategies. Consensus
around goals such as those laid out by the African Union
(see box) is growing. The UNDP's TOKTEN (Transfer of
Knowledge through Expatriate Nationals) program, established
in 1977, is being joined by a host of parallel efforts, such
as the World Bank's African Diaspora Program. Their
success, however, is likely to depend primarily on the
progress of development in specific sectors and specific
countries.35
Footnotes
25. Although they confine their study to developed
countries, comparing countries as well as states within the
United States, Wilkinson and Pickett (2009) in The Spirit
Level make a strong case that inequality has multiple
negative effects not only for those on the bottom ranks but
also for human development outcomes for other societal
strata and for society as a whole.
26. For an extensive review of current policy debates on
these specific issues, and more current statistics,
published too late to the new data be incorporated
systematically into this essay, see Ratha et al. (2011).
27. But, notes the World Bank (2009a: 8), remittance data
for Sub-Saharan Africa is thought to be even less reliable
than in other world regions. Flows are probably
substantially higher than reported.
28. See, for example, the study of Ghanaian migrant networks
by Valentina Mazzucato, in DeWind and Holdaway 2008: 71-102.
29. For regularly updated data, see the World Bank's
database on remittance prices
(http://remittanceprices.worldbank.org/).
30. In recent studies, Global Financial Integrity
(http://www.gfintegrity.org) has begun efforts to estimate these
flows. According to this nongovernmental organization,
illicit capital flows worldwide from crime, corruption, and
trade mispricing amounted to some $1.26 trillion in 2008,
having increased by 18% a year since 2000 from a base figure
of $369.3 billion. Illicit financial flows out of Africa
were estimated at at $63.8 billion in 2008, including some
$37 billion from Nigeria alone (Global Financial Integrity
2010, 2011).
31. For recent sources on health worker migration see
http://www.guardian.co.uk/global-health-workers,
http://www.who.int/hrh/migration/en, and
http://www.who.int/workforcealliance/en/.
32. For data sources, see particularly Docquier (2007),
Docquier and Marfouk (2006), and the online datasets at
http://perso.uclouvain.be/frederic.docquier/oxlight.htm.
Summary statistics for African skilled migration, as of
2000, are in Marfouk (2007).
33. See Docquier (2007) and several chapters in Ozden and
Schiff (2006).
34. See, in particular, Physicians for Human Rights (2004),
Mensah, Mackintosh, and Henry (2005), and Khadria (2010).
35. Among the most promising, which can be implemented at
multiple levels, are programs for collaboration between
universities. See, for recent reports, focused on Europe and
Africa in particular, the program co-sponsored by the
European University Association, the Association of African
Universities, and related groups
(http://www.accesstosuccess-africa.eu).
African Union Draft Strategic Framework on Migration in
Africa: Suggested Actions on Brain Drain
- Counter the exodus of skilled nationals by promoting the
NEPAD strategy for retention of Africa's human capacities;
targeting economic development programmes to provide gainful
employment, professional development and educational
opportunities to qualified nationals in their home
countries.
- Counter the effects of "brain drain" by encouraging
nationals abroad to contribute to the development of their
country of origin through financial and human capital
transfers such as short and long term return migration, the
transfer of skills, knowledge and technology including in
the context of programmes such as the IOM MIDA (Migration in
Development for Africa) Programme, and activities of ILO,
WHO and other relevant agencies.
- Foster private sector opportunities to provide alternative
employment to the low paying public sector and reduce brain
drain
- Member States establish policies for the replacement of
qualified persons who have left the country of origin and
implement retention policies and related strategies.
- Maximize the contribution of skilled professionals in the
continent by facilitating mobility and deployment of
professionals in a continental and regional framework
African Union (2005: 27)
AfricaFocus Bulletin is an independent electronic
publication providing reposted commentary and analysis on
African issues, with a particular focus on U.S. and
international policies. AfricaFocus Bulletin is edited by
William Minter.
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