Section Three Socio-economic Impact of Migration by runout


									    MIGRATION AND DEVELOPMENT: Challenges and
          Opportunities for Sending Countries

                     GHANA COUNTRY CASE STUDY


                                    PETER QUARTEY1

             Institute of Statistical, Social and Economic Research
                              (University of Ghana)2


 Peter Quartey (PhD)
Research Fellow
Institute of Statistical, Social & Economic Research
University of Ghana
P.O. Box LG 74, Legon, Accra, Ghana
  I am most grateful to Mr. Ken Achakoma (Department of Economics, University of Ghana) for helpful
research assistance.

Migration of both skilled and unskilled labour has been one of the survival strategies of
many African countries particularly the youth. Similarly, migrating from Ghana to
Europe and America has become one of the surest means of acquiring skills and also
improving the living standards of both the skilled and unskilled labour force.
International migrations from Ghana have been precipitated by poor working conditions,
coupled with huge wage disparities between Ghana and the host economy. Ghana used
to be a net immigration country with migrants coming from neighbouring African
countries. However, the changes in the economic conditions of the country in the 1980s
and 1990s completely altered the country‟s migration pattern. Consequently, skilled
personnel, particularly from the health and education sub-sectors are leaving the country
at an alarming rate with its socio-economic consequences. For instance, Buchan and
Dovlo (2004) reports that both the nurse and doctor vacancy rates doubled between 1998
and 2002, a period characterized by rapid migration of health personnel from Ghana to
Europe and the USA. It is estimated that 3 million Ghanaians live abroad – ie, 15% of
Population (Twum-Baah, 2004) while Black et al (2003) quotes 10-20%. These
Ghanaian migrants also remit their relations which significantly help to reduce poverty
(Quartey, 2005; Adams, 2006). Private inward remittances through the banks and other
finance companies amounted to $1.318 billion (Jan. to Sept. 2005), $1.910 billion in
2004, $1.4 billion in 2002 as compared to $ 479 million recorded for the year 1999 (BOG
BOP Estimate).

The trends in migration and remittances discussed above raises the following issues: does
migration benefit sending countries? If not, when is it better for citizens to stay in their
home country? Is permanence the preferred option? If it is, what incentives can countries
offer potential migrants (skilled and unskilled) to stay? When migration is encouraged,
what length of time should economic migrants work abroad, and when and how should
they be enticed to return home to provide labor, economic, and intellectual resources
earned abroad and thus turn potential „brain drain‟ into „brain gain‟? What structures
facilitate migrant exit and return? These issues will be the focus of this paper. Section
two outlines the migration patterns in Ghana, followed by a section discussing the socio-
economic impact of migration. Section four discusses return migration where issues on
how long people should stay, the brain drain and brain regain, managed migration is
discussed in detail. The final section provides the concluding remarks

Traditionally, Ghana has been a net immigration country with migrants mainly from
Togo, Baukina Fasso, Nigeria and Cote D‟Ivoire. This trend continued until the late
1970s when economic and political instability led to a reversal of migration trends in
Ghana. The introduction of the ERP in 1983 led to improvements in living conditions but
this coincided with the repatriation of illegal Ghanaian immigrants from Nigeria and Cote
D‟Ivoire. Again, this led to a reversal in the migration pattern to net immigration. The
changes in Ghana‟s economic and political conditions in the 1980s and early 1990s
completely changed the country‟s international migration patterns; it ceased to be a net

recipient of migrants but rather became a net `exporter‟ and this trend had continued till
date (Table 1).

Table 1: Arrival and Departures from Ghana
                                ARRIVALS                                             DEPARTURES
REGION               1999     2000     2001                  2002       1999        2000   2001           2002
Africa                      61001      181680     323371     191274     143109      225448       288329   224845
Asia                        9772       9916       14826      17209      7328        12118        15000    18296
Europe                      33912      37690      58535      63876      33425       56558        46846    61124
LAC                         846        783        1172       1851       762         988          1297     1051
North America               6288       16572      33093      39056      22688       120216       26698    36812
Oceanic                     982        1485       1808       1734       1585        25102        1903     1561
Total                       112801     248126     432805     315000     208897      440430       380073   343689
Source: Twum-Baah (2004), Ghana Statistical Service, p 12

It is evident from Table 1 that while departures to African countries declined between
2001 and 2002, the number of departures to Asia, Europe and North America increased
substantially. Cote D‟Ivoire represents the highest number of Africans arriving into
Ghana, followed by Nigeria. Indians and Lebanese nationals form the highest proportion
of Asians arriving in Ghana between 1999 and 2002 and it is unlikely that the trend has
changed. The UK forms the majority of European arrivals in Ghana followed by the
Netherlands and Germany respectively, while the United States comprised of the largest
proportion of arrivals in Ghana by North American nationals. In terms of departures,
Europeans form the majority of travelers leaving Ghana between 1999 and 2002, except
for the year 2000 when for some unknown reasons, over 120,000 North Americans left
the country. Data on departures from Ghana shows that resident Ghanaians leaving for
commercial activities form the majority followed by spouse and child dependents. It
must be noted that this trend has not changed considerably over the years. Also, among
the visitor category, tourism, transit and those going on business trips are in the majority
(Twum-Baah, 2004).

