Neocolonialist past: Is migration brain drain an outdated concept?

There is only one cancer treatment center in all of Zambia, a country of nearly 20 million people. So for many there a cancer diagnosis also means racking up costs in travel to and from the Cancer Diseases Hospital in the capital Lusaka. That’s where my former schoolmate Dorothy Lombe worked as a radiation oncologist until summer 2021 when she left her job for a position in New Zealand. “I’m not sure that my particular skill set would have been utilised anyway,” she tells me in a video call, “and that was one of my biggest drivers to move.” “It wasn’t really to move away, but it was more to do what I love, which is radiation oncology,” she adds.

It’s the first time we are speaking in years, but I have been seeing Dorothy’s updates on social media. Her studies in medicine and oncology took her to Russia, South Africa and Canada. Unlike me and a few other schoolmates who left Zambia for university abroad, she has been back to work there. But it wasn’t easy, she tells me. There were only three radiation therapy machines for the whole country, and only one was functioning. She was seeing as many as 60 patients a day.

Dorothy wanted to change that by launching Zambia’s first private cancer treatment center to help ease the burden on the public hospital. But she couldn’t follow through. Despite Zambia’s glaring need for more cancer treatment facilities, Dorothy could get neither the funds nor the support she needed. Setting up a radiotherapy center in a country like Zambia requires an investment of around $6 million, according to the Vienna Center for Disarmament and Non-Proliferation. The return on investment would have taken years, so Dorothy’s idea wasn’t convincing enough for investors. That contributed to her decision to leave Zambia.

While the cancer burden is growing in lower- and middle-income economies, there were only 664 oncologists practicing in these countries in 2018. It wouldn’t be unusual to conclude that Dorothy should have remained in Zambia. Her departure led to the loss of a much needed health care worker.

But skilled workers shouldn’t be forced to stay, says economist and poverty researcher Johannes Haushofer. “Wanting someone to stay where they are, even though they might want to migrate, is quite patronising,” he says. “This worry about brain drain has a neocolonialist flavour to it ... to want to keep people trapped in the places where they are, whether or not they want to leave.” Haushofer is the founder of Malengo, a charity that facilitates international education migration from Uganda to Germany. The organisation funds the first year of study at German universities for high-achieving low-income Ugandan students, who agree to pay back that money through an income share program upon graduation.

While the initiative aims to foster education for the students it neither expects nor encourages them to return to their home country. “Migration may not just be good for the person who migrates but also for the people who stay behind,” Haushofer says.

Remittances are often touted as the direct benefit for the families and countries of migrants. The Ugandan students sponsored by Malengo send an average of $165 a month back to their families, and that amount could rise with their earnings. Skilled-worker migration can also encourage more investment in human capital, according to economist Haushofer. It shows others that studying can pay off and provide a path to professional development.

While brain drain is conventionally understood to involve creation of a gap, some believe the term no longer describes the reality of voluntary migration. Critics of the term say new terminology is needed that reflects the complexity and nuance of the movement of skilled labor between countries.