Reassessing the Notion of a "Brain Drain"

The idea of a drain hardly ever evokes a positive reaction especially in the context of the siphoning of intellectual capital from developing countries. The impact of the “brain drain” phenomenon has been hotly debated in development circles, particularly in relationship to the flight of health care workers who emigrate from countries facing incredible public health challenges. This has been discussed previously on the ANPA blog here and here. Outside of the usual culprits – corruption, bad governance, and the like – some are wont to place the blame of Nigeria’s health care struggles on the backs of doctors and nurses who participate in destabilizing the healthcare infrastructure by abandoning the country. Nearly one in ten Nigerian physicians practices in the United States or Canada. To add insult to injury, reports surface indicating that foreign-trained health professionals in developed countries, at times, outperform their home-grown counterparts – begging the question, why have we (Nigerians) not benefited from the fruits of our labour (that is, educating such professionals)? One may come to conclusion that while developing nations invest resources into the training of its professionals, developed nations are unfairly poised to reap the benefits of such harvests. However, this line of reasoning requires a serious rethink. In full disclosure, I must admit that I am a somewhat biased, since I am a product of Nigerian intellectual refugees, and would not wish it any other way. But, I cannot help but highlight a number of incorrect assumptions made by the above argument that may debunk the notion of the brain drain as the critical destabilizing force in Nigerian healthcare.

I’ve struggled with how best to say this without being offensive, but, the idea of that the Nigerian government has and continues to lose out on its investment into the training its healthcare force, is, quite simply, laughable. Investment, ke? When overall health infrastructure spending falls at a paltry 4% of a nation’s total budget, one can only imagine that how much less is “invested” into training the healthcare force – in terms of financial assistance for education and future career support. For the overwhelming majority of Nigerian physicians practicing both in Nigeria and abroad, the heavy lifting of such support primarily rested on self, family, benevolent communities and non-governmental organizations. Furthermore, the American Medical Association reports that more than half of African born physicians practicing in the United States spent a significant portion of their educational careers at American universities and hospitals.

While doctors and nurses play an irreplaceably essential role in a nation’s overall healthcare, one must remember that the success of any national healthcare system depends on far much more than its healthcare workers. The World Health Organization identifies a number of key components of an effective healthcare system, of which, interestingly, health care staff play a merely supporting role. Of chief importance are, again, good governance and financing, but also functioning information systems, diligent public health surveillance and access (to be distinguished from availability) to essential drugs and technologies. While the desire to return home and practice medicine in Nigeria remains a strong desire for many a Nigerian physician in the US, packing up and re-inserting oneself into a virtually non-existent health system may prove frustrating to both healthcare provider and patient. It goes without saying that organizations such as ANPA have and continue to contribute to the welfare of Nigerian patients and some Nigerian physicians in America, have in small groups, given back to their homelands, whether in financial assistance, educational support, or short-term projects. Though not yet quantifiable, doctors in the West may be contributing far more than they could have while in Nigeria and a mass exodus back to Nigeria, may prove counterproductive, particularly in the absence of policies and structures. It is critical, therefore, to reassess what is actually being drained and what the consequences are of haphazardly reversing that process.