Who's to blame for brain drain?

Who's to blame for Ghana, and Africa's, doctors and health care professionals leaving for better paying jobs in rich countries? It depends who you ask, writes New York University Professor Jonathan Zimmerman in the International Herald Tribune. He cites a World Bank study that claims 47 percent of college-education Ghanaians live abroad; This includes more than half of doctors who received their training between 1999 and 2004, which has created an acute shortage in medical personal.

With numbers like these, it's no wonder this debate is very emotional.

Ghanaians will tell you, there are more Ghanaian physicians in New York City alone than there are in Ghana. I've never been able to confirm this statistic. But people here repeat it so often that it has become part of national lore. It speaks to the larger truth of the brain drain, even if the actual number is false.

So who's at fault for this grim state of affairs? Like the African-American speaker at my conference, many Ghanaians blame their own "greedy" professionals. Ghana gave them skills, the argument goes, but they won't give back. They value their pocketbooks more than their patriotism.

Never mind that they remit millions of dollars back into Ghana, or that large numbers of overseas professionals return home. By some estimates, for example, 60 percent of Africans who go to the United States eventually come back.

No, the real question is whether any human being has a greater duty to his or her "own kind" - be it race, ethnicity or nation - than to humanity as a whole. Compared to other Americans, do middle class blacks have a special responsibility to lift inner-city African-Americans out of poverty? Do Ghanaian physicians have a higher obligation - than any other doctor, in any other nation - to treat Ghanaian patients?

I think not. The greatest humanists of history -think Schweitzer, Gandhi or King - all emphasized our shared moral duty to one another, no matter where we live. Even more, they reminded us, holding some groups to a higher duty lets the rest of us off the hook.

There's also the argument that African health professionals aren't so much "pulled" to Western countries as they are "pushed." From Wendy Glauser in World Politics Review.

[Judith] Oulton of the International Council of Nurses noted that while South Africa currently suffers from a nursing shortage, it also hosts 30,000 unemployed nurses. In Uganda, meanwhile, many health care workers are migrating out of the sector, rather than out of the country. "We have trained doctors who become lawyers, doctors who work for NGOs," said Stephen Malligna, the minister of health for Uganda.

On the bright side, international health funding bodies like the Global Fund for HIV/AIDS, Tuberculosis and Malaria, and the Global Alliance for Vaccines and Immunization have pledged to support basic health care systems in the countries they give aid to, according to Dr. Francis Omaswa the head of WHO's Global Health Workforce Alliance. Up until now, donor money has been focused primarily on the purchase of medicines or the implementation of isolated projects.

And successful initiatives by governments in India and Ethiopia, cited several times during the conference, prove that developing countries can go a long way toward addressing the health workforce gap without outside assistance.