CORRUPTION AND EMIGRATION OF PHYSICIANS FROM AFRICA

Abstract

(ProQuest: ... denotes formulae omitted.)1.INTRODUCTIONPhysician emigration remains one of the challenges of developing countries and gives rise to controversial debates in economic literature. Some views tend to support the beneficial effects of emigration of highly educated labor forces, especially, medical brain drain (Stark et al., 1998; Clemens, 2007; Beine et al., 2008; Benie et al., 2011). However, this phenomenon is supposed to lower indicators of human development in the source countries significantly (Bhargava et al., 2011; Capuano and Marfouk, 2013) by: imposing negative externalities on those who do not migrate (Clemens, 2014), predicting higher mortality rate (Bhargava and Docquier, 2008; Bhargava et al., 2011), causing severe medical personnel shortages and higher disease prevalence, and making countries unable to manage epidemic diseases. The incapacity of Liberia, Guinea, and SierraLeone to manage and limit the spread of the 2014 Ebola virus disease in record time is partly attributed to medical personnel shortages, which is exacerbated by higher physician emigration (Torrey, 2014).Physician migration from African countries to rich countries is an old phenomenon; it has been started in some parts of the continent (West Africa) since the first medical doctors were trained in the middle of the 20th century (Hagopian et al., 2005). Despite national and international policy responses to reduce this phenomenon, physician brain drain rates as well as the total number of physician emigrants have drastically increased in African countries. The analysis of the revised panel data set on physician emigration (1991-2004) constructed by Bhargava, Docquier and Moullan in 2010 (Bhargava et al., 2011)1 reveals that about 21716 physicians emigrated from Africa in 1991. This number has quadrupled in 14 years to reach about 95220 in 2004 (Figure 1). The top affected countries were South Africa (16433), Egypt (8515), Nigeria (5499), Algeria (1387), and Sudan (1235). While the rate of physician emigration, defined as the total number of physician emigrants from a given source country divided by the sum of the migrant and resident physician population in the same source country, is high in Liberia (51.2 percent),2 Zimbabwe (45.4 percent), Ghana (37.8 percent), Uganda (34.3 percent) and South Africa (34.1 percent).The preferred destinations of migrants from 52 African countries in 2004 were United Kingdom (38964), United States of America (29847), and Canada (5983). However, Tankwanchi et al. (2014) showed that migration trends among Sub-Saharan Africa-trained physicians increased from 2002 to 2011 for most of the African countries. They identified 10,819 physicians born or trained in 28 sub-Saharan African countries who currently practice in the United States.3 They concluded that the high emigration trends will persist, and the United States will remain one of the leading destinations for Sub-Saharan Africa (SSA) physicians emigrating from the continent of greatest need for physicians.4Most of the reasons that have been highlighted to explain the flight of physicians include lower wages, poor working conditions, lack of resources in the health system, limited career opportunities insufficient post-graduate training opportunities, general political and economic conditions, family ties and culture (Hagopian et al., 2005). However, recent studies pointed out poor economic and political institutions (Bertocchi and Strozzi, 2008; Yakovlev and Steinkopf, 2014) especially corruption as a major push factor of (high skilled) migration (Dimnat et al., 2013; Ariu and Squicciarini, 2013a; Ariu and Squicciarini, 2013b; Cooray and Schneider, 2014; Poprawe, 2015). Therefore, it is important to investigate whether corruption in African countries is a major driver of medical brain drain.Figure 2 presents regional average scores of Corruption Perception Index (CPI) in 2003 and 2013. It shows that Sub-Saharan Africa experiences low scores (about less than the half of the score of the Europe Union and Western Europe areas) implying that this region is one of the most corrupt in the world. …