The developmental impact of the highly-skilled: developing countries of origin
In the migration and development debate, most attention has focused on the impact of the exodus of the highly-skilled on countries of origin: that the loss of the skilled has been prejudicial to the development prospects of countries across the developing world. This viewpoint has been at the root of the so-called ‘brain drain’ and developed countries are seen to be ‘poaching’ the best and brightest, perhaps most particularly from the health sectors of the developing world. Thus, the developed world, by taking the skilled whose education and training were paid in whole or part by poorer countries, is part of a global system of unequal relations. This interpretation is but part of dependency theory, in which the developed world/Global North stymies the development of the developing world/ Global South through the exploitation of its human capital. However, the evidence from recent decades has not been supportive of this simple binary interpretation and more nuanced views have emerged.
The starting point must be the underlying pattern of the absolute size of global flows of the highly-skilled. These are dominated by movement originating within the countries of the developed world itself, plus a relatively small number of middle-income developing countries such as the Philippines, India, Mexico, and China. Size, location, and historical ties are important explanatory factors, plus the fact that in order to be significant sources of skilled migrants, the institutions to produce them must be well established in those countries. This means that certain countries in Europe that are now seen as countries of net-immigration, such as the United Kingdom and Germany, are amongst the largest suppliers of skilled migrants. Around the year 2000, the United Kingdom, for example, had a larger stock of skilled migrants overseas than any other country at 1.14 million (Docquier and Marfouk 2006, 175) and in 2013, it had a larger stock of emigrants as a percentage of total population than a country normally seen as a ‘classic’ country of emigration, the Philippines: 8 per cent for the United Kingdom against 6.2 per cent for the Philippines (World Bank 2016). The composition and pattern of the flows are very different from the two countries but the United Kingdom remains a major country of emigration; its out movements are mainly to other OECD countries and some 37.8 per cent of the UK stock in those countries consist of the tertiary educated (World Bank 2016, 259). The term ‘brain drain’ was first coined with reference to the movement of large numbers of scientists and engineers from the United Kingdom, mainly to the United States, Canada, and Australia from the late 1950s, but evidence of a strong negative impact of this movement on the economy remains elusive (Hatton and Price 2005, 164). The key point remains, however, that the skilled migration system is not simply from the developing to the developed world but, at the global level, is largely an interchange of brains within the developed world.
One can argue that any impact of the skilled on countries of origin is not simply a matter of numbers: a small number of skilled workers leaving a poor country could have a major impact on weak economies. The global data shows that the vast majority of countries where the highest proportion of skilled were to be found outside, were small and primarily island countries (Docquier and Marfouk 2006). Some 89 per cent of skilled Guyanans were to be found outside Guyana, for example. The figures for Grenada, Jamaica, St Vincent, and the Grenadines and Haiti were all in excess of 80 per cent and many countries had over half of their skilled overseas. Such figures for small countries are suggestive of a serious loss of skilled personnel and perhaps evidence of a brain drain.
The impact of emigration of skilled people is going to have different consequences depending upon the size and robustness of the economy of origin. However, a number of factors need to be brought into the discussion before any conclusion of either a negative or a positive impact can be drawn. The first relates to the types of data available. The data presented above refer only to the number of skilled by country of birth and country of present residence, which follow the current international definitions of international migration. The data tell us nothing about where the migrants received their education and training. While the majority may have received their basic primary, and even secondary, schooling in their countries of origin, an assumption that certainly may not universally apply, the critical tertiary education for them to be classified as ‘skilled’ is more likely to have been gained abroad. Conversely, if data is only available on the place of training, the loss to countries where the leading universities or training schools are located will be exaggerated. Rarely is information on birthplace (or citizenship), place of training and place of practice available.
As mentioned above, many poorer and smaller economies do not have the institutions to provide advanced education within their boundaries and those wishing to pursue tertiary training will first have to migrate as students to a more developed country or to a regional centre. For example, the University of the West Indies serves all 18 English-speaking Caribbean countries from its largest campus at Mona in Jamaica, and other campuses in Trinidad and Tobago and Barbados. For the island economies of the Pacific, the University of the South Pacific in Suva, Fiji, performs a similar function, although more recent campuses have been established across that vast region, with the largest in Samoa and Vanuatu.
