I took the title of this post from the BBC report which, like many, many others, implies that African doctors and nurses working abroad are causing major problems in their home countries.
The author, Michael Clemens, of the original paper has said in a blog post that he is very uneasy about these conclusions being drawn and has written another to show that there is little evidence for the assumptions.
The reasons that it may not be a negative picture can be summed up as follows:
- The doctor or nurse may be following up an opportunity unavailable at home.
- The salary may be five or ten times as high as in Africa, enabling support for families left behind.
- The main causes of death in Africa are more dependent on prevention than care, for example: diarrhoea, malaria, HIV.
- Many of the care givers in Africa, sometimes as many as two-thirds, live in or near the main cities, so the majority of people who live in rural areas at great distances from the cities are unlikely to be affected by a doctor leaving to work abroad. Many rural clinics can find no-one at all to fill vacancies.
- The option to emigrate has positively encouraged Africans' decisions to enter the health professions.
Michael Clemens' final paragraph:
If you think that limiting the movement of Ghanaian doctors is justified by the fact that Ghana doesn't have enough doctors, ask yourself: Does Ghana have enough entrepreneurs? Does it have enough engineers? Does it have enough wise politicians? The answer is 'no' across the board, so the logical conclusion of this sort of thinking is that we will somehow develop Ghana if we stand at the airport and prevent all Ghanaians with any kind of skill from leaving, preventing them from accessing the very high-paying jobs to which most of us living in rich countries have access by birthright alone. That is ethically problematic at a minimum, as well as ineffective -- trapping entrepreneurs in Ghana would not produce an efflorescence of investment.
The situation is very much more complex than it seems at first sight.