Who gains, who is drained? From worst cases to best practices

Package of the Game Brain Drain


by Mariama Awumbila

The increase in the numbers of international migrants in recent decades has brought into focus several issues among which is the migration of the skilled. Among the increasing number of migrants are millions of highly educated people who move to developed countries from developing countries that already suffer from low levels of human capital and skilled workers.

Human capital formation is considered to be of central importance to development and the ultimate reduction of poverty. Thus, any loss of the skilled through migration may be detrimental to the achievement of development goals.

Originally, the discussion of a “brain drain” was framed in the context of the loss of British scientists and doctors from the United Kingdom. However, it quickly came to be applied to the loss of skilled labour from developing countries and its impact on the countries of origin.  Of particular concern was the emigration of those with scarce professional skills, like doctors, nurses and engineers, who had been trained at considerable expense by means of taxpayers' subsidies to higher education. Recent estimates indicate that sub-Saharan African countries have a shortfall of more than 600,000 nurses needed to meet the Millennium Development Goals (MDGs) of improving the health and wellbeing of the population.

 Although the debate on the ‘brain drain’, or the emigration of skilled workers, is not new, it has taken on greater urgency in the context of a globalizing world economy and ageing societies. As international migration has undergone a transformation particularly in the last two decades suggesting a “new era of mobility” characterized by a greater degree of nonpermanent migration, involving a diversity of actors and taking a wider variety of forms, so also has the debate on migration and skilled labour undergone several shifts. The migration of health professionals especially has been accompanied by politically and ethically charged discussions on the effect of such migration on the health and economy of those left behind in their countries of origin, and more recently the need to see the emigration of the skilled as  not necessarily negative for development.

This paper discuses the debate on the brain drain using the Ghanaian case as the context for the discussion. It begins by situating the debate on the migration of skilled workers within the broader migration and development discourses, and then discusses the specific Ghanaian case. The implications of the brain gain and brain circulation for receiving countries such as Ghana and the role they can play in shaping the migration agenda are discussed.

Migration and Development: An overview

The debate on the brain drain is situated within the context of the broader issues of migration and development.  Over the past four decades, the impact of migration and specifically the migration of skilled workers on development in countries of origin has been the subject of continuous debate. De Haas (2008) broadly identifies two radically opposed approaches, which he terms “migration optimists” and “migration pessimists”

Most migration pessimists tend to address migration as a negative phenomenon contributing to the further underdevelopment of sending societies through the “migrant syndrome” which drains developing countries of their labour and human capital resources (Papademetriou 1985). Thus migration is not only seen as a means to development, but actually also does increases spatial and inter-personal disparities in developmental levels, as well as socio-cultural effects. In sum, migration is believed to intensify regional development inequalities. Linked to this and perhaps of more relevance in the Ghanaian context is also the migration of much lower skilled labour migration from developing countries often made up of young, able-bodied men and women from rural areas often referred to as the “brain drain”, which can cause a critical shortage of agricultural labour and the de-intensification of agriculture and the decline of land under cultivation (Rubenstein 1999). Briefly then migration is seen as an undesirable product of poverty, as a problem which needs to be “solved”.

The migration optimists on the other hand largely believe that migration has generally had a positive impact on the development process in sending societies, as it can generate counterflows of capital (remittances and investment) and knowledge, which can be invested and are believed to subsequently stimulate development and modernization. In particular return migrants are seen as active agents of economic growth.

However as de Haas notes (2008) the variation and complexity of real-life migration-development interactions make it difficult to fit them into deterministic schemes predicting the development outcome of migration and that there is no automatic mechanism by which international migration results in development. Thus since the 1990s several studies indicate that  in most cases, migration is typically not a desperate response to destitution or extreme conditions of poverty and unemployment , but  a deliberate attempt by social groups to spread income risks, to improve their social and economic status and, hence, to overcome local development constraints. Thus migration is generally a reaction to relative rather than to absolute poverty and thus rather a survival or coping strategy (de Haas, 2008).  In line with this transnational approaches tend to see migration as an expression of strong social bonds and of the wish to improve the lives of those left behind.

More recent studies emphasis that the brain drain can be accompanied by a significant brain gain and a brain circulation (World Bank, 2006).

The Brain drain in Ghana

From a period of net immigration up until the mid 1960s, Ghana witnessed a period of large-scale emigration of Ghanaians in the 1980s and 1990s (Anarfi, 2000). By the mid 1990s, it was estimated that about 3 million Ghanaians (15% of the population) lived abroad (Twum-Baah, 2004). Skilled workers and professionals dominated early flows from Ghana, but, by the 1980s, many semiskilled and unskilled workers chose to leave as well. A study of the brain drain by the IMF estimated that by 1990, 15 percent of Ghanaians with tertiary education had migrated to USA and a further 10 percent to other OECD countries (Black et al. 2003) and 35.9% of Ghanaian residents in England/Wales (aged 16-74 years) had a higher level of qualification.

