Ms. Volda Lawrence, the Minister of Public Health, when speaking to a gathering of overseas Guyanese in the United States last week, stated that Guyana and Caribbean countries should stop complaining about the impact of the brain drain of nurses. Instead, she intends to train nurses from both places for the international nursing marketplace, largely because this is likely to increase foreign exchange remittances. ‘I said to them,’ she said, ‘that this is not something to complain [about]. You got to fix it. If they want our people, let us train them and send them out so we could get forty Western Unions in our countries instead of ten; so that we can exchange human resources and get back the monies into our country. We have to find a way; we just can’t complain’ (http://demerarawaves.com/2018/09/26/).
There is no doubt that the Ministry of Public Health, like the Ministry of Education and all sectors in Guyana, faces a real problem of how to acquire professionals but more specifically of how to retain those that are trained with the scarce resources of the Guyanese people. As a result, it could be argued that other sectors, but particularly education/teaching in which there is also a significant brain drain, could be treated as the minister suggested. What is certain, however, is that encouraging migration is not ‘fixing’ the problem of retaining nurses, which one would have thought should have been her main concern. The minister is merely attempting to exploit the inevitable for the national good and I would have no difficulty with that approach if it was necessary and not likely to bring additional negative consequences.
According to former Minister of Education Dr. Rupert Roopnaraine, some 93% of the tertiary educated people in Guyana migrate (https://www.kaieteurnewsonline. com/2016/07/23/migrating-tertiary-educated-guyanese-a-national-tragedy-minister-roopnaraine/) and thus cynics might say that the official encouragement of migration does little harm given the numbers already leaving. However, I believe that there is an important difference between trying to make the best of a bad situation and contributing to making that bad situation both psychologically and practically worse. The minister needs to detail her plans but in doing so she needs to be aware that in certain countries graduates in other important disciplines are subsequently training as nurses because it is easier to find external jobs and migrate. Given the worldwide demand for nurses, what is most likely to happen if her project gets off the ground is that many of the best and brightest will go to nursing as a means of exit particularly if the graduates of the school she proposes to establish will be immediately guaranteed overseas postings.
Furthermore, although the specific conditions of each country and the inadequacy of the existing data may prevent definitive conclusions, I believe that before she proceeds, the minister should take note of what those who have seriously considered the issue believe are some of the negative consequences of professional migration (http://guyanachronicle.com/2016/07/23/the-migration-of-tertiary-educated-guyanese).
Speaking specifically about the migration of medical doctors, one commentator identified the alarming scope of the problem. ‘Migration has worked to the detriment of the low-income economies. Rather than being a path toward development, it has been cited by the historical-structural theorists as one of the causes of under-development. … The migration-induced shortage of physicians has become a significant impediment to the provision of healthcare in the low-income countries. The brain drain reflects the loss of public resources invested in the education of the physicians and to the reduction in production capacity. It has led to the establishment of new medical schools to produce physicians to mitigate the adverse impact of the migration, thus creating additional fiscal burdens.’
Professional migration also has wider social implications, as it ‘has retarded the development of democratic political institutions and values in the low-income countries. That is, the emigration of a critical mass of educated and capable individuals has led to loss of governance capacity in the low income countries, all of which have weak political institutions and varying degrees of instability.’ Furthermore, migration operates as a type of tension maintenance. ‘[I]t can be a mechanism for the release of political pressure on the regime diminishing the incentives for political reform, the elimination of corruption and governmental effectiveness’ (https://benthamopen.com/FULLTEXT/MEDJ-2-17).
As we have seen, what the minister is proposing is a business venture that she hopes will increase remittances coming into Guyana. Remittances do contribute significant foreign revenue for Guyana and other developing countries and help to improve the purchasing power of those who receive them. However, it is argued that if they are to sensibly compensate for the brain drain, they will need to be properly formalised, and is this what the minister has in mind. ‘Formalising the transfer of remittances might permit the generation of revenues that could be invested nationally in the social and economic development of the developing home country.’ However, paradoxically, ‘the magnitude and economic importance of remittances to economic development and growth, and ultimately social equity, depend on the endogenous capacity of each nation’s human resources’(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1275994/).
Before going forward with this scheme, the minister also badly needs to say in some detail what is intended. For example, how will the new scheme be integrated with the old? Are there going to be two classes of training – one for overseas placement and one for placement in Guyana? Is the overseas training for those who could pay for it and if so, to avoid the class implications, are student loans going to be provided for candidates?
My own feeling is that if the regime does intend to press ahead with this idea, there are good reasons why it should be left to the private sector: This is a business venture and our governments have not been good at managing businesses; the public purse will be eased; being a private sector venture will not affect the usual level of remittances coming from the migrants; and since such an enterprise could have internal and external consequences that could affect the reputation of the state, it will require proper monitoring by the state, giving rise to a conflict of interest if the state also owns, controls and makes profit from the business.
But the entire approach appears unnecessary, for arguably Guyana is the most efficient country in the world at getting rid of its graduates. Thus, if the minister is after more remittances, she need not encourage migration by idealising it as some kind of a good. All she could do is quietly increase the number of trainees to the level required and focus, laser-like, on improving the quality of her output. 93% of graduates leave without help from anyone and it is most doubtful that one can or would want to be more efficient than that. In any event, if she succeeds she would be able to claim that the quality of those who migrate has improved.
Retention of those professionals upon whom a country has spent large amount of training resources is another problem altogether, and sensible means to make the best of the inevitability of migration would be useful. This column has made some suggestions (SN: 07&15/09/2012, 31/10/2012) of how this might be achieved in relation to teachers that might be applicable to other professions.