Abel Chikanda

Skilled Health Professionals’ Migration and its Impact on Health Delivery in Zimbabwe

The paper investigates the magnitude of migration of health professionals from Zimbabwe, the causes of such movements and the associated impacts on health care delivery. International migration of health professionals has led to staff shortages and the situation is worse in public compared to private health institutions. The quality of care given to patients has also declined. The research calls for the adoption of an integrated approach in solving the problems of the health professions.

The third wave: mixed migration from Zimbabwe to South Africa

Migration from Zimbabwe has recently been described as an archetypal form of “mixed migration” in which refugees and migrants are indistinguishable from one another. This paper argues that such a state-centred understanding of mixed migration oversimplifies a far more complex reality and fails to adequately account for the changing nature of Zimbabwean out-migration. Based on data from three separate Southern African Migration Programme (SAMP) surveys undertaken in 1997, 2005 and 2010 at key moments of transition, the paper shows how the form and character of mixed migration from the country has changed over time. The country’s emigration experience since 1990 is divided into three periods or “waves”. The third wave (roughly from 2005 onwards) has seen a major shift away from circular, temporary migration of individual working-age adults towards greater permanence and more family and child migration to South Africa. Zimbabwean migrants no longer see South Africa as a place of temporary economic opportunity for survival but rather as a place to stay and build a future for themselves and their families.

Health worker migration from South Africa: causes, consequences and policy responses

BackgroundThis paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries—Jamaica, India, the Philippines, and South Africa—have historically been “sources” of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa.MethodsThe study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically.ResultsThere has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself.ConclusionsIn the near past, South Africa’s health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.

The Disengagement of the South African Medical Diaspora in Canada

Conventional wisdom holds that the ‘brain drain’ of health professionals from Africa is deeply damaging to the continent. Recently, a group of North American and European neoliberal economists has challenged this view, variously arguing that the negative consequences are highly exaggerated and the compensating benefits many. The benefits include various forms of diaspora engagement in which those who have left then engage in a variety of activities and actions that bring substantial benefits to their country of origin. This article examines the case of South African physicians in Canada to test this argument. The study on which the article is based found that these physicians constitute a profoundly disengaged diaspora. The quantitative evidence shows that while they continue to assert a South African identity and take some interest in events in the country, they do not participate significantly in any of the activities that typify diaspora engagement. The article then uses the qualitative narratives of the physicians to discuss how they justify this situation to themselves. As we show, at the heart of these narratives is a dystopic set of images that show nothing of value and nothing praiseworthy in post-apartheid South Africa.

Diasporas of the South

Most of the recent literature on diasporas and development has focused largely on diasporas located in the North, with very little attention given to those who move to other countries in the South. Therefore, very little is known about the scale of movement between countries in the South and whether the nature and level of development-related engagement by diasporas in the South is comparable to that of diasporas in the North. In this chapter, we show that South–South diasporas compare favorably not only in numerical terms with South–North diasporas but also with respect to other roles that they play in their home countries. For instance, even though South–South remittances are sometimes higher than North–South remittances, the volume of the former is frequently underestimated because of the prevalence in use of informal channels in developing regions. Furthermore, diasporas in the South also show high levels of organization by forming associations with various objectives, ranging from protecting the welfare of members in the host country to facilitating development projects in the home country. Thus, given the role they play in developing their countries of origin, South–South migrants deserve greater attention from researchers and policymakers.

The changing patterns of physician migration from Zimbabwe since 1990

Purpose – The paper seeks to investigate the leading causes of physician migration from Zimbabwe and to highlight the patterns of physician migration over the past‐two decades.Design/methodology/approach – A mixed methods approach, involving a survey and interviews, was used to collect data for the study.Findings – The paper demonstrates that personal networks, not recruitment agencies, are the main drivers of physician migration from the country. However, the importance of recruitment agencies as channels of information about job opportunities abroad has grown substantially over the last decade. The research findings suggest that Zimbabwe will continue losing physicians to other countries until economic and political stability has been restored in the country.Originality/value – By highlighting the patterns and causes of physician migration from Zimbabwe, the paper makes a contribution to the implementation of policy measures aimed at retaining physicians in the country.

