January 2004, Volume 11, Number 1
Professional Migrants and Development
One of the fastest-growing types of international migrants are highly skilled persons moving from developing to developed countries, such as IT specialists and nurses. Does their migration speed or slow economic development in labor-sending countries?
A recent conference organized by the German development agency, GtZ http://www.gtz.de), highlighted the sharp contrast between most Asian and East European countries that welcomed the opportunity to send IT specialists abroad, and lamentations from African countries about the loss of doctors and nurses, often to ex-colonial powers. For example, India in 2002 had about $10 billion in revenues from exports of computer-related products, including services provided to foreign firms in India (outsourcing), a result of exporting IT workers and gradually moving from exporting labor to exporting services. The benefits of this emigration-led growth included a sharp jump in science and engineering graduates and the provision of world-class IT services to private firms and government agencies in India.
The spillover effects of what began as an island of 7,000 IT specialists in the mid-1980s may become even more significant, as India's world-class IT sector sets in motion a virtuous circle affecting everything from more government emphasis on improving the infrastructure to wider acceptance of merit-based selection systems. However, Indian success in transforming IT labor exports into service exports was not preordained. The Indian government opposed IT, fearing job losses, and it was multinationals in India who recognized the IT talent and moved Indians to their operations outside India. Indian firms such as Tata evolved to move Indian IT specialists overseas, and they soon saw the virtues of returning some work to India.
The Indian government bolstered the budding IT industry by reducing barriers to imports of computers, helped to assure reliable infrastructure, and allowed the state-supported Indian Institutes of Technologies to set quality benchmarks for education. India in 2003 had about 700,000 IT workers, an almost seven-fold increase in less than two decades, and sees itself alone in the low-cost, high-quality square of the cost-quality matrix, but with China and the Philippines copying the Indian strategy.
By contrast, the emigration of African doctors and nurses seems to have set in motion a series of vicious circles that leads to poorer health at a time when the need for health care is growing because of AIDS and recent initiatives to improve immunization. Emigration leaves especially rural areas with few health care staff, increases the work load on remaining staff, and prevents changes in what are acknowledged to be bureaucratic, top-down, and often staff- and patient-unfriendly health care systems. South Africa graduates about 1,300 doctors and 2,500 nurses a year from a system that trains health care providers to UK standards, but 40 percent of the South African graduates plan to emigrate as soon as they can. Graduates who received government support for their education must serve two years in rural areas before receiving their license, but this rural experience in unsupervised and poorly equipped and staffed clinics reinforces the desire of many to leave as soon as possible.
Health care is a peculiar sector, with government strongly influencing demand via provision of clinics and hospitals and charges for patients and drugs, and affecting supply via subsidized training and by setting salaries and working conditions. The South African case quickly becomes more complex because the government aims for and has both "first-world" and "third-world" facilities and staff, the staffing problem is most severe in rural areas with concentrations of poor residents, and there are both unfilled nursing vacancies and unemployed nurses in South Africa. For example, there may be only 7,000 South African nurses abroad, but there are 35,000 South African nurses in South Africa who are not working as nurses and 32,000 unfilled nursing jobs. Even if all South African nurses abroad returned, there would be unfilled nursing jobs.
There are many contrasts between IT and health care. IT is a perceived as a luxury rather than a necessity like health care, IT services are largely produced and consumed in the private sector, and IT can be provided with brains and ever-cheaper technology. Some argue that developing countries looking to increase their earnings from exports of human capital should look to the instances of inequalities in the international system, such as the wage gaps between IT workers and nurses in developed and developing countries, and aim to fill them with home-grown workers who can be sent temporarily abroad.
Educational finance influences the effects of sending professionals abroad on their countries of origin. Both India and the Philippines, for example, have private schools that teach nursing to US and UK standards, and have private financing and placement institutions to train and move health-care workers overseas, with hoped-for spin-offs that include "health tourism," as first the Diaspora, and later other patients return to "first-world" institutions for cheaper but high-quality services.
African countries can neither stop the exit of professionals nor expect compensation to be forthcoming from the countries to which professionals move. African countries could do more to retain professionals, including making health care institutions more employee-friendly, with better working conditions, more respect especially for nurses, and more clearly defined career ladders that have transparent criteria for advancement. Money is important, but it is not the only factor prompting the emigration of African professionals. Just as the return of overseas nurses would not fill as many vacancies as could be filled by persuading local nurses to return to work, so higher salaries alone will not fix systemic problems in human resources management.
The movement of professionals from developing to developed countries is neither a problem nor a panacea for development. Professional migration can accelerate development, as with IT specialists in India, and generate significant earnings from a country's human capital, as with Indian and Philippine health care workers. The African case of health-care worker emigration may reflect a "worse case" of sharply rising demand for services coupled with active recruitment from countries with similar systems, especially the UK. In the UK-African commonwealth case, initiatives such as "ethical recruitment," which avoids active recruitment by public sector hospitals in the poorest countries, may mitigate the controversy over health worker emigration without fixing underlying human resource issues in health care systems in both areas.
The migration of professionals from developing to developed countries is likely to increase, but it appears that each flow must be evaluated separately to determine ifs effects on development. The cases of Indian IT specialists and South African doctors and nurses may represent the two extremes of a very wide spectrum of cases.