National development vs brain drain
Today’s theme evinces an inherent paradox. That’s because in one sense at least, national development cannot exist in a vacuum. By logically derivation, brain gains are a sine qua non for national development. Conversely, brain-drains undermine national development.
Fundamentally, there is nothing esoteric about national development. Simply, it seeks to address a basic question: is the quality of life of citizens in a given nation advancing or regressing? If it is sustainably advancing, there is national development. If it is not, then there is simply no national development.
Now, that proposition holds true if one considered the question in such absolutist terms. However, a degree of nuanced thinking is essential to address what, superficially, appears to be such a mundane question. It is in fact, a more complex question. Because, the parameters for evaluating national development, the quantitative metrics and qualitative measures, the remit thereof, must first be defined prior to attempting to tackle the poser.
Thus, for the purpose of this piece, the criteria for assessing whether or not there is indeed national development, would, of necessity, entail the quality of the national and sub-national leadership, the demonstrable beneficial impact of national policies, programmes and projects, on citizens as it pertains to national security, educational attainment, healthcare and well- being, public infrastructure, GDP and socio-economic development. It would also encompass the enduringly positive impacts of initiatives appertaining to employment, environmental stewardship, agricultural self-sufficiency, digital-inclusion, affordable and secure energy supplies, poverty alleviation, robust institutional capacity and, most importantly, human capital et al. This is the context in which countries frame national development plans over the medium to long term. They are policy frameworks to track progress against the aforementioned components with specific, measurable actionable, realistic and timely objectives.
For instance, South Africa’s National Development Plan seeks to eliminate poverty and reduce inequality by 2030. The United Arab Emirates’ National Development Plan is encapsulated in the UAE Centennial 2071 goals. It aims to project the Emirates’ soft power, transform higher education, advance economic development through public private partnerships, artificial intelligence and big data, whilst facilitating sustainable water security. The Nigerian National Development Plan 2021-2025 aims to unlock the country’s opportunities across all economic sectors.
The nexus of human capacity development, evidenced by the brain drain, especially in the medical sector, relative to its impact on national development is the arresting concern of this tome. Broadly, a brain drain entails the displacement and or loss of intellectual capacity, specialist expertise, knowhow, skillsets from one country to another. For instance, doctors, pharmacists, software engineers and technology developers whose primary, secondary and university education has been heavily subsidised by developing country A, upon graduation, exit for a developed economy, country B. In other words, a brain drain from country A, results in a brain gain for country B.
Why does this happen? Is it ethical? Does the economic logic trounce morality? Are the drivers for brain drain simply about a securing better quality of life? How, and if so, to what extent can they be curbed? In the absence of national development, are attempts at curbing it merely shadow-chasing? Is a brain drain a zero-sum game?
Historically, homo sapiens have always sought greener pastures and a better quality of life. This instinctive human desire informed the mass migration of the Alans, Alemanni, Bulgars, Franks, Goths, Huns, early Slavs into swathes of what is presently eastern Europe through AD 375 and 568. That innate desire was evident in the large-scale migration, of over 2,000,000 Jews from present day Russia and Ukraine to Western Europe and the United States through 1903-1906 and subsequently. Fast forward to 1972, in search of a better life, 25,000 Asians emigrated to the United Kingdom and another 6,000 emigrated to Canada, from Uganda. More recently in 2021, the United Nations High Commissioner for Refugees confirmed that there were 123, 300 individual crossings traversing the Mediterranean Sea into Europe. None of this is to suggest that the automatic corollary of mass migrations is a brain drain. No! Neither is the focus of this article on the how’s and whys of mass migrations; those are red herrings! Rather, it is to suggest that homo sapiens have always sought a better quality of life and will continue to do so. That reality, is the primary driver for the phenomenon characterised as the brain drain.
Ethics, within this precinct implies morality, conscientious beliefs and integrity of purpose as defined by an individual. It is therefore subjective. It follows that an individual’s exercise of his freewill to exit the very classless country A, where his medical education has been fully subsidized for country B, a much wealthier socially stratified country, whose brilliant students can barely afford medical school, will argue the purity of his motives. That is, his decision to exit A, for B, is ethical.
As between economic logic and morality, basic economics teaches that a man’s wants are unlimited, however, the means of satisfying them are limited by purchasing capacity. So, if country B, offers more a more compelling economic logic than country A, all other factors being equal, it is more likely than not, that a rational person would move to country B! There is, therefore, no contest between economic logic and morality.
Regarding curbing the brain drain, for as long as the orthodoxy of capitalism subsists globally, this would be almost impossible. That’s plainly because the laws of demand and supply dictate the price of a product or skill, and human capital will inexorably move in the direction where it is in greatest demand at a premium.
Situating the hypothetical countries, A, and B, for the purposes of this write up, the former represents Nigeria and the latter the United Kingdom. So, is there true national development in Nigeria to sufficiently stymie a brain drain? Or put differently, what are the real factors informing a brain drain from Nigeria to a brain gain for the UK et al?
The first, is perennial insecurity in Nigeria. In the last decade, there is no state amongst Nigeria’s 36 states and the federal capital, that is unblemished by ethno-religious terrorism, violent extremism, banditry or kidnapping. Over the last decade, terrorism has cost at least 27,000 lives, displaced some 2, 000,000 with the Global Terrorism Index ranking Nigeria 6th out of 10 countries according to the Institute for Peace and Economics. In the 15 months to March 2022, 19 doctors were killed or kidnapped (HumAngle).
