A few thought. 1. It is a substantial frustration for technically educated persons to work in areas for which their prior education is not applied. We have little data on this, however. 2. Salary differences are vast, to be sure, but we've been surprised at how often the quality of work life was the incentive for departure, more than salary. People do not like feeling that the quality of their work is compromised by extreme infrastructure, health workforce, or supply constraints. 3. Yes, high income nations that under-train for their own health workforce needs and recruit from low income countries are surely exploiting those nations. Why is there no compensation paid to universities/governments for the educational costs of the SSA migrants? 4. Selection criteria in most lower income nations is by academic merit alone. It may be that other criteria should be considered. Persons from rural areas are more likely to serve after training in rural areas. Persons from minority population groups are more likely to serve those groups. Hence, selection criteria for medical/nursing/other health schools may need to consider this, not just the elite academic student. Of course, better health infrastructures, health workforce, and quality of care would make for a happier and more satisfying work environment. 5. It is true that if a doctor or other health care provider is solely motivated by salary, the incentives to avoid migration will be hard to offer. But I believe that picking the right people for medical school, task-shifting to health personnel less likely to migrate, and improving work conditions at home can help. I also think that the moral imperative for rich countries to compensate lower income nations for the costs that they have incurred to train staff for the high income nation. Thanks, that's all for now.