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Mar 16, 2006 - In my previous commentary on the 10/90 Gap, I discussed the severe shortage of manpower in the field of health research in developing.
Journal of Perinatology (2006) 26, 246–247 r 2006 Nature Publishing Group All rights reserved. 0743-8346/06 $30 www.nature.com/jp

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Global notes: brain drain or brain power – human resources in a globalized world D Vidyasagar University of Illinois at Chicago Medical Center, Chicago, IL, USA Journal of Perinatology (2006) 26, 246–247. doi:10.1038/sj.jp.7211486; published online 16 March 2006

In my previous commentary on the 10/90 Gap, I discussed the severe shortage of manpower in the field of health research in developing countries.1 I also pointed out that capacity building of health professionals in conducting research is one of the major goals of Global Health Research Forum. Interestingly, shortage of highly skilled professionals has been a problem for both developing and developed countries. Indeed, the problem of losing skilled scientists from Britain was noted as early as 1950s. It was the British Royal Society that coined the expression ‘Brain Drain’ to describe the outflow of scientists and technologists from UK to US and Canada.2 It is indeed a myth that the problem of Brain Drain only affects developing and transition economies. Rich countries such as UK, Germany, Australia, and Canada also suffer from this malaise. However, poor countries face greater challenges when they lose their skilled professionals. These countries spend enormous amounts of money on education of the professionals only to see them go to greener pastures. It is estimated that there are 10 million African-born emigrants living in US, UK, and other countries outside Africa. One-third of the African budget spent on education of African nationals is working as a supplement to the American education budget, as most of the African graduates end up in USA. In effect, the African countries are giving developmental assistance to USA!3 With the loss of professionals, the countries are unable to sustain a stable middle class society, which is essential for the growth of the country. Same is true of other countries such as India and Philippines, which supply large number of health professionals (Doctors and Nurses) to UK, Canada and USA. The article ‘Brain Drain Costs India Billions,’ which appeared in Times of India,4 quoted the 2001 UNDP report that India loses $2 Billion a year in resources because of the emigration of computer professionals to USA alone. Why do professionals emigrate? There are many reasons: professional satisfaction, ambition, increased earning and better Correspondence: Dr D Vidyasagar, Division of Neonatology MC 856, University of Illinois at Chicago Medical Center, 840 S Wood Street, Chicago, IL 60612, USA. E-mail: [email protected]

future for the children. The statement is true for any profession. There is also a migration of scientists and professionals from one developed country to another developed country. This phenomenon of ‘Brain Circulation’ is indeed healthy and has higher dividends. Brain Circulation in itself has several advantages for the three parties involved: the scientist, the host and the guest countries. Scientists gain new experience; the host country gains new expertise; and upon return to their country, the new experience enhances further research. Not all scientists ‘circulate.’ Many remain in the host country which gains the most. US is a major beneficiary of the process. One can only look at the number of foreign-born US Nobel Prize winners. At least one-third of the Nobel Prize winners in Medicine and Physiology during 1901 to 2000 were immigrant scientists.5

Migration of health professionals Extensive studies indicate that health professionals migrate to developed countries for several reasons. The core issues include: the lack of availability of facilities to practice medicine in the country of origin, for postgraduate education and for better economic opportunities. Among the many countries which lose their doctors (India, Philippines, and African countries), sub-Saharan countries are the most affected in the world. The emigration of doctors from sub-Saharan African countries has left many a country with national crises in providing health care to people. Some countries have experienced a loss of physicians to the extent that more of their doctors are outside the country than in the country. Eastwood et al.6 discuss loss of health professionals from sub-Saharan countries. Of the 47 countries, 24 have only one medical school, 11 do not have any at all. Yet, the number of doctors who immigrated into UK in 2003 was staggeringly high. UK approved entry of 5880 health professionals and doctors from South Africa, 2825 from Zimbabwe, 1510 from Nigeria, and 850 from Ghana. It is noted that only 50 out of 600 doctors trained since independence are still practicing in Zambia.7 These migrations not only reflect manpower losses but enormous economic losses for countries. Each migrating health professional costs $184 000 to Africa.

