Reasssessing 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.

Reflections on Brain Drain and Brain Gain in Nigeria

Over the holidays, a colleague of mine who has a thriving practice here in the United States shocked me and many of our friends when he said he was planning on returning home to Nigeria to set up a private clinical practice. In fact, he said he has shipped personal belongings and medical equipments to Nigeria. He said he believes he has learned all there is to learn in advances in medical science having undergone training in the United Kingdom and the United States. He said it is time to return to Nigeria and give Nigerians the benefit of the expertise he has acquired over the almost twenty five years since left the shores of Nigeria in search of greener pastures. One of our colleagues jokingly asked if the pastures were no longer and that he hoped he was making the right decision.

Today as I reflect on this conversation with our friend, I am once again drawn into the ever contentious exchanges on “Brain drain” and Brain gain”. Many have argued that my Nigerian professionals including physicians would not have reached full potentials and achieved professional expertise and competence if they had remained in Nigeria. May be and may be not. Others argue that even if this was the case, Nigerian professionals should return home after their training to contribute to the development of the country; after all to whom much is given much is expected. This is so much so when one remembers that most individuals in my generation were literally paid to go school. We all received bursaries, scholarships, and all kinds of grant to attend universities in Nigeria, and did not pay tuition.

So my friend is turning brain drain into brain gain by returning to Nigeria to contribute his expertise to health care delivery. Returning home to Nigeria is one way of turning brain drain into brain gain. Unfortunately, many Nigerian professionals can not take such giant leaps for fear of failure, insecurity, and an unfriendly practice environment that does not engender professional satisfaction and fulfillment. For the majority for whom returning home is not feasible, there should be other ways to give back to Nigeria and contribute to her development. Nigerian professional organizations in the Diaspora need to develop constructive, long-term sustainable strategies to develop particularly the education and health sector in Nigeria. The Diaspora Commission set up over a year ago is still bugged down with bureaucracy and has no tangible achievements to date. During my days in academia, I had Indian colleagues who go to India every summer to teach in medical schools and provide development workshops to practicing physicians. Such arrangements are done through their professional associations, are not done sporadically for self-recognition, develop clout, or for personal or political gains, but regularly in the overall interest of Indians.

Wherever you stand, or whatever your believes, “Brain drain” or “Brain gain” one thing is clear; Nigerians in diaspora particularly professionals need to be more involved in the rebuilding of the Nigerian state.

Reversing the Brain Drain Phenomenon

The subject of brain drain or professional intellectual loss from underdeveloped to developed countries remains a hot topic.This phenomenon is not unique to medicine and, in fact, encompasses many professional fields including other areas of science, humanities and professional sports.

To elaborate on the brain drain attributable to the medical profession, let me start by saying that many people choose to go into the medical field for various reasons. Most physicians have the gift of knowledge, forming the core of intellectual elites that elect to delay their gratifications from many years of educational torture that might eventually result in a comfortable life style.While many choose the profession to help others, some believe they do so because of the respect or prestige bestowed by the society at large. Others do so for money and yet others pursue the art of medicine because of their special gifts.

Whatever the reasons for choosing this noble profession, the fundamental act of practicing medicine must be supported by the right environment, offering adequate nurturing , security and diagnostic equipments to treat the sick and the injured. Any imbalance in this unique medical equilibrium will create an uncomfortable force that shifts the effort of the professional giver to look elsewhere and transport their expertise to a more favorable environment. Large scale migration of trained medical professionals whether from Nigeria, India or any other place seems to have the common denominators of poverty, lack of adequate medical infrastructures, poor security and inadequate allocation of health care funding. Thus the same brain that is been drained from one area can easily be filled elsewhere with the right environment. The transformation of acquired skill from a country with poor health structures is therefore not because of incompetent professionals or pure monetary seeking behavior, but rather because the new environment offers the right climate of innovation, improved experience, competency and well equipped facilities to entertain favorable and humane health care practices.