Think Again: Brain Drain

The movement of skilled workers from poor countries to rich ones is nothing to fear. In the long run, it will benefit both.

BY MICHAEL A. CLEMENS, DAVID MCKENZIE | OCTOBER 22, 2009

"The emigration of doctors kills people in Africa."

Hardly. Allowing or encouraging doctors to leave Africa for rich destination countries can reduce the number of doctors within the countries they come from, although even this is not clear if more people undertake medical training with the hope of migrating. However, the level of medical care provided by doctors in Africa depends on a vast array of factors that have little or nothing to do with international movement -- such as scant wages in the public health service, poor or absent rural service incentives, few other performance incentives of any kind, a lack of adequate medical supplies and pharmaceuticals, a mismatch between medical training and the health problems of the poorest, weak transportation infrastructure, or abysmal sanitation systems.

To illustrate just one of these -- the lack of rural service incentives -- policies that limit international movement choices per se do not change the strong incentive for African physicians to concentrate in urban areas far from the least?served populations. Nairobi is home to just 8 percent of Kenya's population, but 66 percent of its physicians. More Mozambican physicians live in the capital Maputo (51 percent) than in the entire rest of Mozambique, though Maputo comprises just 8 percent of the national population. Roughly half of Ethiopian physicians work in the capital Addis Ababa, where only one in 20 Ethiopians lives.

This and the many other barriers to domestic effectiveness of physicians may explain why, across 53 African countries, there is no relationship whatsoever between the departure of physicians or nurses and poor health statistics as measured by indicators such as child mortality or the percentage of births attended by modern health professionals. If anything, the relationship is positive: African countries with the largest number of their physicians residing abroad in the rich country are typically those with the lowest child mortality, and vice versa. This suggests that whatever is determining whether or not African children live or die, other factors besides international migration of physicians are vastly more important. Fiddling with immigration or recruitment policies of destination countries do precisely nothing to address those underlying problems.

JUNIE DOCTOR/AFP/Getty Images

 SUBJECTS:
 

Michael Clemens is a Research Fellow at the Center for Global Development and an Affiliated Associate Professor of Public Policy at Georgetown University. David McKenzie is a Senior Economist in the Development Research Group of the World Bank, a fellow of the Center for Research and Analysis of Migration, and a research affiliate of Innovations for Poverty Action

POLY

3:08 PM ET

October 22, 2009

wonderful!

GREAT article!

i live in brazil and have considered leaving for a masters degree in europe and have been oftentimes discriminated for this because people think i'm going to "flee yet again" my home country...

your article inspired me to write a post :-)

http://polyanabrasil.blogspot.com/2009/10/skilled-migrants-good-or-bad.html

 

MAGDALENA

1:49 AM ET

October 23, 2009

unbelievable

Studying, reaearch stays, or an exchange of creative ideas between nations is not emigration. Go to Europe or the U.S. and study hard, instead of listening to idiots

 

MAGDALENA

1:45 AM ET

October 23, 2009

INFANTILE, KNOW-NOTHING ECONOMISTS

OR SOMEONE PAYS YOU GENEROUSLY FOR WRITING SUCH STUFF.
Of course, emigration is beneficial for both parties at PRIVATE level, but this tends not to be true/manifestly wrong as regards the public dimension of education. I take into account highly-skilled workers, not necssarily workers who are "easily reproduced", such as nurses

 

MAGDALENA

4:37 AM ET

October 23, 2009

corrigendum

of course, I meant the public dimension of emigration (the effects thereof at public level), not edu. Maybe my post is elliptic, too ; in particular, I meant "this tends not to be true or is manifestly wrong (depending on the countries concerned and their specific eco and so problems and the quantitative and qualitative aspects of emigration). Just study this subject a little bit more and then write an article (in this order!). Otherwise, you may devote your time to writing immigration brochures for the European Commission. They’d be delighted. Sorry for sarcasm, but I couldn’t resist

 

MICHAEL_CLEMENS

4:29 PM ET

October 23, 2009

Think again... again.

@Magdalena, thanks for sharing your thoughts. I'm afraid I'm a little too old and wrinkled to be "infantile". It is common for people to assert, as you do, that skilled worker migration causes large public harm of various kinds. Note what this implies, however: That stopping skilled worker migration --- per se, all else equal --- would by itself produce large public benefit. It's the same statement in reverse.

And that is where the argument runs into trouble. Migration is a choice, a choice of location, so stopping migration is abrogating the choice of location --- that is, forcing people to be in a location that (by revealed preference) they do not want to be in. So the claim that we can cause large public benefit by stopping migration per se is equivalent to claiming that we can cause large public benefit by forcing skilled workers to live somewhere they don't want to live.

What would you think of forcing skilled, talented people who grew up in poor neighborhoods of the United States to live in those neighborhoods, even if they wished to leave, because their presence there would bring public benefits to the neighborhood? Most people would be profoundly uncomfortable with that, as intuitively we sense that it would be both ineffective and unethical. But many of the same people have no trouble believing that forcing skilled workers to live in poor countries they grew up in would be both ethical and effective, and I'm not sure where that belief comes from.

If you would agree that it would take more than just forcing skilled workers to stay in the places they come from in order to realize the benefit, then you're accepting that migration itself is not the underlying cause of the public harm from their loss, just as the fact that the departure of many talented youths from ghettos is not the underlying cause of the problems of those neighborhoods.

These are issues we need to think through carefully, and I invite you and others to ponder not just the fact that skilled workers are leaving developing countries, but *why* they are leaving --- that is, I invite everyone to focus on the underlying causes of the problems of which skilled workers' departure is an easily-seen symptom.

 

PER KUROWSKI

11:26 AM ET

November 6, 2009

Brains? Hah! Foremost it is about keeping the hearts

This article proves what I have been arguing for years, namely that the debate on migration has been focused too much on discussing the wrong organ.

Yes brain drain or brain gain matters but, at the end of the day, it is really whether there is heart drain or heart gain that is going to be the truly important issue.

http://theamericanunion.blogspot.com/2006/07/scaling-up-imagination-about.html