Eze Japas Abroad

Brain drain or brain gain?

Moha Amin via Atlas

Japa: Yoruba word; to migrate (escape, more like) from Nigeria’s many headaches.

I recently read Daniel Yu’s “Exporters Without Borders: Why You Should Start a Company Instead of Working in Aid.”

It’s a contrast to In Development’s inaugural piece on unconditional cash transfers (I find it brilliant that the magazine lets two opposite approaches to global development sit that close to each other), and Daniel does a great job addressing the usual objections to why value export is Africa’s surest bet to rapid development…But I am digressing.

After reading his article, I started looking for more information about his projects on the continent. Then I landed on Africa Jobs Fund, a Ren Phil-backed initiative to improve the continent’s welfare by export manufacturing and international labor mobility. The project’s thesis argues that these interventions are the most cost-effective in improving the welfare of Africans at less than $10 per year of doubled income, which translates to $25 per DALY; four times more cost-effective than GiveWell’s top performing charities and 50 times better than most livelihood interventions.

I was wondering if their model included losses due to skilled labour movement from the continent, and was thinking of a commentary on this when In Development published Charles Kenny’s Where’s My Ministry of Emigration?

In it, he described the benefits of emigration to origin countries: remittances, economic growth, and a brain gain effect where workforce vacuums encourage a ramping up of domestic supply.

But what about losses, though? Particularly, from health workers migrating? Who, by Oliver’s argument, are very valuable to destination countries.

For my master’s dissertation, I did a systematic review of the costs of health worker migration from the continent. My review showed that most of the literature focused on direct costs: capital losses from subsidized medical\nursing education and the associated ROI over the worker’s career. Only one paper modelled indirect costs: U5 and maternal deaths. And even that is just one way to think of indirect costs.

Charles took time to explain safeguards against these losses: bilateral trade agreements with destination countries, the need for source countries to ramp up training via expanding private (not public) education, and the provision of loans, etc.

I’m doubtful if this has worked in Africa. At the moment, the UK only has bilateral agreements with just two countries (Kenya and South Africa), and for good reason, 37 African countries are on the WHO’s health workforce safeguarding list.

Now, about the benefits of emigration to source countries: We can argue that emigration ramps up more training of health workers, as in the Philippines. But they are currently experiencing a shortage of nurses, and in 2022 removed an 11-year moratorium on the creation of new nursing schools. Furthermore, because the Philippines ramped up nursing training specifically for emigration and not to boost domestic supply, it created a trend where nurses worked mainly for the required work experience to emigrate.

This trend had a negative spillover during the COVID pandemic when the country placed a 6-month ban on health worker emigration. Experienced nurses refused to work, bidding their time when the travel ban was called off. Major contributors to this clocking-out trend were the poor pay and poorer working conditions in most of the country’s public hospitals.

Now the bit about remittances. Yes, remittances have a huge role to play in Africa. They have outpaced ODA flows to the continent in the last two decades and will continue to do so well into the future. However, these remittances are not cohesive enough to reach/impact the most vulnerable. Take Nigeria, for instance. The FP, along with the Ford Foundation, released a report on the state of Nigeria’s diasporan philanthropy. I gleaned two things: one, remittances for infrastructure are heavily skewed towards private housing and real estate rather than health, education, and other social infrastructure. Two, philanthropy is geographically skewed towards the South-Western region (which has one of the highest HDI in the country). The North-East, with the lowest HDI, receives the least flow of diasporan philanthropy. This report added credence to a newsletter where I argued that remittances from Africa’s diasporan health workforce do not reach the people most vulnerable to their emigration.

Am I anti immigration? Of course not. Everyone has the right to migrate to improve their welfare. Heck, I am a non-practising doctor living in England! But has my emigration contributed to my country’s welfare? Nope. To be brutal, I think I am part of the wave of health professionals who japa abroad for better pay, better living, and better working conditions.

But I believe that emigration can be a useful tool for improving the continent’s welfare. Hey, we have a young and energetic population! But we must be clear-eyed about the costs, benefits, and tradeoffs involved.