The composition of international migration has implications for policy and development
of the sending and receiving countries. However, in view of the difficulty in obtaining
data on international migration disaggregated by the required characteristics at the
country level, the report uses information on the characteristics of Ghanaian emigrants
from different sources which makes cross-country comparison difficult or inappropriate.
Nevertheless, they are used to explain the characteristics of Ghanaian migrants. In terms
of age and migration, it is evident that young adults are more likely to migrate than older
people. As reported in Twum-Baah (2004) in the year 2000, 32.8% of Ghanaian
residents in the Netherlands3 in 2000 are aged between 0-14 years; 17.1% are aged 15-29
years, 41.5% are aged 30-34 years with the rest aged 45 years and above. Similarly, in
England and Wales, it was reported that 10.2% of Ghanaian residents are aged between
0-19 while 27.2% have ages ranging from 20-34 years. Also, 30.3% and 28.9% aged 35-
44 years and 45-64 years respectively.

    Both the Netherlands and England and Wales data refers to only migrants with legal status.

In sub-Saharan Africa, males form the majority of the migrant stock since 1965.
However, the proportion of female migrants increased from 41% in 1960 to 47% in 1990
(Twum-Baah, 2004). Twum-Baah (2004) further argues that the proportion of Ghanaian
female migrants is below 40%. It is worth mentioning that although migration related
policies are not gender-specific, evidence suggests that because of the distinct roles
performed by males and females, they are affected differently by the regulations in force.
It is also suggestive that female migrants have benefited more than male migrants from
provisions in the destination countries which favour family re-union. For instance,
information from the German Embassy indicates that those who live legally in Germany
either got their residence permit through successful asylum applications or through
family re-union (Twum-Baah, 2004). Similarly, the increase in the number of Ghanaian
emigrants in the Netherlands between 1992 and 1999 is mainly accounted for by family
re-union and chain migration (58%); asylum seekers (16.5%) and labour migration
(26%). Data from England and Wales indicates a higher percentage, particularly, the
younger ages (Twum-Baah, 2004). Thus, the migratory policy regimes significantly
affect migration patterns and legal status of migrants. It therefore comes as no surprise to
observe that Ghanaian nurses prefer the UK while their counterparts who are medical
doctors prefer the USA.

In terms of marital status, the evidence from the two countries is quite mixed; whereas
data from the Netherlands indicate that the majority of Ghanaian migrants have never
married (59.8%), 12.3% have married and over twice the proportion of migrants who
have married have divorced (27.3%), while the rest are widowed. On the contrary, over
half of Ghanaian migrants in England and Wales are married (50.8%), while 36.2% and
10.9% have never married or divorced respectively. Migrations within ECOWAS also
show similar trends to the England and Wales data; 67% of migrants are married while
26.1% have never married. It must be pointed out that migration within ECOWAS
countries are normally temporary with the ultimate aim is to reach an OECD country.
Also, the high divorce rate in the Netherlands can be attributed to the stress involved in
adjusting and integrating to the unfamiliar conditions. Generally, Ghanaian migrants are
educated and many with skills for immediate employment. Twum-Baah (2004) reports
that only 18% of Ghanaian residents in England and Wales aged 16-74 years have no
known qualification, while 46.1% have lower level qualification and 35.9% have higher
level qualification.

The OECD database also provides useful information on migration characteristics of
Ghanaians. It is estimated that there are about 189,442 Ghanaians migrants spread across
the OECD countries of which 25.3% are natives of their respective countries of residents,
44.9% live as foreigners while the remaining 25.8% are with unknown status (Table 2).
The destination countries for Ghanaian migrants include USA, Europe and some other
relatively developed countries. However, migrants who travel to African countries have
clear intentions to travel to Europe or America. Great Britain has about 29.6% (56,112)
of the total Ghanaian emigrant population while the United States has about 67,190
Ghanaians, representing 35.5%, thus having the largest share of Ghanaian emigrants
(Table 3). Other countries with sizeable share of Ghanaians emigrants include Canada
9% (17,070), Italy (9.2%), The Netherlands (5.9%), and France (2.3%).

Table 2: Status of Ghanaians Residing in OECD
Status           Number % (of total population)
As foreigners 84996          44.9
As natives       48017       25.3
Unknown          56429       29.8
TOTAL            1899442 100.0
Source: OECD Database, 2005

Table 3: Ghanaians in Some Selected OECD Countries
Country        Status       Number % (of total population)
Great Britain Unknown 56112                 29.6
USA            Foreigners 44915       23.7 35.5
               Natives      22275     11.8
Italy          Foreigners 17024       9     9.2
               Natives      447       0.2
Canada         Foreigners 5605        3     9.1
               Natives      11465     6.1
Netherlands    Foreigners 3931        2.1   5.9
               Natives      7270      3.8
Source: OECD Migration Database 2005

Migration of skilled professionals has remained a major challenge for most developing
countries. In Ghana, the issue of exodus has assumed alarming proportion in recent years.
The trend is generally skewed towards certain important categories of skilled
professional, particularly health professionals, and more recently engineers, particularly,
petrochemical engineers. Statistics from OECD countries indicate that Ghana has a
skilled expatriate rate of 45.65% (ERCSHS15). In terms of their skill characteristics4
31.2% (52,370) of the population who are 15 years and above are highly skilled, this
represents 27.6% of total Ghanaian emigrant population in OECD countries. The medium
skilled and low skilled constitute 38.1% (64,005) and 27.2% (45693) respectively, while
the remaining 3.6% (5995) are without any known skilled (Table 4).

