In a recent get-together of all my friends who passed from ‘Jhenidah Cadet College’, it was like a bolt from the blue when we discovered that only 23 out of 48 of us are now staying in Bangladesh. It was the same distressing revelation when we found that 69 out of our 136 friends who passed from ‘Dhaka Medical College’ have committed their services to another nation. Perhaps the oldest question in economics is why some countries are rich while others are poor. Economic theory has emphasized that differences in the educational levels of the population are an important part of the answer and that improved schooling opportunities should raise incomes in developing countries. Yet, while there is little doubt that highly educated workers in many developing countries are scarce, it is also true that many scientists, engineers, physicians, and other professionals from developing countries work in Canada, the United States, and Western Europe. This phenomenon, often referred to as the “brain drain”, was noticed as early as the 1960s and has been a contentious issue in the North-South debate ever since. The migration of tertiary educated people from poor to rich countries has become an increasingly important feature of international migration.
Trained and skilled people constitute a very scarce resource for poor countries. Losing them sets development back in these countries. In fact, many countries, having lost their best brains to the industrial world, have had to import expensive consultants from abroad. A country spends its precious resources to educate and train its people. Losing them to developed countries is a form of reverse foreign assistance, from resource-poor to resource-rich countries. Brain drain -- the emigration of skilled workers that takes away this human ingenuity -- is pervasive in most least developed countries (LDCs), and is a serious barrier to using technology to help such nations expand their economies and raise living standards. The work of skilled professionals is a precondition for upgrading the productive structures, and for improving the sophistication of domestic businesses -- not to mention improving domestic health and education, which benefits the entire population. Without enough trained agronomists, biologists, engineers, scientists, doctors, nurses and information and communication technology (ICT) professionals, it is impossible for the LDCs to use technology to promote their products and efficiency -- and that makes it difficult for them to face foreign competitors. Lost human capital, thus, cripples a nation. Some of the poorest nations on earth, including Haiti, Samoa, Gambia and Somalia, are among those, which have lost more than half of their university-educated professionals, who took jobs abroad. A report in 2004 noted that a million skilled people emigrated from less developed countries out of a total pool of 6.6 million -- which is a loss of 15 per cent. In a country like Bangladesh, where illiteracy is high, advancement in development is at stake. On the other hand, the ones who are educated and capable of contributing towards the growth of the nation prefer to live abroad. Statistics show that, in Bangladesh, 65 per cent of all newly graduated doctors seek jobs abroad and the country loses 200 doctors from the government sector each year, while every year thousands of people die due to untreated diseases.
Human flight and brain drain index, expressed in the range from 0 (low) to 10 (high), in 2022 - Country rankings show that the average for 2022 based on 177 countries was 5.21 index points. The highest value was in Samoa: 10 index points and the lowest value was in Australia: 0.4 index points. Data sourced from the Global Economy indicates a 6.7 index point for Bangladesh's brain-drain in 2022, ranks 43rd among 177 countries. Young Bangladeshis, who make up about 40% of the South Asian country’s population, are leaving in droves for greener pastures. Our neighboring nation, India, had an index point of 5.2 ranks 98th, which is much lower than us. DR Congo, Kenya, Yemen Venezuela, Myanmar, Rwanda are performing better than us in this account. Worst performing countries include Samoa, Palestine, Somalia, Syria Afghanistan, and Sudan. All of these countries scoring worse than Bangladesh are either underdeveloped, or war ravaged which is a significant determinant of brain drain. According to Transparency International Bangladesh, at least 250,000 foreigners are working in Bangladesh to meet the gap in skilled professionals resulting from outbound emigration.
The Organisation for Economic Co-operation and Development recently reported that in 2005 between a quarter and a third of all practising doctors in countries such as the UK, US, Canada and Australia were trained in another country. Rwanda and Burundi lost 19 per cent of their skilled people in 2000, while Tanzania saw 15.8 per cent of its intellectuals move abroad. Gambia tops the list in Africa: 64.7 per cent of its educated people left in 2000, followed by Somalia (58.6 per cent), Eritrea (45.8 per cent), Mozambique (42 per cent) and Sierra Leone (41 per cent). India is the world's biggest exporter of doctors. The impact of the brain-drain can be seen in this disturbing statistic: there is one Indian doctor in the United States for every 1,325 Americans. However, there is only one Indian doctor in India for over 2,400 Indians. The causes are often seen in a bi-polar model of "pulls" exerted by the foreign countries and the "push" exerted factors operating in the home countries determine the decision of the individual who migrates. The push factors are depressing characteristics in the country of origin. On the other hand, pull factors are the attracting features in the destination.
