BibiWhile countries may encourage the exodus of skilled workers in exchange for remittances, they are also concerned about losing their best-educated professionals, thinkers and entrepreneurs, potential future leaders, to other countries.

In spite of migrants’ remittances, when the proportion of educated workers represents a substantial share of the migrant population, migration generally results in a severe net loss to the source country. Source countries lose not only the services of skilled professionals but their contributions to productivity. They also see no return on their investments in educating highly-skilled workers.(1)

Bibi is one of the thousands of health care workers from developing countries who plan to go to Europe or North America in search of a well-paid job. Her plan to migrate is not exceptional: she lives in a region that sends abroad a high proportion of its skilled professionals. In fact, the Caribbean has the highest percentage of migrating skilled workers in the world. The latest figures on skilled migrants in Suriname show that almost half the educated labour force left the country between 1965 and 2000.(2) Due to migration, the educated labour force of both Jamaica and Haiti has been reduced by 85 per cent.(3)

In some middle-income countries, governments train young people for work abroad. For example, the Philippines places trained nurses in OECD countries such as the UK or the US immediately after graduation.(4)

Although they account for a small proportion of labour migrants, healthcare workers who move represent an irreplaceable loss in human resources to already weakened health systems in developing countries.(5) According to the World Health Organization, about 23 per cent of doctors trained in ten Sub-Saharan African countries are currently working in eight OECD countries, in particular, in English speaking countries. At the same time, the HIV/AIDS epidemic has rapidly increased the demand for health care workers in the region, given not only the growing caseload but the impact of HIV/AIDS on health care workers themselves.

Better remuneration, living conditions and security in receiving countries, and lack of facilities, promotion incentives and prospects in their own countries, are among the principal reasons given by physicians from Cameroon, South Africa, Uganda and Zimbabwe for moving abroad.(6)

A few source countries are experimenting with innovative programmes that address some of the conditions driving migration. Ghana for example, which has lost about 69 per cent of the physicians and 19 per cent of the nurses trained between 1995 and 2002, has adopted a “brain gain” action plan that includes incentives such as overtime pay, cars for doctors and other non-financial compensations. The plan has already yielded positive results among doctors.(7)

The Philippines is also trying to bring healthcare migrants home after a period of service abroad. In 1995, the government created the Philippine Overseas Employment Administration which developed an incentive-based programme including loans and subsidized scholarships for returning workers.(8)

Receiving countries can also contribute to reduce the flow of qualified migrants by abstaining from recruiting in countries with shortages of health care workers; sending countries see this as good ethical practice. South Africa and the UK for example have signed agreements to collaborate in exchange programmes for health workers; twinning partnerships among institutions, and sabbatical leaves to encourage short-term movement among health care workers of both receiving and sending countries, with the expectation of removing some of the factors that make health workers leave for good.(9)