The recent tragedy off the coast of Lampedusa, Italy highlights the risks that many migrants face. For a large number of people around the world moving is still one of the surest ways of expanding their opportunities and improving their lives. The World Bank's International Labor Mobility program has been dedicated to rethinking the current approach to this movement. Our new series, ‘On the Move’ presents new ideas which showcase a sample of this program's approach, with the aim of changing the debate around migration by focusing on ways of promoting the safe movement of people and unlocking its many potential gains.
This blog has been co-authored by Michael Clemens and Nabil Hashmi
For a lot of people, moving offers the best chance to improve both their income and welfare. Migration itself, then, becomes the vehicle of development when viewed through the eyes of the migrants. By the same token, restrictions on movement are nothing less than development in reverse: Preventing people from accessing and participating in systems that would allow them to improve their conditions.
The fact that these systems are international rather than local does not diminish the impact on development.
The first blog in this series challenged how we frame our work on migration and outlined a policy agenda that would facilitate the movement of people—both skilled and unskilled. Building on this idea of migration as a means for development, we presented in our second blog and third, concrete ideas on how to enable the movement of low and mid skill migrants. And while it is true that the high skilled do not suffer from the same obstacles as the less skilled, the concept label of ‘brain drain’ has stigmatized this kind of movement as being development-unfriendly or even unethical. Nowhere is this truer than in the field of healthcare. Health worker migration is often described as draining away precious human resources from less developed countries and denying their sick access to quality health care. A report of the Joint Learning Initiative defined health workers’ decisions to leave certain countries as “fatal flows.”
An objective assessment of these serious claims requires an objective language. Imagine labeling female labor force participation with the loaded term “kitchen drain”, and then proceeding to conduct an objective assessment of the effects of “kitchen drain” on women’s families. Intuitively, we know that female labor force participation has all kinds of complex effects. For example, working outside the home is an expression of a woman’s rights, it could induce her to invest in more education, and produce numerous benefits for her family. None of these would be captured by the restrictive and over simplified ‘kitchen drain.’
It’s the same with skill flow, which is the movement of skilled workers and their ideas. Skill flow is an expression of the emigration right guaranteed by the United Nations Universal Declaration of Human Rights. It can induce migrants to invest in more education, more than they would if they remained in their countries and provide numerous benefits for both and countries of origin. It does not make sense to simply represent all this complexity as something negative for the sake of an archaic rhyme like “brain drain”. Let’s dump terminology that reflect bias and talk more objectively about “skill flow”.
What is the cause of bad health outcomes in developing countries? When you see a car in motion, it’s an easy mistake to attribute its movement to the wheels rather than the unseen engine, and thus, I It would be a costly error, however, to focus strictly on the wheels when trying to figure why a car isn’t moving. Similarly, to improve health outcomes, we need to examine not just the visible phenomenon of migration, but also the array of less visible factors that are causing it. Health worker movement is often a symptom rather than a disease—a symptom of deep issues in the health system, the economy, and the society of the countries that health workers leave. Diseases are not properly addressed by focusing on their symptoms alone.
Health professionals migrate not just because of the better pay and living conditions available in richer countries. World Health Organization surveys show that dire conditions in health workers’ home countries like poor facilities, corruption, cronyism, violence, bureaucracy, crime, and inadequate management push workers to migrate. These underlying causes of migration are better targets for policy action than the act of migration itself. Stopping migration only succeeds in forcing health workers to live and work under those conditions, but there is little evidence that it contributes to changing those conditions. Much more fruitful than stopping health workers from moving is creating systems whereby health workers’ free movement can be more beneficial to everyone involved.
For this purpose, the Center for Global Development and the World Bank’s International Labor Mobility (ILM) program in the Middle East and North Africa (MENA) region have come together to offer a new way of thinking. While this is essentially a global issue, it has special resonance in the MENA region. Roughly nine percent of MENA university graduates born in the region live outside it – one of the highest levels compared to other regions —and MENA’s neighbor Europe has an aging population in need of health services. Based on discussions with several representatives of countries in the region, we were struck by the untapped opportunity that lies in bringing about a cooperative solution to the problem of health worker shortages.
A bilateral agreement called a Global Skill Partnership could help facilitate migration, which would improve the supply of health workers in the destination country. The cost of educating migrant health workers could in turn be shifted away from origin countries towards future beneficiaries, i.e. receiving firms and governments - or even the workers themselves. Such partnerships could take the form of training schools, which would acknowledge the desire of some health workers to emigrate and would help those individuals finance their educations and find employment. Furthermore, such schools, developed through a Global Skill Partnership, could improve health worker training in the origin country for students who want to serve in that country.
With wealthy neighbors and domestic systems both in need of skilled health workers, countries in the MENA region could provide a suitable home for these partnerships. Just as an example, Germany and Tunisia could partner to create a training institute in Tunis that would increase the number of skilled health workers in both countries by providing opportunities to interested Tunisians. There are a variety of ways these schools could be financed, and instruction at the schools could be customized to meet the health needs of both countries
Global Skill Partnerships get beyond zero-sum thinking. They help turn international movement of skilled workers into an engine that fills global shortages—both in origin and receiving countries. Now is the time to bring all the beneficiaries of skilled worker migration together to cooperate on investing in talent to address global shortages. This is most pressing in health care but a range of other fields would also benefit from this sort of international cooperation.
The movement of people within countries has always been a part of national development. People often acquire skills, in part, to move, and it is through movement that many make the best use of their skills. In this century, these same forces are at work. Global movement is part and parcel of global skill formation. The movement of skilled workers could be far more than a zero-sum game. Structured correctly, skill flow can benefit everyone involved: migrants, the countries they migrate to, and their country of origin. Global Skill Partnerships are well placed to realize these multiple benefits.