The World Bank Economic Review Advance Access published online on May 15, 2008
The World Bank Economic Review, doi:10.1093/wber/lhn005
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HIV Pandemic, Medical Brain Drain, and Economic Development in Sub-Saharan Africa
Correspondence: Email address is bhargava{at}uh.edu
JEL codes: C33, C5, F22, I12, O11, O55.
Country-level longitudinal data at three-year intervals over 1990–2004 are used to analyze the factors affecting emigration of physicians from Sub-Saharan countries and the effects of this medical brain drain on life expectancy and number of deaths due to AIDS. Data are compiled on emigrating African physicians from 16 receiving Organisation for Economic Co-operation and Development (OECD) countries. A comprehensive longitudinal database is developed by merging the medical brain drain variables with recent data on HIV prevalence rates, public health expenditures, physicians' wages, and economic and demographic variables. A triangular system of equations is estimated in a random effects framework using five time observations for medical brain drain rates, life expectancy, and number of deaths due to AIDS, taking into account the interdependence of these variables. Lower wages and higher HIV prevalence rates are strongly associated with the brain drain of physicians from Sub-Saharan African to OECD countries. In countries in which the HIV prevalence rate exceeds 3 percent, a doubling of the medical brain drain rate is associated with a 20 percent increase in adult deaths from AIDS; medical brain drain does not appear to affect life expectancy. These findings underscore the need to improve economic conditions for physicians in order to retain physicians in Sub-Saharan Africa, especially as antiretroviral treatment becomes more widely available.
Alok Bhargava (corresponding author) is Professor of Economics at the University of Houston. Frédéric Docquier is a research associate at the National Fund for Economic Research and professor of economics at the Université Catholique de Louvain; his email address is frederic.docquier{at}uclouvain.be. The authors thank C. Ozden, M. Schiff, and A. Winters, of the World Bank, for encouragement and the International Migration and Development Research Program for research support. They also thank P. Ghys and K. Stanecki, of UNAIDS; L.J. Johnson and A. Wittrup, of the International Labour Organization; T. Tan-Torres and N. Van de Maele, of the WHO; and statistical and medical agencies in 16 OECD countries for help in obtaining the data used in the analysis. This article benefited from the helpful comments of three reviewers and the journal editor. The article is dedicated to the memory of Enid M. Fogel, who inspired many economists by her warmth and who devoted herself to improving the lives of young people.