The Health Worker Exodus?
Chapter 8: The Costs and Benefits of Skill Drain
For half a century there has been concern over the extent to which the migration of SHWs constituted a skill or brain drain, if there was a significant loss or merely an ‘overflow’, and how costly this might be for the source countries. Despite the obvious significance of such issues, there has been remarkably little detailed analysis. Anecdotes, assumptions and crude estimates have tended to focus on worst-case scenarios, to analyse only part of the situation and to have been confined to a small number of cases. Countries that lose the most skilled migrants have been assumed to bear the heaviest costs, but this is not necessarily so. This chapter therefore seeks to provide a more detailed analysis of the costs, benefits and consequences of the skill drain, at various scales, although this too is necessarily fragmented and incomplete. Migration occurs in very different circumstances. For ‘source countries’, where the balance of flows is outwards, there is an overall loss of workers and thus a skill or brain drain. Early on it was argued for countries such as India and the Philippines that the flow was of ‘excess’ workers – an overflow – since national needs were adequately met. More recently it has been argued, for both India and Pakistan, that since the shortage of doctors was in rural areas and ‘most of those doctors who migrate overseas were unlikely to settle in rural areas’, it was not a loss (Dalmia 2006: 281; Aly and Taj 2008). In contexts where rural health...
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