Table 4: Skilled Characteristics of Ghanaians (15+) in OECD
Characteristics Number % of 15+ % of total Ghanaians
Highly skilled    52370        31.2        27.6
Medium Skilled 64005           38.1        33.8
Low Skilled       45693        27.2        24.1
Unknown           5995         3.6         3.2
Total             168063       100         88.7
Source: Source: OECD Database, 2005

  (1) Highly skilled refers to those with academic qualification up to the tertiary level; (2) Medium skilled
refers to those with education up to upper secondary and post-secondary non tertiary; (3) Low skilled refers
to those with less than upper secondary.

Migration of the highly skilled remains a major challenge to the source countries. Some
countries have benefited significantly from the exodus of Ghanaian professionals. There
are some 53,254 people, representing 31.7% of Ghanaian migrants within the 15+ age
bracket living in Great Britain alone. About 36% (19,078) of this number constitute the
highly skilled professionals. This number as well represents 36.3% of the highly skilled
Ghanaian emigrants in OECD countries. The medium skilled Ghanaians emigrants in
Great Britain constitute 10.5% of the 15+ group, and 27.5% of all medium skilled
Ghanaians in OECD countries. United States appears to have the highest proportion of
Ghanaians residing in OECD countries. For example, there are some 62,485 working
class Ghanaians living in USA which represents 37% of the 15+ age group. The highly
skilled professionals in USA alone constitute 45% of all the highly skilled professionals
in OECD countries, 54% of this number have naturalized. The medium skilled Ghanaians
also form a significant proportion of the total working class of Ghanaians in OECD
countries. For example, there are some 8,485 medium skilled Ghanaians residing in the
USA as natives compared with 20,465 who live as foreigners (Table 5). The US again,
has a large number of low skilled Ghanaians, representing 21.9% of the total low skilled
Ghanaians in OECD countries.

Table 5: Skilled Characteristics of Ghanaians in Some Selected Countries
   Country                 Characteristics             Number       % of 15+       % of total
                 Nationality Status Skilled Status
Great Britain        Unknown              High          19078          11.4           10.1
                                         Medium         17598           7.4            6.6
      USA             Foreign             High          13245           7.9            7.0
                                         Medium         20465          12.2           10.8
                      Native              High          10335           6.1            5.5
                                         Medium          8485           5.0            4.5
Canada                Foreign             High           1195           0.9            0.8
                                         Medium          2175           1.3            1.1
                      Native              High           3820           2.3            2.0
                                         Medium          4790           2.9            2.5
Italy                Unknown              High            750           0.5            0.4
                                         Medium          4821           2.9            2.5
Source: Source: OECD Database, 2005

The proportion of tertiary educated Ghanaian population in OECD countries is also high
and above 20% (Figure 1).

Figure 1: Percent of Tertiary Educated Population in OECD Countries

Another point worth discussing is the nature of internal migration in Ghana. Internal
migration has mainly been a rural-urban phenomena and this has gradually led to
deteriorating conditions in urban areas and has also worsened urban poverty. Most
internal migrant particularly those who migrate to the cities are engaged in informal petty
trading and related services. Some find themselves learning a trade but that usually
happens after accumulating some savings from hawking and petty trading. In addition,
internal migration also sometimes serves as a starting journey for international migration.

Thus, from the above the exodus of Ghanaians, particularly, the skilled workforce has
assumed an increasing trend and therefore the cost as well as the benefits needs to be
ascertained to inform policy on how to maximize the gain.

International migration has prompted growing interest as the number of migrants
worldwide has increased, and the economic, social and political implications of migration
for developing and developed countries assert themselves. However, while migration is
often analyzed in terms of the „„push-pull model‟‟, which looks at the (negative) push
factors which drive people to leave their countries and the (positive) pull factors which
attract them to their new destinations, discussions on the consequences of migration
always tended to focus on the negative impacts on the sending (source) country alone.
However, migration creates both opportunities and risks for the sending and receiving
countries, thus it is imperative that a holistic approach be given to discussions on the

socio-economic impacts of migration (Katseli et al, 2005). The movement of people,
particularly labour from one country to another creates for the two countries both
negative and positive socio-economic effects. For the receiving countries, the positive
benefits from immigration are the infusion of „cheap labour‟ into their economies and the
cross-fertilization of cultures. In terms of cost, the increasing flow of foreign immigrants
often leads to a distortion of the labour markets and social tensions such as crime,
unemployment, public welfare burden and other security concerns. There is also the
social dimension. International migration can also have negative social externality on
sending countries. The social fabric of a source country could be polluted with norms,
customs, culture and values acquired by returned migrants from abroad and can hurt the
social capital. Also, at the community and family levels, regardless of the skill level of
migrants, their departure can lead to family disorganization, reduced labour force and loss
of decision makers in the community. Interestingly most of these migrant, largely, no
longer go back to stay in their communities when they return.

