The costs and benefits of health worker migration from East and Southern Africa (ESA): A literature review

6.3 The need for a paradigm shift in research and analysis of the medical brain drain 36 6.4 Migrants' remittances and health outcomes in remittance-receiving households 37 6. The view put forward by a number of influential sources is that sub-Sahara Africa is experiencing a health crisis in human resources and that this crisis is defeating efforts at international, regional and country levels to control and stem the HIV/AIDS epidemic on the African continent. The migration of health professionals from developing countries in general, and sub-Saharan African countries in particular, has become the subject of considerable theoretical and case study research attention in international migration and human resources for health (HRH) literature. This report is a review of all available literature on the costs and benefits of the migration of health workers from East and Southern African (ESA) countries to developed nations. Its findings are as follows: • Four economic models are used by researchers to conceptualise and analyse the costs and benefits of the migration of health professionals from the perspective of developing countries: − the internationalist model, which prioritises benefits over costs; − the nationalist model, which differs from the internationalist model because it puts greater emphasis on costs rather than on benefits; − the beneficial brain drain model, which investigates the impact of the international migration of highly-skilled individuals on investment and growth in their home countries; and − the diaspora knowledge network model, which sees the 'brain drain' as a 'brain gain'. • Many researchers identify the medical brain drain as a serious problem because it impacts negatively on healthcare systems, not only in terms of loss of skilled labour, but also because the governments of developing countries subsidise the education of health workers, only to lose this 'investment' when the workers emigrate. Unfortunately, the theoretical and case study research literature is mostly qualitative in nature when analysing costs. Only two published case studies used the quantitative approach to analyse costs, but they lack technical and analytical merit. • The demand and supply factors affecting the migration of ESA health professionals to developed countries have not yet been brought together into a framework that contextually relates, analyses, and explains how they are 'drivers' of the migration process. • Existing literature largely ignores the benefits that developing countries enjoy when their health workers migrate. For example, there are financial and non-financial flows from developed to developing countries …