Brains Go Wherever They are Paid Best But...

The brain drain of medical personnel to countries that offer better pay and working conditions, and more advanced facilities, has been quietly going on for some time; and it is in the rural areas of Africa that it is noticed most. Medecins sans Frontieres (MSF) says that drugs are available in some clinics but no-one to administer them, and a spokesman criticised donors who fund health clinics but not the wages of nurses. In Zambia the death rate from AIDS is 3.5% for nurses and 2.8% for medical assistants; and the death rate in Lusaka and Kasema districts is double the number who applied to work as medical staff in the U.K. In southern Africa as a whole, doctors and nurses are underpaid, over-worked and disillusioned, and are leaving in large numbers. In 2005 in Malawi, for example, 44 nurses graduated, while 86 left the country

According to the World Health Organisation (WHO), the minimum standard is 20 doctors for every 100,000 patients. This is the minimum; in developed countries it is far higher. Yet, in Lesotho it is 5; in Mozambique 2.6, and in Malawi, 2. What is happening down south is just as much the case here. Many Kenyan and Ugandan doctors are working -not just studying- in South Africa. Tanzania has nearly 200 highly-qualified doctors working outside the country; and 100 skilled medical workers are said to be leaving public service every year. Nurses from the region too have been leaving to man the wards in countries like the U.K. where nursing has ceased to be the attractive profession it was for local women years ago.

So a move on the part of the WHO could be welcome. The organisation is planning to enforce a new world-wide initiative that aims at making it difficult for health workers to migrate from poor to rich countires, by imposing restrictive work conditions. New employment policy guidelines are being developed to be adopted by countries in order to stem the brain drain. These guidelines are expected towards the end of 2008. This is not to say that medical students and personnel should not travel abroad for further studies or for a period of practical experience. But one thing is clear: where they are really needed is at home. Charity, it's often said, begins at home. However, easier said than done. They cannot be expected to survive on meagre wages and carry out a service that is often unpleasant, tiring and sometimes thankless. As the MSF spokesam pointed out: donor money needs to be better invested. Clinics and dispensaries are needed; but without contented, efficient staff, and a sufficient number of them - and, of course, the necessary medicines and basic equipment-, they are little more than white elephants.

This raises the question of the brain drain, and not only of medics. Brain drain is not the same as emigration. The United States and Australia are examples of countries that have developed owing to large-scale immigration, mainly during the previous century. The average emigrant left his home land because he couldn't make a living there, or for fear of persecution; once he arrived he started on the lowest rung of the social and economic ladder.The brain drain is the drain of the intellectual and skilled elites. Brains go wherever they are paid best, and not just to survive from day to day. Many European and Asian "brains" have settled in the United States, not because they cannot live well at home, but because they were made an offer they couldn't refuse.

Is this fair to their home country? What about loyalty and patriotism? If the best brains leave, who will develop home? Questions not easy to answer. Some leave to earn money quickly for the family, and come back as soon as they can; they have the family at home, and do not want to be separated for long. Others, often the brightest, are offered a university course which no local university can match; the chance is once in a lifetime. Of course they will take it, only to discover that they are too qualified to come back; no local company or institution can absorb them, and certainly not at the level of pay and job description they consider fair. These are gone forever. Others go to study and would like to come back; they get homesick, miss friends, food, climate and familiar routine, but find they are trapped. Things don't quite work out as they had hoped, they run out of money, and cannot afford to come home. Or, instead of doing a university course, they try their hand at business, finding the environment more competitive than expected.

Most developed countries that still need immigrants are now restricting it to people with qualifications. Others, like France, also offer incentives to more immigrants to return home voluntarily. The new French Immigration minister, Brice Hortefeux, said that a family with two children would be paid 6,000 euros to return to their country of origin. France has a population of 2 million immigrants from north and sub-Saharan Africa, according to the latest census, 2004. In 2005-6, 3,000 families took up this offer.

In our new global world, with its greater mobility and looser home ties, people seem less attached to any one place. With the low birth rate and high proportion of the elderly who no longer work, the developed world will soon be in dire need of hands, from outside. Many of these immigrants will come from Africa, and will be running essential services; therefore, they should be treated as such. What about developing one's own country?

While the policies of allowing in immigrants, even skilled ones, is still restrictive, we have no choice but to entice our own skilled and intellectual elites to remain here, and those outside to return as soon as they can - and to make it worth their while to do so.