For the sending countries, the socio-economic effects vary widely. International
migration has the potential to contribute to sustainable development through remittances,
skills transfer, investment, brain circulation and Diaspora networks. The most notable
positive economic effect, short-term though, of migration is found in remittances. This
refers to monetary and other cash transfers sent from migrants to their families and
communities at country of origin. Remittance flows globally currently exceed USD$100
billion which is higher than the value of official development assistance. Remittance
flows have great potential to generate a positive impact in migrants‟ home region.
Remittances to developing countries amount to some $65 billion, and this amount
exceeds ODA of $ 55 billion (Maimbo, 2003). An IMF report (2001) has indicated that
migrant remittances are increasingly becoming a more constant source of income to most
developing countries with a doubling of annual remittances between 1988 and 1999.
Sander (2003) also reported that remittances have proved to be the most stable flow
compared to ODA and to private capital flows. Solimano (2003) notes that remittance
flows have concentrated in a group of developing countries. In 2002, Latin America and
the Caribbean had the highest level of remittances, totaling US$ 25 billion, followed by
South Asia with US$ 16 billion and the Middle East and North Africa (MENA) with US$
14 billion. Sub-Saharan Africa had the lowest level of remittances amounting to US$ 4
billion (with an annual growth rate of 5.2%).

There are three ways of measuring remittance flows in Ghana. The first is the Balance of
Payments (BOP) estimates and the second approach is based on inferences from the
Ghana Living Standards Survey (GLSS) while the third focuses on transfers through
banks or financial institutions in origin countries (Addison, 2005). Data from the Central
Bank of Ghana (using BOP estimates) for instance shows that private inward remittances
through the banks and other finance companies amounted to about $ 1.017 billion in 2003
as compared to $ 479 million recorded for the year 1999. The 2003 figure, we even
consider to be lower than the actual figure as many migrants use informal mechanisms to
send money. Nuro (1999) estimated that remittances from professional migrants in the
United Kingdom to Ghana ranged between$1,000 and $14,000 per annum.

Remittances have been noted to play critical roles in countries‟ development. They
contribute to the diversification of economic activities through infusing of foreign
exchange, allow the migrants and their families to invest in education, build a house and
have become a prominent source of external funding for developing countries that
surpass official development assistance and has helped to sustain the economies of many
countries and reduce poverty levels. But the developmental impacts of remittances
depends strongly on credit market conditions, which determine the cost of transferring
money and thus the channel chosen by migrants to send remittances back home (Katseli
et al, 2005). Additionally, sending countries can also gain through the transfer of
knowledge, skills and social capital. Normally the migrants, both skilled and unskilled
who will acquire skills while abroad might possibly return home with these, resulting in
brain gain. Thus international migration has become one source for the acquisition of
knowledge and skills which in itself is an investment in human resources.

Another positive effect of migration is the reduction in underemployment in economies
that are experiencing little growth. If surplus of skilled or unskilled labour exists, then out
migration of that labour can lead to increase productivity and wages of the labour left
behind. Sending countries can also benefit from the Diaspora networks in various ways
namely, remittances, transfer of expertise, among others. The Diaspora does only remit
but networks can be created in the form of associations in the host country with links in
migrants‟ country. This goes to improve communication between the sending and host
country and enhances trade, market activities, capital flows and growth. In Ghana, the
`Okyeman‟ state has benefited from Diaspora associations located in the UK, USA,
Canada and other countries (SEND, 2004). For instance, the Okyeman Cultural
Association with chapters in various parts of Europe has been assisting in environmental
projects in Ghana.

At the same time, sending countries (developing countries) can suffer negatively from
migration. A major negative effect of migration for sending countries is "brain drain", the
loss of trained and educated individuals to migration. In most cases, migration involves
the outflow of the most educated persons from developing countries to advanced
industrialized countries where they expect to find better economic and social
opportunities. This issue is at the forefront of developing countries‟ concerns, and raises
many more questions than available data enable us to answer. For example, there are
currently more African scientists and engineers working in the United States than there
are in Africa, according to the International Organization for Migration (IOM), a
worldwide agency that assists migrants. The IOM estimates Africa's brain drain has cost
nearly $9 billion in lost human capital and growth potential since 1997. In Ghana, the
continuous loss of highly trained professionals, notably nurses, doctors, teachers
(lectures) and engineers is on the increase and is of great concern to the government. It
has been observed that at least 60% of doctors trained in Ghana during the 1980s have
left the country (UN, 2003).

A memo from the Director General of Ghana Health Service (2002), estimated that 1,200
Ghanaian physicians work in the USA, 150 in South Africa and 50 in Canada. An
interesting exodus pattern is also reported for nurses; in 2003/04 about 1689 Ghanaian

nurses are in South Africa while the USA had 141, but the total in all overseas numbered
14,122 nurses (NMC, 2005). The figures may even be underestimated since the current
attrition rate is even worse, culminating in complains by the Health Authorities of
shortages of doctors and other paramedics in the country. In the case of teachers
(lecturers), the situation is not different, leading to shortage of lecturers in Ghana‟s higher
educational institutions. According to the KNUST Institutional Report (2002), of the total
4,227 staff required, only 2,918 were available. The most seriously affected area being
teaching (lecturers) with only 473 instead of 978. This has a negative effect on the quality
of teaching and research. On the whole, considering that these are countries with
relatively little skilled labour, the loss of such labour often has disastrous consequences
for sustainable development since scarce national resources are spent to educate these
individuals who in their most productive years leave to work abroad. Many institutions
become poorly managed and economic organization is worsened.

