However, those who are most needed at home are often the ones who are able to and often choose to leave. There are now more Ethiopian doctors in the city of Chicago than in Ethiopia, just one indication the phenomenon of “brain drain,” the outflow of skilled professionals to more developed countries, has reached a new high both in Ethiopia and Africa as a continent.

Brain drain is perhaps most damaging in the field of health care, where the lack of skilled professionals can mean death and unnecessary suffering, especially in nations most affected by the HIV/AIDS crisis.

Opening a global dialogue

In early March, the first Global Forum on Human Resources for Health, held in Uganda, heard that Africa’s health-worker deficit had reached one million doctors, nurses, midwives, and medical technicians.

An innovative new global dialogue, developed by the UN’s World Health Organization, has created an online forum, connecting doctors, NGOs, policymakers and stakeholders worldwide in the aim of finding solutions to the global crisis. Called the Virtual Global Community of Practice, the videoconference and discussion forum opened March 31, with participants from over 60 countries. From the beginning of the videoconference and discussion, contributions were focused on the outflow of skilled workers from the poorest countries, particularly in Africa, to the richest.

“There can be few more important issues affecting the life and health chances of millions in our world today than the brain drain of health workers from countries who need them most,” Mary Robinson, co-chair of the Health Worker Migration Policy Initiative, which led the conference, told participants on its opening day.

Robinson, former UN High Commissioner for Human Rights and former president of Ireland, decried the lack of action and political will to address the loss of skilled workers.

“We can’t continue to shake our heads and bemoan the devastating brain drain from some of the poorest countries with high disease prevalence,” she said.

Professional health-worker outflow from Africa to the rest of the world is a major problem, says Belay Kidane, first counselor at the Ethiopian embassy in Ottawa.

Local NGOs say that with just three doctors per 100,000 people, Ethiopia, situated in the horn of Africa, is the worst-affected country in the world. Other countries on the continent are not much better off, with 13 African nations having fewer than five doctors for the same number of people.

“Africa suffers 25 per cent of the global burden of disease but has only three per cent of the global health workforce,” Robinson said. The continent loses approximately 20,000 trained health professionals per year to migration, many within two years of graduation.

Ethiopian doctors make an estimated $200 to $300 Canadian per month, says Temesghen Hailu, an Ethiopian-Canadian who has lived in Canada since 1986.

“People get tempted,” he says. “The work situation in Ethiopia is so difficult. There isn’t access to the most basic medication, especially in rural areas, so they basically can’t practice.” With an unbearable work environment coupled with a global desire for health-care workers, brain drain becomes a major problem, he says.

Temesghen Hailu works with other ex-pats to help provide medical students in Ethiopia with a step up to start a basic medical practice in the country. Photo courtesy of Temesghen Hailu

Hailu is part of a growing international movement to include the African continent’s diaspora in finding solutions to the loss of human capital. He is the president and executive director of the Association for Higher Education and Development, a small, volunteer-run Ottawa NGO that works with Canadian and international groups to help Ethiopian-Canadians give back to their home nation from abroad.

Known as the diaspora solution, the movement is a global attempt to engage the African diaspora’s some 300,000 professional members in development and finding solutions to brain drain on their home continent. Contributions include returning to their home nation as guest lecturers or contributing financially to local programs.

A pervasive problem

“We as Canadian-Ethiopians have a kind of moral obligation to give back to our country,” he says. In Ethiopia, the government pays for education. “So professionals leaving Ethiopia for better prospects are benefiting adopting countries, whereas Ethiopia is losing profoundly after all the poor farmers paid for our education.”

Kidane says the government considers it an investment to fund education, which is wasted when educated nationals leave. “That’s good maybe for their own sake, but it’s putting our country in a bad position,” he says.            

Put simply, Ethiopia and its neighbours are funding the education of their nationals only to wave them goodbye as they head off and contribute to developed countries. Adding insult to injury, Africa spends $4 billion US per year to employ the approximately 100,000 Western professionals it needs to fill the brain-drain gap.

The mass exodus of doctors and nurses has a profound effect on the source societies, says Daniel Osabu-Kle, renowned African scholar and professor of political science at Carleton University. Osabu-Kle has traveled to Ethiopia at the invitation of the African Union and has seen the impacts of brain drain first hand.

