Thanks for raising this point, Nick, and for the many good arguments you’re making!
Out of all the forms of labor emigration, I find physician and nurse migration to be the most concerning. I’d stress that the idea proposed in our report doesn’t focus on skilled workers (only as a potential later extension, needing careful consideration), so it largely avoids this concern. We focus on low- and mid-skilled workers, as those are poorer to begin with, much more numerous, and there’s an oversupply of them in many LMICs (as opposed to shortages).
I did spend a little bit of time looking into the literature on brain drain and didn’t arrive at a clear conclusion. There are many factors pointing in different directions, and whether the overall effect is net positive or net negative may vary between countries and professions.
Aside from the considerations that you and David mentioned, there are also remittances, the effects of return migration (the rates of which vary a lot) and associated “brain gain”, or the fact emigrating physicians are more likely to come from well-staffed urban areas. E.g. this (very old) article by Clemens and McKenzie says that, in Kenya, some 66% of physicians live in Nairobi where only 8% of the national population lives. They argue that low incentives to work in rural areas are a much bigger problem than the total supply of physicians (and how that supply is affected by emigration).
Concerning the CGD, I’m actually quite excited about their efforts to push for so-called global skills partnerships in the skilled space. Within these programs, countries like the UK would pay countries like Nigeria to train nurses and have agreed quotas on how many nurses can stay vs migrate. This seems like a more sophisticated solution to the issue than saying “nurse emigration is good.” Here is their proposal specifically for Nigeria.
In any case, this is not a topic that we at CE decided to focus on at this point. If we do look into skilled migration in the future, we will do a much more thorough dive (and will be keen to get your input!).
Hi Nick, thank you very much for your thoughtful feedback! I researched the syphilis idea so will address those questions.
1. The dual tests have recently become very cheap too, costing some $0.95 each (largely thanks to CHAI’s work in this area). In our understanding, this is only some $0.15 more expensive than a single HIV test – though I’m sure prices will vary geographically. If there are places where the dual tests are more expensive than two separate rapid tests, then I agree that the dual tests wouldn’t make sense there.
2. You are right that changing the existing system (including updating diagnostic algorithms and training the relevant health workers) is one of the main challenges and one of the reasons why this idea has not already been implemented more widely. However, it seems that what is currently lacking is technical assistance for countries’ health systems to make this switch – and this is exactly the sort of implementational work that we think strong charity entrepreneurs can do well!