3.2 Empirical Analysis of Migration and Economic Development
The impact of migration on development can be analyzed in two ways, namely, through
its effect on labour supply and productivity. Migration affects the sending country in
several ways but the key ones are shocks due to changes in labour supply as well as
productivity (Katseli et al, 2005). Negative shocks to labour supply as a result of large
exodus of people, particularly economic migrants appear at the early stages of migration
but the positive shocks may appear at a later stage when return migration takes place.
Migration leads to exodus of labour with specific skills such as doctors, nurses or
teachers which may adversely affect the stock of human capital. Thus, the changes in
labour supply induced by migration forms the first channel through which migration
affects development. The second channel through which migration affects development
is through remittances sent by migrants to families and relations in their countries of
origin. Both effects (labour supply and remittances) affect economic growth and poverty
directly through substitution and income effects and indirectly through productivity
changes (Katseli et al, 2005). Based on the above theoretical inter-relationships, this
report uses two case studies to analyze the impact of migration on development.

Migration, labour Supply and Economic Development (Macro Evidence)
Migrations out of Ghana have become an integral part of the survival strategies of many
households in Ghana. These migrations have wide-ranging economic, social and cultural
dimensions for Ghanaians and the increasing exodus of health personnel is occurring at
an alarming rate. It is reported that in 1998-9, the share of overseas trained nurses
registered in the UK as a proportion of the total nurse stock were 1.2 %, 17.4% and 1.5%
for Ghana, South Africa and Zimbabwe respectively. In 2002-3, the proportion of nurses
from these countries has increased except for South Africa where a decline was recorded;
it was 2.1%, 12.0% and 4.0% for Ghana, South Africa and Zimbabwe respectively. This
is also confirmed by Stillwell (2003) and also DFID (2004).

Health worker migrations from Ghana have focused mainly on two types of professions
within the health sector, namely, doctors and nurses. Whereas doctors find it easier to
migrate to the USA, nurses find it more convenient to migrate to the UK because of the
ease of absorption into the health system. The choice of destination depends on the

recruitment process and more particularly the ease of registration with the country‟s
professional bodies. According to a DFID Report which also reiterates the point raised
earlier, nurses prefer the UK which does not require examinations and only requires an
adaptation once registration and qualification in Ghana has been verified and accepted.
In the USA, nurses from Ghana will have to sit for examinations which add to the cost of
migrating and therefore makes the USA a less attractive destination. In the case of
Doctors, the USA is the most preferred destination and those working currently in the UK
have intentions of later migrating to the USA (DFID, 2004). Similarly, some Ghanaian
nurses in UK eventually settle in the USA. The choice of countries is evidenced in the
number of professionals seeking verification from the Ghana National Medical Council
(Table 6).

Table 6: Ghanaian Nurses Verification – Country Verified for and Year5
Country of                       Year of Seeking Verification
Destination 1998       1999      2000        2001      2002                       2003        Total
USA         50         42        44          129       81                         80           426
UK          97         265       646         738       405                        317          2468
CANADA 12              13        26          46        33                         10           140
S-AFRICA 9             4         3           2         6                          -            24
OTHERS      4          4         8           8         5                          -            29
TOTAL       172        328       727         923       530                        407          3087
Source: Ghana National Medical Council (cited in DFID 2004)

Migration of nurses and doctors from Ghana has been worrying, particularly, its
consequences for health delivery and the well-being of many Ghanaians, including
children. For instance, the 2003 Ghana Demographic and Health Survey revealed that
infant mortality and under-five mortality have worsened between 1998 and 2003, a
period characterized by a rapid emigration of health professionals from the country
(Table 7). It is worth mentioning that although the number of nurses verified had
declined continuously since 2001 as a result of a new code issued by the UK government
in 2001, which required the National Health Service (NHS) employers not to actively
recruit from developing countries unless there is a government-to-government agreement,
the number of nurses verified after the introduction of the code far exceeds the 1998
levels. Most of these nurses are recruited by private nursing homes and by some NHS
Trusts and thus the code has not adequately addressed the human resource gap caused by
nurses migrating from Ghana. Another point derived from Table 6 is that a liberal or
strict migration policy can significantly affect the decision of nurses to migrate.