Major reasons for the migration of professionals include better standard of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. Another reason why young, skilled labour force leaving the country is better rewards for their effort and talent. Better salaries are not the only motive for the migration of skilled professionals; it is the overall social safety net that is one of the main reasons for families to relocate. While the U.S. continues to be the favorite destination, Canada is quickly catching up. The idea of a welfare state where a family’s basic needs of education and health are taken care of or are available at quite an affordable price, is too good an offer for someone to refuse.
The medical profession is among the most mobile of highly skilled professions, particularly in Europe, and is also the sector that experiences the most serious labour shortages. A study reveals that a lower unemployment rate, good remuneration of physicians, an aging population, and a high level of medical technology at the destination are among the main drivers of physicians’ brain drain. Furthermore, an analysis of the mobility of medical doctors from a number of regions worldwide shows differential determinants for choosing the destination countries. Physicians from African countries are particularly attracted to destination countries offering higher wages, and to those where the density of medical doctors is relatively low. Concurrently, a higher demand for healthcare services and better medical technology in the receiving country drives the inflow of medical doctors from Central and Eastern Europe, while Asian doctors seem to preferentially migrate to countries with better school systems.
A significant factor is the professional milieu within which an individual has to operate. The political control of professional associations, corruption, and outmoded attitudes and procedures often repeatedly discourage the young and aspiring reformer. The system of higher education is not rooted in local problems, issues and values. Quality and relevance have not yet turned into the criteria for educational planning and development, thus facilitating the upsetting brain-drain.
It is characteristic of brain-drain that the more underdeveloped a country is economically the more it loses by brain-drain, while only developed countries profit from the process. It is stimulated by the lack of an educational system, as well as the absence of a manpower policy in most of the under-developed countries. These deficiencies normally hinder the efficient use of those who are qualified, as well as those having talent. As against this, there are the higher living standards and better research and working opportunities of the more developed countries, which provide thousands of possibilities for developing human potential. In addition to these objective economic factors, brain-drain is also kindled by the actually realised intention of the developed countries to acquire intellectual capital free, and as quickly as possible.
The only positive outcome of brain-drain is inflow of remittances. But, in the true sense, the remittances fail to add to development because they are not spent on investment goods but mostly on unproductive purposes -- housing, land purchase, transport, repayment of debt -- or wasted on conspicuous consumption, or simply saved as insurance and old age pension funds. Thus, they do not contribute effectively to long-term, substantial development of the nation. It has been argued that the adverse impact of skilled versus unskilled labor migration can be mitigated or even offset by the fact that skilled migrants remit more than unskilled ones.
Remittances and the brain drain, i.e., the migration of highly educated workers, have occupied the center of attention in the migration literature and policy debates in recent years. It is believed that “Migrants’ remittances constitute an important channel through which the brain drain may generate positive indirect effects for source countries.” A related argument is that the negative development impact of skilled labor migration relative to unskilled can be mitigated or even offset by the fact that skilled migrants might remit more than unskilled ones. A study by ADB in 2008 showed that the negative impact for sending countries of skilled relative to unskilled labor migration is mitigated or even offset by the fact that skilled migrants remit more than unskilled ones is not supported by the evidence. In hitherto, evidences are ample that unskilled migrants actually send more remittances to parent countries, than that the skilled migrants in general.
The time has come to reverse this devastating phenomenon, before grave, irreversible damage is done to resource starved poor nations. To begin with, we need to think about why we are failing to keep our brains within our own heads. We need to focus on addressing rationally the push and pull factors responsible for brain-drain to augment brain-gain instead. China has adopted an official policy and introduced industry incentives, which are friendly to the expatriates who want to return. The Chinese encouraged their best to acquire valuable expertise abroad, and then wooed them back to set up businesses or work in top government posts. They have succeeded in creating a professionally stimulating environment to attract students back. In a business friendly environment, returnees have founded most of the country's high-tech companies. Scientists who have emigrated for whatever reason are recoverable, and can play a part in developing opportunities at home. However, this requires the opening of diverse and creative conduits.
Today's policymakers, scientists, doctors, engineers, and economists were yesterday's students. By understanding the situation now, we can shape the future for millions. Tackling the issue requires efforts at all levels of professionalism. Innovative graduate opportunities and programs can be developed with the help of foreign professionals. This requires political decisions, funding, infrastructure, technical support and knowledge sharing among the international community. Subsidised education is taking away many opportunities from our poor farmers, hoping to change the face of the nation, but has ended up in dust because of the distressing brain-drain. This trend can be ended, largely by creating conditions that make pursuit of excellence possible, and by making it promising for an engineer, a doctor, scientist or other professional to find personal and professional fulfillment. We desperately need our brains to be contained in our own heads to maintain a momentum of development.

The writer is a physician and former Director
(Hospital) of Bangabandhu Sheikh Mujib Medical University (BSMMU)