The migration of highly skilled from Ghana was dominated by health professionals.  Between 1995 and 2002, 69.4% of medical officers trained in Ghana left to practice in other countries, and 20% of nurses and midwives had also emigrated.  The effect on Ghana’s health care delivery system was severe. In 1998 the Ghana Health Service had vacancies for doctors (43%) and nurses (26%). By 2002, this rose to 57% & 47% respectively (Dovlo & Nyanator, 2004). In terms of the direct consequences for the well being of Ghanaians, the Ghana Demographic and Health survey, 2003 indicated that Ghana’s infant mortality and under-five mortality worsened between 1998 and 2003 (Ghana Statistical Service, 2004), a period characterized by a rapid emigration of health professionals from the country.

To address the loss of health workers from Ghana a number of strategies have been developed and implemented with mixed results which have included: Measures to improve the conditions of service of health workers included increases in basic salaries and allowances, the introduction of the additional duty hour allowance (ADHA) for health workers in 1998, which literally doubled or in some cases trebled salaries overnight,  and incentive schemes such as housing and cars to encourage staff at post and attract potential staff. The West Africa College of Surgeons was also established to provide local postgraduate training and Study leave with pay is offered to qualified staff at all levels to upgrade their skills. Increasing enrolment in all health training institutions through private sector participation were also instituted among others.

At the national level the government has instituted measures and policies aimed at creating a legal atmosphere conducive to return migration and maximizing benefits from migration. This has included the adoption of citizenship legislation such as the dual citizenship arrangement, the Representation of the Peoples Act, and flexible residency rights making re‐entry to Ghana easier, as well as the creation of a Ministry of Tourism and Diasporan Relations.

In the receiving countries ethical recruitment policies have been devised with mixed results. In the United Kingdom for example The UK Department of health has since 1999 developed and gradually strengthened a Code of Practice for the International Recruitment of Healthcare professionals (Department of Health 2004) which requires the National Health Service employers not to actively recruit from developing countries unless there is a government-to-government agreement.

At the international level, various programmes have been instituted such as by the Royal Netherlands Government, and the International Organization for Migration, to encourage Ghanaian professionals in the Diaspora to return to Ghana. The number of nurses and doctors migrating has been on the decline since 2003 probably as a result of these measures. However it is thought that some policies may have inadvertently aggravated the migration problem (Mensah et al, 2005), indicating the complexity of the issues the need for a holistic policy approach.

Who gains, Who is drained? From Brain Drain to Brain Gain and circulation

The popular image of migration is that migrants move to a receiving country, settle there permanently and are assimilated into a new culture. For the brain-drain, the assumption is that skilled workers leave a poor country to work and stay permanently in a rich country. Recent studies indicate that a large percentage of these migrants do not make this simple and permanent poor to rich country journey and that the phenomenon is clearly much more complex. More recently, a more holistic perspective indicates that much migration is circular (migrants return to their sending country, once or many times) and most is transnational (migrants move to migrant communities in the receiving country and maintain strong social, and economic ties to the sending country) and indeed that the international migration experience may best be described as “brain circulation”, and even as “brain gain”. Thus under some conditions, the prospect of migration may enhance, rather than reduce, human capital formation within source countries.

Thus migrants who depart are not seen as “lost” to the sending country and or “gained” by the receiving country. Instead, a transnational framework is gaining ground where migrants continually forge and sustain multiple attachments across nation states and/or communities. As these transnational migrants return home, it is argued that they can facilitate the transfer of the critical financial and human capital the developing world needs. Thus high skill migration is a vital part of that game, a joint venture from which both source and receiving countries and even the migrants themselves have the potential to gain, thus creating a “triple win” situation to the benefit of everyone and for development and poverty reduction.

In the Ghanaian situation several studies have shown that migrants and return migrants have become direct source of investments. Apart from the large amounts of remittances sent to Ghana (Addison 2005, Quartey, 2006) return migrants have been entrepreneurial and have stimulated investments in a number of instances.  In 2001, a survey of 152 Ghanaian returnees showed that over 55% of those surveyed were self-employed on return, and the vast majority of these individuals employed other Ghanaians in their business (Black and Tiemoko, 2003). Brain circulation can also be a path to job creation and poverty reduction as it is a mechanism for providing capital for the development of small enterprises, particularly amongst poorer and less-skilled migrant, as well as high‐level technology transfer. (Black, 2004; Sjenitzer and Tiemoko, 2003). Anarfi and Kwankye (2003), in a review of several other studies on Ghanaian emigration and return, also highlighted Ghanaian returnees’ contribution to human capital formation in the country.

