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Opinion

Brain Drain to Brain Gain?

May 15, 2012

by JAMES MACKINNON

The North-South Institute

The 2005 Commission for Africa Report estimated that over one million healthcare professionals need to be trained and retained in Africa if the health-related MDGs are to be achieved. However, after decades of brain drain, much of sub-Saharan Africa now suffers from a severe lack of human resources for health, as demonstrated in this map of primary health care staffing shortages taken from the WHO`s World Health Report 2006, to both operate and rebuild state health systems. With an estimated one million trained health care workers within the African diaspora, governments, international organizations and NGO`s have turned their attention to policies and programs aimed at tapping into this immense human resource reservoir.

Diaspora engagement programs have varied little since the mid 1970`s when both the International Organization for Migration (IOM) and the United Nation’s Development Programme (UNDP) introduced their flagship programs. Traditionally, programs have used a physical relocation model which sends qualified diaspora professionals back to their home countries to participate with either short-term (from weeks to a couplemonths) or longer-term (from months to years to fullrepatriation) placements in a variety of sectors to help fill gaps. IOM’s “Return of Qualified African Nationals” program, for example, supported the voluntary repatriation of 2000 skilled African nationals to 41 African countries between 1974 and 1990. More recent programs, such as IOM’s “Migration for Development in Africa” have primarily operated using a temporary return model but have begun exploring alternative approaches such as virtual participation (i.e. webinars), repeat placements, and post-placement engagement programs as the technological and social landscapes evolve.

What has worked?

Reviews of program effectiveness have been mixed and results have been … well, unclear. UNDP’s Transfer of Knowledge through Expatriate Nationals (TOKTEN) program has been described as a “cost-effective option for human capacity development”; however, many engagement programs, including TOKTEN, have been criticized for their overall ineffectiveness in practice. Short-term placements have been criticized for their inability to produce a lasting impact or provide sustainable knowledge transfer due to a lack of coordination and adequate planning. Many programs have failed to sufficiently define the Terms of Reference and objectives for both participants and beneficiaries or have been operated in environments not conducive to successfully leveraging the skills and knowledge of the diaspora professional.

Alternatively, long-term placements and full repatriation are riddled with various issues, such as resentment from local staff; lifestyle and safety concerns of diaspora professionals; and numerous political, social and cultural complications. Nevertheless, the OECD suggests that successful return of even a single individual can create a magnet effect for further return. Diaspora engagement evaluations of the EU funded “Return of Qualified Nationals” programs in Ghana, Afghanistan and Rwanda expressed concern that placements of less than twelve months was “an insufficient period to effect meaningful changes on the efficiency of a company or institutional department“. However, the IOM counters this concern suggesting that placement and project timeframe should “depend on a thorough analysis of activities involved in each assignment.“

Program successes continue to be constrained by a lack of data on diaspora populations and the availability of accurate needs assessments in home countries, which has led to difficulties in matching demand with supply. The African Development Bank suggests that engagement programs have been “invariably ad hoc“ in practice and questions whether physical relocation is even necessary or if the way forward is to nurture network engagement and virtual interaction.

Even with decades of experience our capacity to evaluate these programs remains limited, impeding our ability to accurately guide policy development and improve outcomes. The challenge ultimately lies in determining the overall impact and sustainability of these programs. Measuring success remains subjective due to the lack of apparent mechanisms that can objectively gauge the ‘lasting impact’ of placements, regardless of duration. Additionally, success remains context-dependent, creating unpredictable variability in the development of future programs operated in different environments and under new circumstances. Nevertheless, it is clear that the diaspora represent a significant source of experience, skills and knowledge that – if harnessed effectively within a well-coordinated framework – could provide African nations with an immense pool of human capital to draw on as they move towards their development goals.