Like the flows of the skilled in general, it is the developed countries of North America, Australasia, and Europe that dominate the destinations of the global inflows of students. From less than a million international students around the world in 1975, through 2.1 million in 2001, the total had risen to over 5 million students in 2018, about half originating in China and India (HE 2018). Large numbers do go back to participate in the development of their home economies as long as opportunities exist. This has been the case with China where the incidence of return in 2017 represented about 90 per cent of the number leaving, compared with only 10 per cent in 2000 (Zhou 2018). Increasing rates of return were also observed during the much earlier development of Taiwan from the 1960s and Korea from the 1970s (Skeldon 1992) and yet the pronounced ‘loss’ of these bright young people was not negative, as shown by the subsequent rapid development of these economies (Adams 1968). Rather, these flows are an integral part of the development of origin countries and their future volume and direction will be a function of the subsequent economic transformation and evolution of their education systems.
These flows are about securing credentials that have weight in the country of origin and are recognised internationally, hence widening access to labour markets. However, part of the ‘brain drain’ argument is that the exodus of the skilled also represents a loss to countries of origin in terms of the costs of training, which for tertiary education are high in terms of investment per capita. Certainly, the cost to a country like Ghana, where over one third of Ghana-trained doctors leave (Bhargava, Docquier, and Moullan 2011), might be seen to fit this scenario but a look at the sources of funding of foreign students in the United States in 2017—18 showed that the primary source of funding was family or personal: some 82 per cent for undergraduates and 60 per cent for graduate students. Foreign government sources accounted for 7.7 per cent of undergraduate education of foreign students and 3.8 per cent for graduate students (HE 2018). Thus, the new wealthy of China and India in particular are the main sources of student funds for overseas education in which remittances must play a not insignificant part.
Whether a country would have developed faster had the youth and the skilled stayed at home is the counterfactual, which raises a number of different issues, the most important of which is if migrants could have been either gainfully employed or absorbed into appropriate further education in their economies of origin. Those economies might lack the facilities to provide adequate tertiary education or are already experiencing high unemployment. That is, does the migration of the skilled or educated youth act as a safety valve to reduce the number of talented people who might become tin- or underemployed and who ultimately might cause problems for origin governments? Such hypothetical questions are difficult to answer but attempting to prevent the migration of clever people seems counterproductive.
They will always find ways to migrate irregularly, which is never in the best interests of the country of origin or destination, or the migrants themselves.
An extension of this argument is the question of the most appropriate training needed by developing countries of origin. Clearly, a country like Ghana should have a first-rate medical school to train medical personnel to the highest standards, but policies to educate students to global standards will mean that many will choose to migrate globally. A question exists whether such highly-trained doctors are the best suited to work in isolated rural areas where facilities will be limited and where the key health-development challenges will be in the area of public health to reduce infant, child, and maternal mortality. The deployment of doctors trained to the highest international standards to isolated parts of rural developing countries may not be the best use of a scarce resource and would not be the most appropriate personnel to deal with the basic challenges facing these areas (Clemens 2007). Many will be unwilling to go to isolated areas in the first place and rates of drop out are likely to be high for those who do go. In order to produce and retain a cadre of medical personnel that will meet the main demands of the least developed parts of poor countries, policies to recruit in those areas and train to basic levels of medical care may be a more viable strategy than relying on highly-trained personnel. Specialist skills will be required but these may be better supplied through volunteer doctors, see below, or the use of modern communication between those with paramedical skills in the rural sector and specialists in base hospitals.