  Verification of nursing certificates are normally requested for by the UK Nurses and Midwifery Council
and records on this is documented by the Ghana Health Service. However, it is possible for a Ghanaian
nurse to have his/her certificate verified but that does not necessarily mean he/she actually migrated.
  Until May 2003 only

Table 7: Brain Drain of Health Workers, 1999-2004
          Main Cadres            1999 2000 2001             2002    2003   2004 Total
 Doctors                           72      52     62         105     117    40   448
  Pharmacists                        49      24      58      84      95      30     340
  Allied Health Workers               9      16      14      12      10      8      69
  Nurses/Midwives                   215      207     235     246    252      82    1237
  Source: Ministry of Health

An initial attempt to estimate the net benefit of migration has been provided in Quartey
(2006a) using data on 100 Ghanaian trained nurses working in the UK. A majority of
sampled respondents (92.9%) indicated that they are satisfied with their current job, with
53% indicating `very satisfied‟. Only 5.1% mentioned that they were not satisfied with
their current job. Also, over 95% of sampled Ghanaian nurses in the UK indicated that
they have the opportunity to upgrade themselves or acquire new skills in their current job.
Similarly, about 93.9% of respondents mentioned that the opportunity exist for one to
have a salary increment or rise through the ranks. Interestingly, 34% of sampled
Ghanaian nurses working in the UK indicated they have satisfactory relationships, while
65% indicated they have `very good‟ relationship.

Wage disparity between nurses working in Ghana and their counterparts in the UK
explains exodus of Ghanaian nurses to the UK. The average monthly salary for the
sampled nurses is £1590 with a minimum value of £1200 and the maximum of £1800 per
month. The average normal working hours per week is 37.5 hours but very few nurses
mentioned they work 40 hours per week. Also interesting is the finding that over 88% of
sampled nurses indicated they are allowed to work overtime while 10% indicated they
were not. A related issue is that those who work overtime earn extra income ranging
between £300-600.

It appears migration of Ghanaian nurses to the UK although not uncommon has become a
much more recent phenomenon. Only 2.9% of sampled nurses migrated to the UK
between 1970-79, while 2.9% migrated to the UK between 1980 and 1989, 25% migrated
over the period 1990-99 and the majority (52.9%) migrated over the period 2000-2005.
The reasons for migrating are varied but the major one is better conditions of service.
About 89% of the sample indicated that they migrated mainly to the UK to enjoy better
conditions of service and this is supported by the wage disparity between the two
countries and the opportunities for upgrading skills. It is important to note that majority
(95%) of nurses who have migrated are the very experienced ones who have worked in
hospitals in Ghana for an average of 7.5 years, with a range of between six months and

The survey also revealed that the initial cost of migrating to the UK is expensive when
compared to how much nurses receive in wages in Ghana. On average, it cost £463 in air
ticket, £292 for documentation and £261 in respect of luggage and internal transport.
Other additional expenses include job search cost, living expenses prior to obtaining a
job, warm clothing to mention but a few. It is possible that the migrants were either fully
or partly financed by their relations in Ghana or overseas. The volume of remittances
sent by these migrants supports the point that these migrants may have been supported by
their relations in Ghana. About 50% of the sample indicated that they send remittances
bi-weekly or monthly, whereas the rest send it quarterly, annually or irregularly. The
average amount of remittances sent monthly to finance education is £140.9, while on
average, £87.0 is sent monthly for health and health related expenditures. Remittances
sent to cover living expenses averages around £121 per month while on average, monies
sent home for other related expenditures amounted to £203

Thus, migration affects the labour market positively and negatively. Whereas migrants
leave the already over-stretched local health system, migration also improves the skills
and competence of migrants who in turn pass on the acquired skills when they return to
their home country. Thus, the role of return migrants is an important issue for
investigating. Secondly, migrants also send remittances in cash and in kind which have
developmental impacts on the migrants‟ home country. The net effect of migration on
development is computed in Quartey (2006a). After discounting the net wage gap and
subtracting both percuniary and non-percuniary cost of migration, it emerged that
migration has positive net private and social benefit and it was also evident that there was
no significant difference in outcomes between liberal and strict regimes under the NHS
code of conduct. It must be emphasized that the net social benefit excludes social cost
due to deaths associated with nurse migration to the UK. If it was possible to estimate
this cost, the net social benefit would have been negative. The study believes that the
outflow of nurses has had an impact on health outcomes in Ghana and this is evidenced
by the maternal and infant mortality ratios, nurse population ratios etc.

Another empirical approach to the migration-development nexus is a statistical analysis
of the impact of remittances on welfare. Quartey (2006b) using a survey of 166 receivers
of migrant remittances finds that 51.8% of the sample mentioned that the remittances are
consumption purposes (living expenses, funerals and other social activities) while about
44 percent of the sample indicated that the funds are for investment purposes. This is
corroborated by Mazzucato (2004) where it was observed from a transnational survey
that remittances affect Ghana through investment in housing and also the spin-off effects
on a large number of businesses that are involved in funeral ceremonies and other social
functions. Also, the relatively significant proportion of remittances invested clearly
indicates that migrant remittances have significant long term impacts on household
welfare. The survey also revealed that remittances form quite a significant proportion of
recipients‟ income; whereas 40% of the sample stated that migrant remittances are the
main source of income, 60% stated they have other main sources of income. About 20%
of the sample lives solely on migrant remittances. On average, migrant remittances form
57.4% of recipients‟ total income (Table 8).