“When they migrate away, the already weak government has to spend more money to train people again,” he says. “And the cycle continues.”

Osabu-Kle says the cyclical nature of brain drain makes solutions even harder to find. He also says that since a lack of proper health care lowers the health of citizens, the country becomes less vital and able to develop, adding to the cycle.

“Surely you need healthy people before you can develop,” he says. “When the people are not healthy their productivity will be lower and that will affect the economy. When you have weak economies that causes political instability also.” A country that is economically and politically weak, he says, will be unable to develop and convince workers to stay at home.

On an individual scale, Hailu says the social impact of brain drain is huge.

“Ethiopian doctors support up to 30 or 40 family members,” he says. “It’s a big loss for the country to lose one, especially with HIV/AIDS, which is a major problem for Africa and becoming more difficult because of the shortage.”

The search for solutions

Several African countries, most notably South Africa, have tried to regulate migration in an effort to curb brain drain. Some programs require a certain amount of service in the nation, a medical curriculum that would limit the ability to work abroad by being country-specific, or financial incentives. Results have been mixed at best, largely because source nations are unable to match the incentives offered by developed countries.

The Ethiopian government admits it is at a loss. “The government is doing its level best to attract professionals to their country,” Kidane says. “Solutions are hard to find.”

An oft-quoted statistic is that Africans working lucrative positions abroad send home roughly $45 billion US per year. True, says Hailu, but remittances such as these do little to alleviate the deficiencies created by a lack of workers.

“If I send home $1,000 to my mother and she gets sick, where can she go?” he asks. “She can’t have basic medical care in the country.”

An economist by profession, Hailu’s NGO focuses on fostering health-care workers in Ethiopia. The organization works with four medical colleges in the nation, collecting and donating up-to-date medical books requested by the universities. They also work with a local non-profit organization to select medical students who need financial help, supporting him or her for up to three years. Upon graduation, they provide students with basic medical equipment to help them start a practice in Ethiopia.

Hailu says engaging the diaspora is a crucial part of breaking the cycle of brain drain. Estimates from the Ottawa-based International Development Research Centre say there are over 300,000 highly qualified Africans working abroad, including 30,000 with PhDs in various fields. Ethiopia is ranked first on the continent in terms of the rate of loss of human capital, followed by Nigeria and Ghana.

The diaspora option, also known as virtual participation, emerged from global dialogue on brain drain in the 1990s as a more realistic solution to the problem. The concept is to use the Internet and technology to encourage skilled ex-pats to contribute experience and resources to their home country without requiring them to physically return.

In 2003, the African Union called for the diaspora to be considered the sixth region of Africa. Since then, the desire to include Africans working abroad in development efforts has grown. Currently, there are at least six knowledge networks, including the Association for Higher Education and Development, linking African countries with their foreign nationals.

The global dialogue created by the World Health Organization’s Virtual Global Community of Practice reflects the growing use of technology to try to combat the impacts of brain drain. The goal of the conference is to contribute to a global code of practice for health-worker migration.

Hailu says the key will be in the individual countries obtaining or maintaining political stability and developing their economies and education systems.

“They have to fight for their daily lives. If you pay them $200, why should they stay there?” he asks. It also may require a number of professionals staying at home, in spite of the sacrifices.

This group of medical students in Ethiopia have received funding from the Association for Higher Education and Development. AHEAD's slogan: "A book at a time, a student a year." Photo courtesy of Temesghen Hailu

Kidane says he has seen a shift in foreign nationals’ involvement in Ethiopia in recent years. Many ex-pats have returned to the country as investors or as visiting scholars, he says. “They’ve started to be engaged. So we see that change, but we need to work a lot,” he says.

In spite of growing global interest, there are no clear solutions to mitigate the effects of brain drain. While overcoming global inequities and addressing the root causes is a formidable challenge, the international community and the African diaspora has never been more engaged.

Article 25 of the Universal Declaration of Human Rights states: “everyone has the right to a standard of living adequate for the health and well-being of himself and his family including medical care…” In 2008, the 60th anniversary of the declaration, the need for global unity and action in addressing universal access to health care is as powerful as ever.