The doctor to patient ratio in the UK is 2.8 doctors to 1000 patients; Austria 5.1 doctors per 1000 patients; and Germany 4 doctors per 1000; whilst in Nigeria it is 1 doctor per 4500 patients (World Health Organisation /British Medical Journal). Put differently, Nigerian doctors see 22 times as many patients as Austrian doctors! Invariably, Nigeria loses approximately USD 1.5 billion annually to medical tourism (Nigeria Medical Association). Compounding this, is the deplorable healthcare infrastructure in the country. And whilst there are modern private healthcare facilities in parts of the country, these are completely inaccessible to the vast majority of Nigeria’s circa 220 million population on grounds of affordability!
Yes, the country has made incremental progress in socio-economic realms recently, nevertheless, its human capital index ranked 150 out of 157. Major cross-cutting developmental challenges remain. These intersect overreliance on crude oil exports for foreign exchange earnings, weak institutions, governance concerns, insufficient infrastructure, crippling debt burdens, variable degrees of public finance stewardship and overlapping functions. Youth unemployment is 42.5%, general unemployment is 33.3% and a 21.34% inflation rate has hit average households hard (NBS).
These are humongous issues directly impacting supine claims as to national development. In fact, they need to be robustly addressed before there can be any real reversal of the country’s brain drain crisis in the medical profession. To illustrate, the UK’s General Medical Council confirmed that as of August 30, 2022, 10,096 Nigerian- trained, and Nigerian taxpayers’ subsidised doctors, had migrated to Britain. Likewise, as at 2020, over 3, 894 Nigerian-funded doctors were authorized to practice medicine in the United States and no fewer than 632 were practising in Canada within the same timeframe.
Is this a zero- sum game? Yes! Nigerian taxpayers’ train these doctors only for them to relocate abroad because the conditions just aren’t right for them locally. Of course, the Nigerian taxpayer loses! Nigerian patients lose! The Nigerian government loses its returns on investment on these brilliant doctors! The Nigerian exchequer loses of millions of dollars in potential fiscal revenues!
To conclude, it is entirely natural, and reasonable, for doctors and healthcare workers to search for greener pastures outside the shores of Nigeria where there is greater security, better conditions of service, career prospects, enhanced and effective healthcare infrastructure. That is to say, ethically, morally, and philosophically, there is absolutely nothing wrong with a brain drain, in the absence of sustained national development. And even with proven national development, human capital is a flexibly deployable resource.
However, challenging as it clearly is, it is not all gloomy. The brain drain can be reversed and these are my practical recommendations:
1.) Effective leadership. This implies vision, strategic leadership and the capacity to prioritize, in policy terms, effective healthcare improvements and reform.
2.) Improved security and welfare. For as long as insecurity and extremist terrorism persists in the country, it inexorably serves as a disincentive to healthcare workers’ retention.
Resolutely and successfully tackling insecurity nationwide could help reverse the trend of brain drain currently skewed towards Europe and north America.
3.) Demonstrable improvements in national development. Figuratively, this is akin to turning an oil tanker 180 degrees in short order. The point is that action and results are required.
4.) Better conditions and terms of service. Healthcare workers ought reasonably, to be adequately, competitively and properly incentivised. This will not only help reverse the brain drain, but also go a long way, in recognising the sparklingly heroic contributions of those outstanding physicians who have freely elected, to remain not just in Nigeria, but in public hospitals in the country, and deliver a selfless public service. They have the option to leave Nigeria for greener pastures, but have chosen to remain to treat patients. In fact, many of them in the course of their phenomenal public service have lost their lives. Should their lives be lost in vain?
5.) Enhanced public and private sector participation. The current system of public healthcare delivery is unsustainable and bursting at the seams! Innovation, competition and collaborative models are needed to enhance service delivery. The National Strategic Health Development Plan (NSHDP II 2018-2022), is laudable. However, its effects and demonstrable impacts are yet to be fully felt.
6.) Sustainable healthcare infrastructure. Smart (er) thinking is required in developing effective compacts and knowledge sharing with local and international partners including the US Department of Health, the WHO, NHS England plus, private partners to name a few.
7.) Increased budgetary allocations. Inevitably, there are always degrees of contestability and opportunity cost considerations in sectoral allocations by Government. For instance, how much should be allocated to education and what impact would that have on transport infrastructure? How would a reduction in defence expenditure impinge agricultural self-sufficiency? Will an increase in healthcare allocations adversely affect environmental sustainability and digital inclusion programmes? All valid posers. However, without a safe and healthy population, not much can be achieved. So, the argument for increased healthcare is insuperable.
8.) Reviewing funding options. As previously stated, the government is saddled with crippling debts, approximately USD 102 billion in 2022 (NBS). Policy experts should critically analyse the merits of a marginal tax increase that’s hypothecated strictly for healthcare. Plus, a compulsory healthcare insurance policy should be carefully considered with perhaps six months pilots in the six geo-political zones. Afterall, government alone cannot fund transformational healthcare and none of these recommendations are mutually exclusive.
Ojumu is Principal Partner at Balliol Myers LP, a firm of legal practitioners in Lagos, Nigeria.