Any crisis facing health in some of the poorest countries in the world seems unlikely to be caused by the emigration of the skilled. More trained health professionals in some African countries are to be found outside the public health sector but within their country than there are medical personnel from those countries practising outside the country. (Clemens 2007, 37). For example, in South Africa, at a time when 32,000 vacancies for nurses existed, some 35,000 nurses were inactive or unemployed in the country itself (OECD 2004). Trying to slow or stop the emigration of skilled medical personnel from developing countries might help to reduce child mortality and increase the uptake of vaccinations but not to the extent of having a significant impact on overall trends (Bhar-gava, Docquier, and Moullan 2011). Even for small island economies alone, it has proved difficult to attribute any specifically negative impact on the health service to the loss of skills through migration (Connell 2009, 150). Other factors such as levels of pay, promotion prospects and working conditions within the service that have given rise to strikes and low morale are likely to be more important. Nevertheless, the international community has taken on commitments to introduce codes of practice that will, if not prohibit, at least encourage responsible recruitment of skilled migrants from developing countries. The 2010 WHO voluntary code to promote ethical recruitment of medical personnel or the United Kingdom’s commitment to prohibit direct recruitment into the National Health Service from all developing countries except India and the Philippines, which have government-to-government agreements on this issue, are examples of this intent.
In contradistinction to the dominant brain discourse, some have argued that the exodus of skilled migrants can be beneficial to countries of origin (Mountford 1997; Stark 2004). Once the idea that leaving a country to obtain employment in a specific profession becomes diffused within the society, more and more young people will enrol in the types of courses or training that will then allow them to follow in the footsteps of earlier skilled migrants. However, because the skilled are required to pass through the filter of the immigration policies of destination countries, not all will be selected and at the end of any specific period, a country is likely to be left with more people in these skill categories than it started with at the beginning of the period. Assessments of this ‘new brain drain’ literature, however, suggest that the empirical evidence to support the case is weak (Schiff 2006; Lucas 2005). Nevertheless, as suggested above, the evidence to support the argument that the exodus of the skilled stymies development is equally weak. Other factors are more important and the movement of the skilled has to be conceptualised within a broader matrix of change in which the movement is more a consequence than a driver of that development.
This does not deny that the migration of the skilled is important as a provider of critical services at particular times and in particular places. Often excluded from the discussion of brain drain is the importation of skills to the developing world on a temporary or longer-term basis. These can come from two, not necessarily separate, sources. The first are foreign civil society organisations, medical missionaries or organisations such as Doctors Without Borders, or directly through foreign government programmes. In the health field, perhaps the most famous programme involves many thousand Cuban doctors providing services in some of the most isolated parts of Latin America and sub-Saharan Africa. Estimates vary, but perhaps 37,000 doctors and nurses are working in 77 countries, bringing not only basic medical care to poor people but also some 8 billion dollars a year to Cuba itself in revenue (Wharton 2015). Such flows are subject to the vagaries of political change with the expulsion of up to 8500 doctors from Brazil following the accession of Jair Bolsonaro as president in January 2019. This mass expulsion will have a profound impact on millions of poor Brazilians in some 1500 remote municipalities where Cuban doctors provide the only source of medical care (Alves 2018). Thus, brain drains can indeed occur with potentially devasting effects in scenarios of forced migration, emphasising the need to bring such flows into the discussion of migration and development.
The second source of outside expertise, and one which has been a recurrent theme in the global migration and development debate, is the diaspora. Countries of origin may seek the skilled living in destination countries in the ‘Global North’ on a temporary or longer-term basis to provide training in universities or medical schools or the financial investment required for particular development projects. Circular migration of skilled long-term residents, immigrants to the developed world, back to their home countries may be one viable pathway through which to promote development (see Chapter 13 in this Handbook on diasporas). This form of migration is a key part of the international knowledge transfers that are central to the whole idea of development.
While the skilled in the health sector relate to the provision of services that impact on key developmental variables associated with mortality, the movement of the skilled from other sectors can be as important and no more so than in education, where several parallels with health exist. Teacher shortages and the difficulty of retaining teachers in rural areas are serious policy concerns, together with the perceived loss of skilled personnel, perhaps particularly from small and mainly island countries. In 2004, a Protocol for the recruitment of teachers, with clear parallels to the code of conduct for medical personnel, was adopted by Ministers from Commonwealth Countries (Commonwealth 2004). Equally clearly, those with other skills in IT, agronomy, engineering, and so on are also important to the whole process of development. Nevertheless, any attempt to associate the movements in or out of any country with developmental variables is likely to be fraught with difficulty. Not everyone in any particular skill category is equal, which introduces the importance of that nebulous issue of quality into the discussion. A very few driven skilled individuals may make all the difference in implementing health, education or other development programmes in ways that are difficult to measure even if the results are clear to all.