Global notes D Vidyasagar

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Stilwell8 analyzed the loss of health professionals from Nigeria. About 20 000 health professionals migrate from Africa annually. The annual legal Migration of Nigerian nurses to UK increased from 347 in 2000 to 2001, to 432 in 2001 to 2002: causing a great threat to the sustainability of health care in Nigeria. Where do professionals migrate to? US is the center of attraction for skilled workers from around the world. Since early 1990s, close to a million highly skilled professionals from India, China, Russia, and some from UK, Germany, and Canada have entered the workforce in US. US is also the center for 32% of all foreign students studying in the OECD countries. In total, 40% of its foreign-born adult population has tertiary level education, the main driving force that fuels the scientific and economic engine of America. As of 1995, 79% of the students with doctoral degrees is from India and 88% from China in 1990 to 1991 remained in USA . Same is true of migrant population from the Caribbean region.9 Majority of them continue to stay in US and add to the Brain Power and the associated economic growth of the country. Brain drain or brain bank? Mrs Gandhi, the visionary Prime Minister of India during 1970s to 1980s, is quoted to have said that losing scientists to developed countries ‘is not brain drain but it is a brain bank’ that the country can draw upon. Indeed, schemes were developed to invite expatriate scientists to India to interact with scientists and industries. On the economic front, the expatriates’ remittances to their country of origin have exceeded the foreign aid. The amount of remittance to home countries in 1995 was only US $70 billion; in 2003 it was estimated to be more than 100 billion USD. Close to home, the immigrants from Latin America have contributed over $32 billion dollars to their county of origin, an amount that exceeds US aid.9 Reverse brain drain: the future Although the poor countries are experiencing Brain Drain of health professionals, in other fields, especially in the field of computers and information technology. The phenomenon of reverse Brain Drain and Brain Power is being discussed in the business world of the rich countries with great interest. When countries like Taiwan, Korea, Japan in the past, and India and China most recently, create the right environment of openness, of freedom from governmental restraints and of promotion of science and free market economy, there is hope for the return of expatriates. The UNDP10 report identified the return of IT companies backed by Indian expatriates to the city of Bangalore as one of India’s success stories. Other countries are following suit.

The challenge is to keep their skilled professionals ‘at home’ through various incentives. Return of the Brain Power, however, occurs in small doses and in few countries. In a recent book, ‘Flight Capital: The Alarming Exodus of America’s Best and Brightest,’11 the author says that as many as 1000 former US immigrants leave US every day. Heenan, the author, expresses severe concerns that such reverse Brain Drain may create a generation gap in human capital for America. The same fears expressed by the poor countries so far. I would argue that Brain Mobility or circulation is good for the global economic health. The fears are based on the old paradigm that existed before globalization of trade and communication: once you are out of the country, your bearings are out. It can be speculated that current well-developed communications will only become more sophisticated in future. Whether you are in New York City Wall Street or in a remote corner of the world, you are instantaneously connected to the world by the tail of the mouse. Managing business through Internet makes the physical presence/ residence of a skilled person in the country less important. This is substantiated by the shifting of call centers to India and elsewhere. In essence, we foresee the world to become a TRUE GLOBAL VILLAGE, where each one of us, although thousands of miles apart, will be connected to each other in every aspect of life. The term Brain Drain, then, will become irrelevant.

References 1 Vidyasagar D. Global Notes: the 10/90 Gap – disparities in global health research. J Perinat 2006; 26: 55–56. 2 Cervantes M, Guellec D. The Brain Drain: Old Myths, New Realities. OECDObserver; May 2002. http://www.oecdobserver.org/news. 3 Kaba AJ. Africa’s migration brain drain: the costs and benefits to the continent. Chimera; The Creation of Imagination, vol. 2: 3, Fall-Winter 2004. 4 Brain Drain Costs India Billions. The Times of India Online mhtml:file:// C:\Documents and Settings\ekoh\Local Settings\Temp\11 July 2001. 5 Raju TNK. The Nobel Chronicles. A Handbook of Nobel Prizes in Physiology or Medicine, 1901–2000. 1st Books Library Inc, 2002 pp 478. 6 Eastwood JB, Conroy RE, Naicker S, West PA, Tutt RC, Plange-Rhule J. Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK. Lancet 2005; 365: 1893–1900. 7 Report of Global Commission on International Migration. 2005, www.gcim.org. 8 Stilwell B. Migration of health-care workers from developing countries: strategic approaches to its management. Bull World Health Organ 2004; 82: 595–600. 9 Lowell L. Skilled Migration Abroad or Human Capital Flight? Migration Information Source. June 1, 2003. http://www.migrationinformation.org. 10 Kanth DR. India Set to Witness Reverse Brain Drain. Deccan Herald; June 23, 2005, http://www.deccanherald.com. 11 Heenan D. Flight Capital; The Alarming Exodus of America’s Best and Brightest. Davies-Black Publishing: Mountain View, CA, 2005. Journal of Perinatology