Executive summary
The view put forward by a number of influential sources is that sub-Sahara Africa is experiencing a health crisis in human resources and that this crisis is defeating efforts at international, regional and country levels to control and stem the HIV/AIDS epidemic on the African continent. The migration of health professionals from developing countries in general, and sub-Saharan African countries in particular, has become the subject of considerable theoretical and case study research attention in international migration and human resources for health (HRH) literature.
This report is a review of all available literature on the costs and benefits of the migration of health workers from East and Southern African (ESA) countries to developed nations. Its findings are as follows:
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Four economic models are used by researchers to conceptualise and analyse the costs and benefits of the migration of health professionals from the perspective of developing countries:
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the internationalist model, which prioritises benefits over costs;
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the nationalist model, which differs from the internationalist model because it puts greater emphasis on costs rather than on benefits;
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the beneficial brain drain model, which investigates the impact of the international migration of highly-skilled individuals on investment and growth in their home countries; and
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the diaspora knowledge network model, which sees the 'brain drain' as a 'brain gain'.
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Many researchers identify the medical brain drain as a serious problem because it impacts negatively on healthcare systems, not only in terms of loss of skilled labour, but also because the governments of developing countries subsidise the education of health workers, only to lose this 'investment' when the workers emigrate. Unfortunately, the theoretical and case study research literature is mostly qualitative in nature when analysing costs. Only two published case studies used the quantitative approach to analyse costs, but they lack technical and analytical merit.
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The demand and supply factors affecting the migration of ESA health professionals to developed countries have not yet been brought together into a framework that contextually relates, analyses, and explains how they are 'drivers' of the migration process.
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Existing literature largely ignores the benefits that developing countries enjoy when their health workers migrate. For example, there are financial and non-financial flows from developed to developing countries that are associated with this pattern of international migration, either through circular migration, return migration, the diaspora or transnational migrant communities.
The gaps in the existing literature regarding supply and demand, as well as the benefits to ESA countries of outward migration, appear to have three principal causes:
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The nationalist model is used by researchers more often than any of the other three economic models.
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The HRH literature focuses almost exclusively on costs, in other words, on the gross impacts on ESA countries of the international migration of their health professionals instead of the net impacts.
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Perhaps the most critical information gap is that there is currently a lack of reasonably sound data to empirically validate, analyse and evaluate the costs identified and discussed in this literature.
In conclusion, the existing HRH literature can provide a foundation for building a future programme of evidence-based policy research, with studies that use 'hard' economic and noneconomic time-series and panel data on costs and benefits, a more balanced conceptual framework and sounder analytical research techniques. The objective should be to manage the migration of health professionals from ESA countries in such a way that it minimises the costs while allowing these countries to enjoy the benefits. Above all, what needs to be established is a well-resourced comprehensive and demand-driven database on the economic, social and demographic aspects of the migration of health professionals from sub- Saharan African countries.
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