This AfricaFocus Bulletin contains an excerpt on Migration and Development from a longer study by the AfricaFocus editor published in 2011 by the Nordic Africa Institute, "African Migration, Global Inequalities, and Human Rights: Connecting the Dots."
A specific illustration of how issues such as the "brain drain" need to be considered by looking at both receiving and sending countries can be found in another AfricaFocus Bulletin sent out today, and available on the web at http://www.africafocus.org/docs12/bd1202a.php This contains excerpts from a new study published in the British Medical Journal, providing quantitative estimates of the losses to nine sub-Saharan African countries (and associated gains to recipient countries) from the emigration of doctors to the United States, United Kingdom, Canada, and Australia, reaching a cumulative total of at least $2 billion. This raises the question of how to compensate the countries who provided these doctors for their de facto subsidies to the countries receiving these skilled workers.
This brief review of specific issues related to migration and development offers no new policy solutions. The objective is rather to illustrate how a human development framework, combined with consideration of global inequalities, can provide a broader context for policy debate. Developing "win-win-win" policies on migration requires building a consensus in favour of "inequalityreducing" human development. In short, development should be redistributive, both globally and within countries.
The challenge of measuring global inequality, or other inequalities based on units other than countries is, of course, substantial, since statistics are based on national boundaries. Thus one can relatively easily generate measures within a specific country or between countries. But finding comparable measures for groups that overlap country borders, such as people born in a specific country (including those now in the diaspora), is more difficult. Nevertheless, the first step is to call attention to the need to do so. Migration systems and networks, as well as specific processes such as the transfer of remittances, operate both within and across national boundaries. In order to understand the dynamics at work, it is important to consider the wider set of relationships, including inequalities, between sending countries and receiving countries. Thus, whether in binational or multinational terms, one might advance migration within the broader policy goals of reducing inequalities. One might develop a measure of inequality across the countries within a migration system, such as Western Europe-North Africa, or within the Southern African region, combining within-country and between-country inequality as in the measures of global inequality discussed above.
Or, while maintaining the focus on a particular sending country, one could develop measures of "income per natural" as well as "income per resident." As advanced by Clemens and Pritchett (2008), such a measure would look at the income for the population born in a specific country, including both residents and migrants living outside the country. Such a measure might indicate, as Clemens and Pritchett argue, that migration is one of the most important means of poverty reduction for a large portion of the developing world. Crossing international boundaries, they argue, is not an "alternative" to development; it is in fact one of the components of development, significantly raising the average income of the set of persons born in a specific country.
Since the World Bank's focus on the issue in Global Economic Prospects 2006, remittances have become part of the mainstream discussion on development. The most recent estimates from the World Bank (2010) note that recorded remittances to developing countries worldwide will recover to $325 billion in 2010, up from $307 billion in 2009, and may even exceed $370 billion by 2012. Despite declines due to the world economic crisis, remittances were more resilient than other financial flows, and remained almost three times greater than official development assistance (ODA) to developing countries.
There is a growing consensus in current research and policy debate that remittances should not be seen as substitutes for other sources of national financing, such as development assistance or foreign investment. Their economic contribution, channelled principally to direct family needs, is valuable in its own right, not only for the individuals and households receiving it but for national economies. As part of their mixed strategies for survival and advancement, households often combine international remittances with those from family members working in urban areas in the home country.28 It follows that attempts to tax remittances or to channel them into development projects are likely to be less effective, from a national development standpoint, than helping households access and invest these remittances for their own survival and betterment, including in health and education.
The costs of sending remittances, which go principally through money transfer operators rather than through the banking system, are high. Although transmission costs have decreased somewhat worldwide, from 9.8% for a $200 transfer in last quarter of 2008 to 8.9% in the first quarter of 2010, the reduction was principally in the U.S./Mexico corridor, with rates remaining high in Africa.29 Substantial savings could be achieved by introducing greater competition into the system, and a Global Remittances Working Group initiated by the G8 countries in 2008 has called for reducing the cost by 5 percentage points over five years. By requiring providers of remittance services to be more transparent about fees, the Wall Street Reform and Consumer Protection Act, signed into U.S. law in 2010, has the potential to give greater leverage to remitters. But the global remittance market is still dominated by large players such as Western Union and MoneyGram, which face little competition in many smaller markets.
While greater competition may bring about incremental reductions in remittance costs, the extent of competition also depends on the size of the national markets and the extent of government initiatives specifically aimed at promoting lower costs. According to the World Bank, SubSaharan Africa has the highest average cost among regions, at 11.57% in the third quarter of 2010.
A promising advance in some African countries is the introduction of money transfer via mobile phone, beginning with M-Pesa in Kenya. This trend is likely to continue. But it has as yet had little impact on transfers across national borders. If regulatory barriers could be overcome, this technology could have a very substantial competitive impact on lowering international remittance costs as well, particularly between neighbouring countries within Africa.
The reforms needed for accurate reporting of data of illicit financial flow are daunting. They include transparency on country-by-country accounts of multinational corporations, documentation of the true residence of beneficiaries of banking accounts, and exchange of tax information between governments in the case of suspicious transactions. In contrast to remittances, however, the amounts involved in individual transactions are likely to be substantial. In looking at the results for inequality within and between countries, and among those born in a country (including diasporas), such flows should also become an essential part of the migration and development debate.