Table 8: Uses of Migrant Remittances – Survey of 166 Recipients in Accra
USES                                OBSERVATIONS    PERCENTAGE
                                                      OF TOTAL
Living Expenses                        79               47.59
School Fees                            45               27.11
Working Capital                         6                3.61
Investment for Sender                  22               13.25
Funeral                                 2                1.20
Others                                 12                7.23
TOTAL                                 166                100
Source: Quartey (2006b), A survey for AERC Project on Migrant Remittances and
Household Welfare in Ghana

The impact of remittances on welfare is also analyzed using GLSS 3 and 4 and it is
reported that remittances significantly improve household welfare; a 1% increase in
remittances will increase household welfare by 0.26% (Quartey, 2006b).

Return migration may be defined as the „end product‟ of the migration cycle. In other
words, it refers to the movement of people who return to their countries of origin or
habitual place of residence after spending at least a year in another country. In this case
the agents involved are the returnees. The UN Department of International Economic and
Social Affairs- Population Division sees returnees as persons who, having the nationality
of the country that they are entering, have spent at least one year abroad and have
returned with the intension of staying at least one year in the country of their nationality.
Return migration can be voluntary or the result of an expulsion order. Even though return
migration and its consequences has attracted increasing attention since Western European
countries adopted policies in the mid 1970s to stop the inflow of foreign workers and to
promote reintegration of emigrants, it is difficult to distinguish return migration from
other forms of migration taking place in the world today. A major reason is that,
relatively little attention has been devoted to return flows of migrants in developing
countries as a result of paucity of information and fluidity of some of the movements

In Ghana voluntary return migration has been ongoing and has taken the form of short
visits to families back home and permanent return with the aim of settling down to
establish business enterprises after a long period abroad. Depending on how the return
migration took place, it could be an asset or a liability. In the case of involuntary return
migration, the returnees may be without their assets or resources, and hence, little or no
impact of their return would be felt, at least for the short-term. But in the long-term, by
which time they would have been fully integrated, the improved skills and experiences
many of them might have acquired, could be put at the disposal of their local economies
as a valuable human resource for socio-economic development. On the contrary,
involuntary returnees can be detrimental to the local and national economy of the country
of origin through increase crime and other social vices if they are not fully integrated.

Notwithstanding the risks, it is significant that governments consider what motivates the
return and perhaps the characteristics of returnees- age, education, and gender; so that
informed decisions can be taken for their acceptance, integration and the role they can
play for national development

Incentives for return
For most migrants, if not all, a decision was taken at one point in time to return home
based on certain considerations. However, motivations will vary from person to person.
In the majority of cases, the decision to return would depend on the existing socio-
economic circumstances of the migrant at a point in time as well as on perceptions of the
future prospects upon return. Thus, it could be induced by policies of source or host
country. In Ghana, the economic recovery program pursued and other policies pursued
thereafter lead to improved conditions back home for a decade or so and this has largely
shaped peoples minds to return. Additionally, better managed political crisis and
improved human rights records can trigger the return of especially, political migrants.
Since 1992, the transformation of Ghana from military to democratic rule has seen the
return of most political emigrants. For skilled migrants, the motivation could be due to
the completion of a course of study and therefore see the need to return and help mother
country. Another determinant is the motivation of the investment in the “Homeland”. For
some migrants it is a „dream becoming a living reality‟ and they will discontinue their
stay abroad. Other factors that might influence a person‟s return include failure to get
necessary documents to guarantee stay abroad, conflicts at destination as well as
encouragements from home governments to come back home. An example is the Homing
Coming Summit organized in Accra, Ghana in 2001. The Government of Ghana has also
initiated policies such as the payment of `Additional Duty Hourly Allowance (ADHA) to
doctors and other incentives packages like acquisition of cars and provision of housing
for doctors. However, nurses in Ghana have not benefit from these incentives and this
has also accounted for the exodus of nurses from the country.

How long should people migrate?
Many return migrants have had long periods of stay abroad. The initial movement could
be temporal, but one may be forced to stay a bit longer if conditions in the host country
are “friendly”. These can be in the form of easy access to stay permits and employment.
The length of stay could also depend on elements such as migrant‟s age, marital status
and education. Normally people who are advanced in age and married are likely to
migrate for shorter periods than the young and unmarried. The unskilled are also likely to
live longer abroad than the skilled since they might accept any type of job. Though the
job conditions might not to be too good, it will be better than returning home considering
the fact that they lack the skills to qualify for a good job at home. Additionally, the length
of stay abroad can be determined by the amount of time needed to accumulate target-
earnings levels and by life cycle considerations.

Brain gain

Migration is seen to be evil in terms of the `brain drain‟, ie, human capital loss it
unleashes on sending countries, although it may also provide an opportunity for the
acquisition of skills, experience and knowledge. The reversal of the `brain drain‟ through
the acquisition of skills for the development at home is referred as `brain gain‟.
Saxenian‟s Brain Circulation Model (Saxenian, 2002) or the more recent Brain Gain
Model argues that those highly skilled migrants from developing countries who have
migrated to advanced countries represent a potential resource for the socio-economic
development of their home countries. Thus, migration may be detrimental to the
community of origin if the labour market is depleted by the departure of its most
productive and/or qualified members (brain drain). However, migrants who have
developed and improved their skills abroad can be actors of the `brain gain‟ by
transferring and infusing knowledge, skills and technology into their countries of origin.
The challenge, therefore, is to develop mechanisms to mitigate as much as possible the
negative effects of `brain drain‟ and to encourage the return of qualified nationals
resulting in `brain gain‟.