Thus the literature shows that until recently many developing countries were alarmed at the ‘brain drain’ linked to migration and the loss of skilled personnel and this led several receiving countries to re-think the recruitment of skilled personnel from countries that lack such human resources. Origin countries in the face of growing global demand for the skilled, have tried to restrict the loss of the skilled sometimes creating tensions between the possibilities that the individual skilled have to improve their situation and the demands of the state that produced them. But is restricting migration an effective response to skilled labour shortages in the developing world.

As pointed out by several researchers, in a world of increased mobility, migration restrictions may not reduce the number of skilled migrants from developing countries, but may make entry into the formal labour market more difficult. Indeed, restrictions may rather increase the cost of migration, imposing an artificial self-selection of migrants on the basis of income. Evidence on the migration of Ghanaian health professionals into the UK indicates that restrictions on recruitment of health professionals by the NHS meant greater costs for migration and a shift to commercial intermediaries (Mensah et al, 2005). Despite this, it is obvious that the Ghanaian health system would benefit if the 69% of doctors trained in Ghana who were working abroad in 2002 (Dovlo and Nyonator, 2004) were working in the country’s under-staffed hospitals. However, it is also clear that restricting migration is far from being the best option to try to achieve a suitable level of adequate skills.

This therefore implies the need to develop more holistic policy responses to the situation. Policies that seek to restrict the migration of the highly skilled are likely to be counterproductive, no matter whether implemented by countries of origin or of destination. Yet the idea of a developing country loss and developed country gain is also an oversimplification of a complex situation (de Haas, 2008)

A critical dimension of the migration of the skilled in recent times is their return to their countries of origin and their contributions even while in the country of destination. This return can either be of previous brains lost in the migration or of brains enhanced through training overseas in a ‘brain gain’. These return migrants contribute to the development of their economies of origin in a number of ways, as shown by the studies by Black et al (2003). However as noted by (Black et al, 2003) they are unlikely to be the key factor in the development of their homeland, but they can play significant roles nevertheless. It is therefore important that return migration of the skilled is seen as playing a complementary role rather than the key role in transforming an economies.

Thus in recent times it has been argued that the focus on circular and return migration, brain gain, may not actually be relevant to the poor as the private capital transfers of such migrants may not filter down to sectors of the economy where the poor are found, whilst the return of professionals may have little impact on services targeted at the poor. Indeed as pointed out by Black (2007) subsidized return-of-talent programs may be described as “expensive failures”.

It is therefore important that the structural causes that are generating the pressures to emigrate should be addressed as well as the important role that states and other institutions play in shaping these general conditions for social and economic development.

Conclusions and implications for policy

The discussion has shown that the issues surrounding the development of a holistic policy for skilled migration are complex and that the developmental impacts and effectiveness of a return and circular migration may be minimal. Despite these concerns, however, it is also clear that, unlike the previous decades, the impact of circular migration on development can no longer be easily dismissed as negligible or even negative. The potential developmental benefits that could accrue from a more circular movement of people are enormous, especially in an increasingly transnational world. The challenge therefore is to understand this new reality and to determine how the potential for circular migration could be harnessed and utilized, while ignoring the structural causes that are generating the pressures to emigrate.

To this end, there is the need for more detailed, comprehensive, and solid research base, driven by the agenda of origin countries within which effective policy interventions can be made. These should include qualitative as well as quantitative studies that may provide context specific data as well as overall trends, which would provide “lessons learned” and “best practices.” This calls for high-quality data which is currently lacking. Not only is there a need for  high quality data, but also the development of appropriate methodologies  that will take into account the complex and dynamic  nature of migration, as well as new inflows and outflows of people. This calls for the need for the establishment of more migration research institutes as well as migration networks in sending countries and the need for collaborative research between sending and receiving countries to provide a more holistic picture.

For a holistic understanding of the migration of skilled labour, it is important to examine the linkages between internal and international migration and the brain drain. As Skeldon (2005) argues the international migration of the highly skilled is primarily from and to large urban areas, and therefore it is important to examine how internal migration is linked with the transnational flows that have dominated the concerns over the loss of skills for any real policy-relevant discussion of the ‘brain drain’. Thus any migration policy must examine the reciprocal linkages between internal and international migration. Internal migration is often a precursor to international migration, and international migration affects internal migration patterns.

Lastly it is important to recognize the right of people to stay in their countries of origin, and not to migrate. It is therefore crucial that governments facilitate people’s survival in their area of origin and institute programmes to enhance access to local jobs and sustainable livelihood. This would include government improving domestic market conditions, which had previously made migration a necessity rather than a choice as a long-term strategy to reverse the brain drain in Africa.



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Mariama Awumbila is Head of the Centre for Migration Studies at the University of Ghana, Legon.