Nevertheless, despite a significant body of research, reliable data are elusive, and effective solutions even more so.32 For Africa, where the total rate of emigration was 1.8% in 2000, the rate of emigration of high-skilled workers was more than five times greater, at 10.4% (Marfouk 2007: 17). Twenty-five African countries had high-skilled emigration rates of 15% or more. The top ten were Cape Verde (67%), The Gambia (63%), Mauritius (56%), Seychelles (56%), Sierra Leone (53%), Ghana (47%), Mozambique (45%), Liberia (45%), Kenya (38%), and Uganda (36%). The largest absolute number of high-skilled emigrants came from countries with larger populations, including South Africa (168,000), Nigeria (149,000), Egypt (149,000), Morocco (141,000), and Algeria (86,000).
The most extensive policy debate on skilled migration has dealt with health workers. However, there is now a growing consensus that the principal responses to date have been ineffective.34 These include measures to prohibit migration of skilled workers (not only ineffective but also in violation of the rights of migrants themselves) or to pay incentives for return (of limited effectiveness). Most widely discussed has been the development of voluntary codes of conduct, culminating in the World Health Assembly's adoption of the "WHO Global Code of Practice on the International Recruitment of Health Personnel" (WHA63.16, 21 May 2010).
Even when voluntary codes are adopted, however, they face a policy climate in developed countries which systematically encourages the immigration of skilled labour. Moreover, professionals continue to be attracted by the higher salaries and generally better working conditions in the rich countries. In the health field, it is unlikely that brain drain issues can be addressed effectively without broad international cooperation to reduce inequality in health systems and health outcomes between countries. The shortage of health personnel in developed as well as developing countries needs to be met through an expansion of education and training capacity, both overall and in the most disadvantaged countries in particular. Global health budgets need to be provided with sustainable financing from both national and international sources, including new innovative financing mechanisms such as those being developed by UNITAID.
In short, the perspective needs to shift to the development of health systems rather than focusing only on the migration of health workers. The supply of health workers is just one of multiple factors affecting health systems equity. Promoting quality health systems both requires and attracts skilled health professionals. If that is accepted as the shared goal, both at national and international levels and by health institutions and professionals themselves, then distribution of personnel to meet the needs can be addressed not only by encouraging return of skilled professionals to their countries of origin, but also by more flexible forms of temporary assignment and collaboration across national lines.
International coordination in planning for human resources in health, including these and other measures, has recently taken significant steps forward with the first Global Forum on Human Resources for Health, held in 2008 in Kampala, Uganda, and the second, which took place in Bangkok, Thailand, in January 2011. The forums are managed by a multi-stakeholder Global Health Workforce Alliance (http://www.who.int/workforcealliance/en/). They aim to address the worldwide shortage of health workers, estimated at 4.2 million, with 1.5 million needed in Africa alone. The Alliance has identified 57 countries that urgently need additional human resources to meet health crises, of which 39 are in Africa.
25. Although they confine their study to developed countries, comparing countries as well as states within the United States, Wilkinson and Pickett (2009) in The Spirit Level make a strong case that inequality has multiple negative effects not only for those on the bottom ranks but also for human development outcomes for other societal strata and for society as a whole.
26. For an extensive review of current policy debates on these specific issues, and more current statistics, published too late to the new data be incorporated systematically into this essay, see Ratha et al. (2011).
27. But, notes the World Bank (2009a: 8), remittance data for Sub-Saharan Africa is thought to be even less reliable than in other world regions. Flows are probably substantially higher than reported.
28. See, for example, the study of Ghanaian migrant networks by Valentina Mazzucato, in DeWind and Holdaway 2008: 71-102.
30. In recent studies, Global Financial Integrity (http://www.gfintegrity.org) has begun efforts to estimate these flows. According to this nongovernmental organization, illicit capital flows worldwide from crime, corruption, and trade mispricing amounted to some $1.26 trillion in 2008, having increased by 18% a year since 2000 from a base figure of $369.3 billion. Illicit financial flows out of Africa were estimated at at $63.8 billion in 2008, including some $37 billion from Nigeria alone (Global Financial Integrity 2010, 2011).
31. For recent sources on health worker migration see http://www.guardian.co.uk/global-health-workers, http://www.who.int/hrh/migration/en, and http://www.who.int/workforcealliance/en/.
32. For data sources, see particularly Docquier (2007), Docquier and Marfouk (2006), and the online datasets at http://perso.uclouvain.be/frederic.docquier/oxlight.htm. Summary statistics for African skilled migration, as of 2000, are in Marfouk (2007).
33. See Docquier (2007) and several chapters in Ozden and Schiff (2006).
34. See, in particular, Physicians for Human Rights (2004), Mensah, Mackintosh, and Henry (2005), and Khadria (2010).
Counter the exodus of skilled nationals by promoting the NEPAD strategy for retention of Africa's human capacities; targeting economic development programmes to provide gainful employment, professional development and educational opportunities to qualified nationals in their home countries.
Counter the effects of "brain drain" by encouraging nationals abroad to contribute to the development of their country of origin through financial and human capital transfers such as short and long term return migration, the transfer of skills, knowledge and technology including in the context of programmes such as the IOM MIDA (Migration in Development for Africa) Programme, and activities of ILO, WHO and other relevant agencies.
Member States establish policies for the replacement of qualified persons who have left the country of origin and implement retention policies and related strategies.