International migration, especially intra-regional in Africa, is likely to rise considering
the movement of persons without visas within the West African sub-region. Even though
migration and development is a growing area of interest, there has been much debate on
the negative impacts of migration on development, and vice-versa. On the one hand, it is
argued that underdevelopment is a cause of migration, and on the other, that migration
causes developing countries to lose their highly skilled nationals. While there is a
measure of truth in each of these assertions, properly managed international migration
holds enormous potential for the development of countries concerned. To substantiate
this assertion, two case studies on Ghana were used to illustrate how migration affects
development and the potential challenges facing sending and receiving countries. It
became evident that migration has led to significant brain drain for Ghana which
negatively affects economic development. However, the impact of remittances sent by
migrants on the economy is significantly positive.

In conclusion, migration can positively affect economic development if properly
managed. It is therefore necessary that the appropriate policy environment is created to
maximize the benefits and minimize the risks of managed migration. Managed migration
facilitate the movement of people that is most likely to bring development while also
acting to protect migrants from abuse and exploitation as well as restricting people who
migrate simply to survive. The elements of migration management are complex and
involve short-term, medium term and long-term measures. The government‟s policy
towards retaining doctors by providing them with cars, houses and better remuneration is
commendable and such facilities should be extended to other professionals. Thus, a
starting point for the country is to ensure an integrated and holistic approach for the
development and implementation of migration management policy, involving major
partners engage in this migration policy arena, especially government sector, private
sector, civil society and trade unions at country level. It also vital to promote and
strengthen the impact of migration both for countries of origin and transit, by making

sure migration policies are part of a comprehensive global `logic‟. Countries should
promote and enhance dialogue and cooperation at the international level. The aim is to
ensure that migration contributes to sustainable development, and that in turn
development also helps to facilitate managed migration.

In order to benefit from remittances, skills transfer and investment opportunities, it is
necessary to create and maintain links between migrants and their countries of origin, and
to tap into their potential by encouraging them to contribute human and financial capital
to the development of their home communities. The 2001 Home Coming Summit in
Ghana is a good example. Migrants could make best use of economic opportunities at
home if internal mobility was facilitated by both the source and host. A secure legal
status at destination with work and residence permits, recognition of dual citizenship by
countries concern are measures needed for circulation to take place. In the case of
irregular migration managing the return, repatriation and resettlement of refugees and
internally displaced persons is an integral component of migration management. These
activities require cooperation between the host, home and transit states, taking into
consideration the needs and concerns of each as well as of the migrants themselves.


Ghana Health Service (2002), Inter-Office Memo-Re: Staffing Situation in the Ghana
      Health Service, November.

International Organization for Migration (IOM) (Programmes & Research data base).
        January, 2004

International Organization for Migration (2002), Remittance to Africa and their
        Contribution to Development, Migration Policy and Research Programme
        Working paper, July

IOM Comprehensive and Solutions-Oriented Approaches to Irregular Migration, IOM,

IOM.2004. World Migration (2003): Challenges and Responses for People on the Move,
      World Migration Report Series vol. 2 IOM, Geneva.

KNUST Institutional Report, submitted as part of the Ghana Universities Case Study,

Nuro, E.A. 1999. “Brain Drain from Ghana: the Case of University Lecturers.” M.Phil.
       Thesis submitted to the Department of Geography and Tourism, University of
       Cape Coast.

Nursing and Midwifery Council (NMC), August 2005 Register

OECD (2004), Trends in International Migration. 28th annual report of the OECD
     Continuous Reporting System on Migration, SOPEMI, 2003 Edition

OECD (2001), Trends in International Migration Annual Report, OECD, Paris, p.115

Quartey P (2006a), The Impact of Rich Countries Policies on Poverty in Developing
       Countries: the case of migrant nurses from Ghana to the UK, Global Development
       Network (GDN) Project Report, GDN, Delhi, April

Quartey P (2006b), The Impact of Migrant Remittances on Household Welfare in Ghana,
       AERC Working Paper (forthcoming)

Republic of Ghana Home Coming Summit for Ghanaians Living Abroad Event Summary
      (Draft Report) Accra, 23rd-25th July

Saxenian, Anna Lee (2002). Silicon Valley's New Immigrant High-Growth
       Entrepreneurs" Economic Development Quarterly, Vol. 16, No. 1, February 2002.

SEND Foundation (2004), One nation, one people, one destiny‟? The Ghanaian
     diaspora‟s contribution to national development using diverse channels, An action
     research study of resource mobilization by Ghanaians in the diaspora to three
     regions in Ghana,. Unpublished report prepared as part of the “Hello Africa:
     Shifting Power, Tackling Poverty by connecting Africa and the African
     Diaspora”, Project, funded by Comic Relief. Accra. May

The Financial Times, 2004

Twum-Baah, (2005), Volume and Characteristics of International Ghanaian Migration,
     in At Home and the World, edited by Takyiwaa Manuh, Sub-Saharan Publishers

United Nations, 2003 “Reversing Africa‟s „brain drain Africa” Recovery Vol.17, No.2,

United Nations, 2003 Levels and Trends of International Migration to Selected Countries
       in Asia, New York: UN Population Division.


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