Using current management and human resource strategy for staff planning, succession and rotation can make a real difference

Looking at the health research sector in low income countries, what do you see as the solution to the brain drain?

First of all, I think we should take a constructive view, to see how countries can achieve ‘brain gain’. The loss of health care workers in Africa and Asia to northern labour markets over the past decade, are certainly real and very critical. Common responses have been to propose legislation or rules to encourage (or oblige) people to work in the country where they are trained. Beyond this there is a lot of discussion and description of the ‘brain drain’ problem but few proposals for long term solutions.

Beyond legislation and inter-country negotiation, what can be done in the health research sector?

Leaders of southern health research organizations should learn the lessons of many northern counterparts and organize themselves to give more attractive work opportunities – especially responsibility to researchers early in their careers.

But if northern countries continue to pay higher salaries, the talent will continue to move north.

Not necessarily. I recently spoke to a research manager from West Africa who explained that the team of young malaria researchers she mentors hope to remain in their country and pursue their careers at home after studying partly abroad. I expect that this is the case with the majority of young researchers. The problem is the lack of opportunities to do solid work in their country.

I believe that most heath researchers will choose to work in their country on issues that concern it, and to work in their society. But the opportunities for substantive work, with a reasonable salary and perspective are not always there. So to remain researchers they will look abroad.

So who is at fault?

Let’s rather talk about responsibilities. We need a dialogue between countries to have an equitable exchange of labour and avoid the wholesale ‘poaching’ of talent from the south to the northern labour markets.

But we should also recognize that part of the responsibility for brain drain also lies with the southern research systems, their managers and leaders. The approach to managing and nurturing talent in developing countries needs to be modernized; just as it has been in the north over the past 50 years.

Certainly, in low-income countries, the economic argument is a strong one. But salary is only one of several factors that motivate health research professionals. Other equally important considerations are: a stimulating work environment; flexibility of employment (for women or men with young children, or time to pursue professional interests or studies); opportunities to get training and build skills; opportunities to take on responsibility in early career. This means to have the possibility to become a project leader, manager, programme leader, to participate in a multi-country team, or to travel and represent the organization.

In my personal experience as a manager who has worked with many African research colleagues and institutions – the issue is clearly a question of the old-style vs new-style of management. In the old style hierarchical structures you have to wait until you’re 50 years or more – before you can advance to a position of responsibility. This environment is a big limiting factor for young and mid-career professionals, who, based on their competence, get to the top in the competitive environments of research in the USA and Europe. Why would someone who can make it in a competitive, merit-based promotion system remain if the main reason for promotion is age or political affilliation? Clearly, working under a ‘lid’ means that talent moves sideways … i.e. migrates to research systems that award competence and commitment.

Is this a typically African Issue?

No. But institutions in low income countries are probably more bound by rigid hierarchical structures. This environment is most demotivating for young and mid-career researchers and technical specialists – the lifeblood of a national health research system. But it seems to happen mostly in the public sector. When one considers more commercial research systems, such as the Pasteur Institutes in the Francophone Africa, it seems clear that there is much to be gained from modernizing management in national health research.

What can the leader of a research organization do to motivate research staff?

Create good governance and strong policies that encourage the professional management of their talent base. Today’s leading organizations are based on individual performance, not seniority. The best performers are rewarded with opportunities, responsibilities and salary increases – they can be of any age (even older too!). There are also staff rotation mechanisms, such as temporary attachment to project teams, shorter-term contracts – even for senior managers – to make room for new talent in an organization.

All this creates an environment where professionals gain experience working in different teams and where there at frequent opportunities to assume new roles and move up in the organization.

How can health research organizations turn brain drain to brain gain?

Put in place policies that motivate and identify high potential talent, such as:

• Base reward and promotion on performance not seniority.
• Create opportunities for staff mobility and rotation.
• Have professional governance to avoid permanent directors, board and senior staff.
• Create opportunities for young an mid-career professionals to take responsibility
• Involve more young people and women in decision making
• Create team environments that encourage good ideas from all.
• Donors – broaden their base of contacts and work in regions and countries.
• Donors – support broader south-south and north-south partnerships with new groups of people, beyond the groups that have privileged access to donors and donor agendas.

You mentioned that the development situation also has its specific ‘market forces’ that affect the human resources situation for health research.

The situation with donors creates a special dynamic in the talent market for health research.

Through their funding and programmes donors provide solutions to countries. But donors can also be a part of the problem that inhibits development of human resources for health research.

Let me give two examples:
Project-based funding provided to research organizations in the south does not encourage development of a professional cadre in institutions and their infrastructures. The fact that overheads are usually not allowed in grant financing creates fragmented institutions without the essential support services needed to make research effective. This includes a lack of sustained activities such as research support staff, IT and database development, research communication, publishing and library services, or professional staff focused on policy analysis or impact assessment.

Secondly, in many regions, donors continue to work with the same group of ‘intermediaries’ or ‘trusted contacts’ year-after-year, despite competitive bidding processes. This prevents new and younger research players from putting their ideas forward. In the end this stifles creativity, limiting the possibility for new talent to develop in regions.

We encourage donors to support the development of human resources in health research by working with wider groups of people and including more new players in projects and programmes – especially at the managerial level. They should encourage broader south-south and north-south partnerships that involve new groups of people, beyond the same groups that have privileged access to donors and donor agendas. Donors should create a more open playing field for research funding and lead by example.

What is your advice and hope for the future?

There is no crystal ball! But I think that the southern research organizations that embrace professional management practices and take investment in their people seriously will come out on top. This includes government departments, universities, health research councils and NGOs.

The institutions that take this on seriously will become Africa’s leaders. They will build better quality partnerships, produce better quality research and attract more donor funds. And – as development donors focus more on measuring the performance of the organizations they fund – those institutes that are professionally managed will receive more donor investment.

COHRED tries to bring a new perspective to the human resource for health research picture. One that looks beyond the ‘researchers’ towards a country’s entire system of health research. Our focus for the Human Resources for Health Research symposium in July in Nairobi brings three new perspectives that are usually neglected from the health research paradigm. There are many more aspects – beyond health researchers that need to be addressed to make health research work –. For example:

• The power of networks and networking. In resource-poor situations, the networking of specialised professionals across countries and regions can contribute to the critical mass needed to stimulate creativity and peer-review. However, networks are not generally very successful, and are seen as expensive – so we want to investigate how to make them work in Africa and other low-income areas.
• Media, communication and community involvement in research are another example. In the developed nations, communities – through organisations, lobbyists, pressure groups, and other modes – have greatly influenced how nations fund health research. Yet, in the low income countries this is not the case. How can the relevance of health priority-related research be best communicated to populations, and how will these communities communicate their interests back to policy makers and researchers? These are some of the new perspectives we will be addressing in Nairobi. From there, in our ‘country-based’ science communication initiative that we started jointly with the Institute of Public Health at Makerere University in Uganda.