The brain drain from developing countries to richer countries is widely seen as a negative trend. But voluntary migration is nuanced and complex
There is only one cancer treatment center in all of Zambia, a country of almost 20 million people. For many there, a cancer diagnosis also means high travel costs to and from the Cancer Diseases Hospital in the capital Lusaka. My former schoolmate Dorothy Lombe worked there as a radiation oncologist until she left her job for a position in New Zealand in the summer of 2021.
“I’m not sure if my special skills would have been used anyway,” she tells me on a video call, “and that was one of my biggest reasons for moving. It wasn’t really moving away, but it was doing more of what I love, which is radiation oncology.”
It’s the first time we’ve spoken to each other in years, but I’ve seen Dorothy’s updates on social media. Her medical and oncology studies took her to Russia, South Africa and Canada. Unlike me and some other schoolmates who left Zambia for university abroad, she has returned to work there. But it wasn’t easy, she tells me.
There were only three radiation therapy machines for the whole country and only one worked. She treated up to 60 patients a day.
Dorothy wanted to change that by opening Zambia’s first private cancer treatment center to take pressure off the public hospital. But she couldn’t get through. Despite Zambia’s glaring need for more cancer treatment facilities, Dorothy was unable to get the funds or support she needed.
Brain drain from migration: a “neo-colonial smack”?
According to the Vienna Center for Disarmament and Non-Proliferation, setting up a radiotherapy center in a country like Zambia requires an investment of around $6 million. The return on investment would have taken years, so Dorothy’s idea wasn’t convincing enough for investors. This contributed to her decision to leave Zambia.
While the cancer burden is increasing in low- and middle-income economies, there were only 664 practicing oncologists in these countries in 2018. It would not be unusual to conclude that Dorothy should have stayed in Zambia. Their departure resulted in the loss of a much-needed health worker.
But skilled workers shouldn’t be forced to stay, says economist and poverty researcher Johannes Haushofer. “Wanting someone to stay where they are, even though they might want to emigrate, is pretty patronizing,” he says. “This concern about brain drain has a neo-colonial tinge… wanting to keep people trapped in the places they are, whether they want to leave or not.”
Haushofer is the founder of Malengo, a charity that facilitates international educational migration from Uganda to Germany. The organization funds the first year of study at German universities for high-performing, low-income Ugandan students who agree to repay this money after graduation through an income-sharing program.
While the initiative aims to promote students’ education, it does not expect or encourage them to return to their home country. “Migration may not only be good for the people who migrate, but also for the people who stay behind,” says Haushofer.
Emigration creates opportunities beyond remittances
Remittances are often touted as a direct benefit to migrants’ families and countries. Malengo-sponsored Ugandan students send back their families an average of $165 a month, and that amount could increase with their income.
According to the economist Haushofer, the migration of skilled workers can also stimulate more investment in human capital. It shows others that studying can pay off and open a path to professional advancement.
The Philippines is a good example of nursing education. Filipino migrants make up 4% of registered nurses in the United States alone.
Zambia, where Dorothy and I went to school, has also trained more nurses as a result of the so-called brain drain – many of whom have gone to South Africa and the UK. Today, the South African country produces more nursing graduates than can be employed in both Zambia’s public and private sectors.
More than 20,000 registered nurses were out of work, according to a figure quoted in a BBC radio document earlier this year. In March, the government pledged to hire more than 11,000 health workers. Still, the numbers clearly show that a Zambian nurse who leaves the country may create an opportunity for someone else.
However, it is worth noting that those who leave the company are also more educated and experienced. Often they are professionals with a special field. Individuals like Dorothy have skills that they can’t always use in the countryside.
In addition to wanting a better salary and working conditions, they are looking for opportunities abroad where they can better thrive and grow in their profession. And that can be good for their country.
The return of the brain drain?
Working in another country does not necessarily prevent expats from contributing to their country’s economy beyond remittances.
“I’m definitely still involved in the Zambian health system as much as I can,” says Dorothy, “I’m very excited to support emerging Zambians who are interested in research as a mentor.”
And she has done so in the past. While on a medical fellowship in Canada, she helped organize a trip for her Zambian colleagues to learn about radiation oncology. And Dorothy still wants to return to Zambia to work one day. Therefore, she believes that one day she will apply the skills she learned in New Zealand, especially if she can set up a cancer treatment center in Zambia.
That comes as no surprise to Haushofer.
“Many of those who migrate do so with the intention of coming back,” the economist tells me. “And the education they get abroad is often a quality education that then benefits the home country,” he adds.
Return migration, remittances and membership in global networks that enable trade, capital flows and knowledge dissemination to their countries are just some of the many benefits that skilled migrants can bring to their countries, according to the World Bank.
So while the departure of a professional may very well create a gap, particularly in the healthcare sector, there are many other obvious benefits to the home countries of professionals going abroad.
Digital transformation is also helping to increase their potential to play a role in these economies. Remote work is also increasingly creating opportunities for expats to get involved in their home country. And it also allows someone like Dorothy to mentor health workers in Zambia or to network with others, including diaspora Africans like me.
While brain drain is traditionally understood as creating a gap, some believe the term no longer describes the reality of voluntary migration. Critics of the term say that new terminology is needed that reflects the complexities and nuances of skilled labor mobility between countries.