Skills migration: from ‘drain’ to gain

The migration of health professionals from Africa in search of higher salaries, job security and career development is by no means new. The NHS has a long history of employing African health professionals. Most observers agree the so-called ‘Brain Drain’ comes at a significant loss to African health sectors, both financial and in terms of human capital. Others point to the long term benefits associated with international migration of skilled workers. A recent report by the Institute of Public Policy Research (IPPR) argues that developing countries benefit in kind from migration of skilled workers through remittances, improved trade links and as people return with new knowledge and experience.

A recent article in the Guardian newspaper argues that the UK’s 'one-way' migration policy discourages skilled African immigrants from returning to support the development of their native country, whether temporarily or permanently. The article, by a Nigerian doctor working in the NHS, sparked much debate in our office. While we all sympathised with his decision to leave Nigeria for the UK, one colleague found Mr Anya’s tone a little disingenuous – he said he was concerned about his country but the article focused entirely on his own needs. Another colleague suggested he wanted to ‘have his cake and eat it’ – he liked the idea of returning home but he wanted his status as a doctor to confer benefits that other immigrants would not be entitled to, namely the right to return to country and job.

Granted Mr Anya’s tone implied some selfishness, but he does raise a number of important issues which the Home Office would do well to consider. Most African health workers do not intend to move abroad permanently. There is a genuine will within the Diaspora to contribute to the development of their native country, but very few opportunities to do so. The UK’s visa framework is notoriously rigid. The Points Based System aims to select immigrants the economy needs most. If migrant workers want to return to their native country for longer than six months they risk compromising their visa or citizenship status in the UK.

In this sense, the aims of UK immigration policy are at odds with the aspirations of our £7 billion international development budget. To quote IPPR “there is almost no other area of UK policy which is so clearly international in its scope and yet where the sole objective is to maximise benefits to the UK”. A recent report by the British charity VSO argues for the UK to promote ‘circular migration’, by making provisions for a ‘pause’ in the citizenship journey for migrants workers wishing to share their skills in their native country. This is one of the key recommendations in the World Health Organisation and Commonwealth Codes of Practice on the International Recruitment of Health Personnel.

In an era of global economic integration, it is neither feasible nor morally defensible to prevent qualified African professionals to seek employment opportunities abroad. But the majority of African countries continue to suffer from chronic shortages of health workers. Of the eight Millennium Development Goals agreed in 2000 those relating to the reduction child mortality and improvement of maternal health are the least likely to be met.

In the run-up to the 2010 general election Africa Research Institute argued that UK should dedicate a share of its aid budget – in proportion to the tax contribution of African processionals in Britain – to reduce the skills deficit in health, education and engineering. In times of fiscal austerity, a programme to encourage circular migration of skilled migrants would be a cost effective way to achieve an ambitious aid target. Skilled migrant workers should be able to take one or two year sabbaticals without having their visa status compromised.

Elections galore: quantity over quality?

Seven African countries are due to hold presidential or parliamentary elections over three months of 2010. Eight have already done so – nine if you count Somaliland, a state in all but recognition. With Kenya’s constitutional referendum, and ballots planned on new constitutions in Niger and Madagascar, more than one third of African nations will have held nationwide elections by the end of the year. Local elections have been organised in a handful more.

Strong on quantity, then, but what of quality? In most countries, voting was relatively well planned, free, and peaceful, and voter turnout was high. Rwanda’s presidential election, which took place in August 2010 was praised by election observers for being highly organised – electoral rolls reflected, by and large, the eligible voter population and there were no reports of people being unable to cast their ballot. In Kenya, the peaceful conduct of the constitutional referendum contrasted starkly with the violence of the 2007 presidential election. The result, lauded by the country’s former anti-corruption tsar John Githongo as an instance of “the ruled imposing their will on the rulers”, reflected widespread support for the democratic process.

Yet most of the elections which have taken place so far this year have fallen well short of ‘fair’. Incumbents have been the clear winners; in Togo, Sudan, Rwanda, and Burundi sitting presidents gained very comfortable majorities. Governing parties also won parliamentary elections in Ethiopia and Mauritius. In all these countries – with the exception of the Mauritius, number one on the Ibrahim Index of good governance – opposition leaders and parties were obstructed. Methods varied from the sophisticated, such as gerrymandering or the creation of ghost parties to confuse the electorate, to the blunt – arrest and intimidation.

Somaliland stood out from the crowd. Not only did the semi-autonomous northern region of Somalia, and wannabe independent state, pull off a reasonably free and fair presidential election, but its defeated president actually relinquished power. No government of national unity for Somaliland - opposition leader Ahmed Mohamed Mahamoud ‘Silanyo’ became the country’s third democratically elected president in June 2010, an achievement made all the more impressive given the ongoing civil war being waged in southern Somalia.