Could health worker migration bring benefits to Malawi?

Malawi, one of the poorest countries in the world, is currently losing health professionals to rich countries while its own health system suffers from a critical lack of human resources. Is this movement of medical staff fundamentally unjust, or could it be a ‘win-win’ for both developed and developing countries?

Many see the migration of nurses anddoctors from developing countries to the developed world (the so-called medical‘brain-drain’) as straightforward exploitation of the poor by the rich.However, new research suggests that health sector migration, if managedproperly, could become a successful form of trade in services.

The researchers explored the costs andbenefits for Malawi of health sector migration. They looked at recent reports, including an analysis by the Malawian Ministry ofHealth which stated an overall health sector vacancy rate of 33 percent (thisfigure hid a vacancy rate for nurses alone of 64 percent). Meanwhile, over 100 Malawiannurses and midwives continue to leave the country to work abroad each year,many to the UK, despite recent efforts to improve pay and conditions. Thistrend outstrips Malawi’s current annual training rate of approximately 60nurses per year.

So what are the effects of this migrationpattern? Its costs include loss of public educational investment, fewer andpoorer health services and chronic staff shortages. However, remittances (sumsof money sent home by those working abroad) are a growing source of foreignexchange in many poor countries. Previous studies fromoutside Malawi have shown that remittances have a significant impact on poverty.The researchers also found that:

• a major cause of the brain-drain is the huge pay gap between Malawiand other countries, with equivalent salaries for newly qualified nursesand doctors around ten times greater in the UK
• without any policy effort, Malawi has shown that it is globallycompetitive in the training or ‘production’ of doctors and nurses
• if migrationis temporary, the migrants bring back a ‘brain gain’ in improved skillsand knowledge.

The authors conclude that Malawi canbenefit from ‘exporting’ health professionals, while providing incentives forsome to remain within or return to the domestic health system. However, thecurrent situation, where the cost of training lies with the state while thebenefits accrue to the individual working abroad, amounts to market failure. Theysuggest various policy options:

• Rich host governments could remit part of a tax (such as incometax or national insurance) to the Malawian government for re-investment inpublic health.
• The state could charge fees for medical training in Malawi; thedebt could then either be written off over a given number of years ofpublic service in Malawi or paid through overseas earnings.
• The government could improve incentives for migrants to remit byallowing the holding of foreign currency accounts by Malawians workingabroad, and reducing the cost of sending money from the UK to Malawi.