South-South cross-border patient travel to South Africa

ABSTRACT This paper explores intra-regional South-South cross-border patient travel within the context of Southern Africa. South Africa, in particular, has been widely touted as one of the emerging destinations of high-end patients from the Global North alongside other destinations such as Brazil, India, Costa Rica and Thailand. Using South Africa as a case study, the paper demonstrates that South-South cross-border patient travel is far more significant than North-South patient travel both in numerical and financial terms. Every year, thousands of patients from neighbouring countries travel to South Africa in search of medical treatment for procedures that are not offered in their own countries. Despite its size and importance, the South-South flow of patients in Southern Africa is not fully understood and requires further scholarly research.

The Making of a Southern Diaspora: South- South Migration and Zimbabweans in South Africa

Diasporas are increasingly viewed as a vital untapped development resource by governments in the global South. As a result, strategies and programmes for diaspora engagement in development are very much on the global migration and development agenda. However, debates about the actual and potential role of diasporas in development are characterized by a striking myopia that tends to view diasporas from the South as located primarily or exclusively in the global North. The case of Zimbabwe is particularly interesting in this regard. The country has been a major global migrant source country for the last two decades as the economic and political crisis in a once well-managed state deepened. Though their lives and status in South Africa remain precarious, they are carving out lives and livelihoods and building social networks in a hostile land. What we are witnessing, therefore, is the act of creation of a diaspora as migration shifts from being temporary and circular in nature to being more diverse and permanent or semi-permanent. Under the current political dispensation in Zimbabwe, most members of the diaspora are likely to confine their engagements to family and personal matters and avoid engagement overtures from the Zimbabwean government. That said, Zimbabweans in South Africa increasingly identify with the notion that they are members of a diaspora and are starting to form associations and organize themselves to pursue a range of diaspora activities.

The rise of medical tourism to South Africa

South Africa is becoming an increasingly important global destination for medical tourists. Medical tourists fall into two main categories. First, there are conventional North-South medical tourists from Europe and North America who travel to access South Africa’s world-class private medical facilities. The country is marketed by medical tourism operators, facilitators and service providers as a cosmetic surgery destination with a related tourist experience (such as a game safari). It has also become a destination for fertility treatment and drug rehabilitation. More controversially, South Africa has also become a destination for (illegal) transplant and stem cell tourism. The second major category consists of South-South medical tourists from within Africa. In recent years, South Africa has become a destination for middle-class ‘medical tourists’ from other African countries. More important in numerical terms is the use of South Africa’s government-funded public healthcare facilities by medical tourists from neighbouring countries for a wide variety of health needs. This chapter provides an overview of these two major forms of medical tourism to South Africa.

Bandaid transnationalism: remittance practices of emigrant Zimbabwean medical doctors

Despite the well-documented negative impacts of the ‘brain drain’ of medical doctors from Africa, there is an argument that their departure is not an absolute loss and that transnationally oriented migrants (or diasporas) can act as development agents in their home countries. Financial remittances, in particular, are said to have significant transformative development potential. This paper assesses the remitting patterns of emigrant Zimbabwean medical doctors and examines the potential impacts of the remittances which they send on both the local and national levels. We argue in this paper that the remittances which are being sent by the medical doctors are only cushioning their close family members against the harsh economic conditions in the country, a practice which we termed ‘bandaid transnationalism’. The research results question the nature of development resulting from bandaid transnationalism. Furthermore, we argue that social remittances from the emigrant medical doctors can achieve greater social development impact than the monetary and material remittances which they send. Even though both social and monetary remittances can benefit Zimbabwe’s economy, a more hopeful solution is one that retains medical doctors in the country and attracts emigrant doctors back home to participate in rebuilding health institutions in a democratic Zimbabwe.