The Brain Drain Fallacy

You can't be what you can't see - skilled migration abroad inspires skills creation at home

Clinic+O is a Guinean health-tech firm that brings digital and in-person care to underserved communities in one of West Africa’s poorest countries. A small but highly skilled team are creating an ecosystem of doctors, nurses and community health workers who have so far delivered outpatient services to over 50,000 patients and screened tens of thousands more for malaria, diabetes, and hypertension. But finding engineering talent in Guinea is tough. So when Clinic+O’s lead software engineer decided to move to Malaysia to pursue a Master’s degree, this was not only a major loss for Clinic+O and Guinean healthcare, but it also appeared to be a textbook example of the “Brain Drain”. Highly skilled citizens of developing countries leaving for rich countries to pursue educational or career opportunities and leaving a skills deficit in their wake. Nevertheless, despite the “evidence” of stories like what happened at Clinic+O, the fact is that outside tragic cases of civil war or political repression, the Brain Drain doesn’t exist. 

Humans are storytelling animals. Narratives that resonate with ‘common sense’ or chime with a lived experience have the power to shape what people think is true. And things that rhyme are wildly more likely to be believed. But stories based off personal experience or anecdote make for a bad basis for public policy and rhyme is an even worse benchmark (Dr Suess had many strengths. But public policy? Not a mensch). Population level effects are what matters for economies. 

When individuals see education as a viable pathway to a better life, they invest more into their education. This demand of education creates more supply, and a more educated society arises. Despite what people say in surveys, only a minority of people – educated or otherwise – ever emigrate. Education, emigration, and a well-educated society are not fixed constants or a zero-sum equation. When The Philippines “exports” their health care workers around the globe, other people in The Philippines see training as a health care worker as a path to a better life. Few of them leave. The ones that do benefit from higher wages, the ones that don’t also benefit from higher wages and The Philippines ends up with more, not less, health care workers. 

The simple narrative of one doctor moving from Country A to Country B, leaving Country A with one less doctor for the rest of time is not how the world works. Many things are in flux and Just So stories based on the personal experience of knowing someone who moved somewhere do not generalise out. Some of Silicon Valley’s best and brightest are Indian expats. India is home to a large and thriving tech scene employing millions of skilled IT workers. This did not happen through luck. Indians saw their fellow Indians gaining better wages and opportunities to move abroad through computer science degrees and so they went and got more of them. 

When the UK shut themselves off from the European labour market, they eventually worked out that they needed to open themselves up to other labour markets to address the shortfall in working migrants. The Health and Care Visa was launched in mid 2020 by Priti Patel. The uncapped scheme extended a residence visa to qualified health workers who had a job offer and a minimum level of English proficiency. Not surprisingly it was health care workers in former colonial countries like Nigeria and India that were the main beneficiaries. In 2020, 685 Nigerian-born nurses joined the UK nursing register. In 2021 that number had increased by more than 400% to 3,010. But fear not, the graph below tells the story.  

The UK got some nurses, more Nigerian nurses got higher salaries in the UK, the Nigerian populace got a lot more nurses. 

Correlation is of course not causation but the trend across countries and professions is clear. Demand creates supply and supply outstrips the demand for emigration. This relationship does break down though under some circumstances, namely in authoritarian regimes who don’t care to, or don’t allow others to, educate their populations or when a significant macro level shock like war causes many people to leave all at once. When Syrians were forced from their homes through civil war, there was no counterbalancing educational expansion back in Damascus.  

Thankfully cases like Syria or Venezuela are rare (although not rare enough). But free or mostly free countries should not fear from their citizens leaving for greener pastures. On the day an educated employee leaves Clinic+O, there will be a hole. But the market for human capital responds and Guinea – and perhaps even Clinic+O – will create more educated people. Over time, some migrants even return. Clinic+O was started by Nasser Diallo. Nasser was born, raised, and educated in Guinea. Then in 2016, just like his future lead software engineer, he headed abroad for further education and his first professional jobs. But then almost four years ago Nasser returned to Guinea. He came with his Master’s from Oxford and professional experience at Facebook but also with a dream to ensure everyone in West Africa has access to affordable quality primary care and to enable the practitioners that provide it. Clinic+O increases the demand for highly skilled workers in Guinea and helps provide basic medical care to those who have too little. 

Don’t believe the Just So story. Even if it rhymes.