Excerpt from Thesis :

Brain Drain of Health Professionals in Zimbabwe

Brain Drain is described in the work of Lowell and Findlay (2001) as something that can occur "...if emigration of tertiary educated persons for permanent or long-stays abroad reaches significant levels and is not offset by the 'feedback' effects of remittances, technology transfer, investments or trade. Brain drain reduces economic growth through unrecompensed investments in education and depletion of a source country's human capital assets." (p.6) Dolvo (2003) writes that the African continent is facing an unprecedented health crisis due to the HIV / AIDS epidemic and the "re-emergence of old communicable diseases such as TB and Malaria, and the apparent paradox of increasing levels disorders linked to changing lifestyles and degenerative diseases." (p.1) Added to this are other problems that impact the health system and that arise from economic challenges, which result in low health care service funding combined with health service infrastructure deterioration. (Dolvo, 2003, paraphrased) It is reported that estimations state that 17 out of 48 African countries reported a reduction in life expectancy between the years of 1981 and 1999. Dolvo states the significant fact that the health worker is "operating within the difficult milieu." (2003, p.1) The health worker is "a critical part of the health system and perhaps the most essential of the health sector's resources, whose motivation and effective utilization enhances the efficiency and effectiveness with which all the other resources are used." (Dolvo, 2003, p.1) Dolvo also reports that the numbers of health professionals who are experiencing brain drain has peaked in previous years largely due to the high demands that come from the developing countries and that these "demands are such that were occasioned by demographic changes, aging populations as well as a reduction in attracting recruits into the health workforce." (2003, p.3) In addition, reported are additional needs for longer work hours meaning that there has been an increase in the demand for doctors and nurses. Stated specifically is that the "brain drain of professionals, combined with the health crisis described...together threatens the entire development process" on the African continent. (Dolvo, 2003, p.3) The flight of professional and skilled people from Zimbabwe is reported by the UN Development Programme (UNDP) to be such that has reached alarming levels and a study conducted by the Scientific and Industrial Research and Development Centre (SIRDC) under contract from the National Economic and Consultative Forum, to measure the rate and level of the brain drain" in Zimbabwe. The study confirms that the "level and trend of the brain drain in Zimbabwe has risen to heights described as levels that were too high. (IRIN News, 2011) Also reported is that the study revealed that Zimbabwe "dropped to 145th place out of 175 countries in the Human Development index in 2004" which is described as a "composite measure of average achievement in three basic dimensions of human development: a long and healthy life, education and a decent standard of living." (IRIN, 2011) According to the SIRCDC study there are 479,348 Zimbabweans 'in the Diaspora" although there were many that could not be contacted. Most of these individuals are reported as having a bachelor's degree with 20% having master's degrees and 5% holding PhD degrees." (IRIN, 2011) The brain drain issue has accelerated in the past ten years and the reasons stated for this by the Southern African Migration Program (SAMP) and it is reported that care is a requirement in the interpretation of the data and policy recommendations for the reasons stated as follows:

Uncertainty over the numbers involved. The extent of the drain is certainly not captured in official statistics.

Most projections about future trends are based on faulty methodological assumptions that tend to exaggerate the likelihood of emigration.

There is a common notion that emigration means departure for good. Many who depart do not intend to stay away permanently. And many who leave retain strong economic and social links with home.

A distinction must be made between a sizable intra-regional brain drain and emigration from the region. Some countries are disadvantaged by both (Zimbabwe). Some may gain what others lose (South Africa, Botswana). For the region as a whole, within-SADC brain drain means no net loss.

The "demand" side means that some sectors are harder hit than others.

The impact of the brain drain of citizens is exacerbated as a result. (SAMP, 2010)

It is reported that state responses to the brain drain "have been control-oriented in character and not informed by research on the actual perceptions and intentions of the skilled." (SAMP, 2010) Reported as a "notable exception…South Africa's Health Professionals Recruitment and Retention Strategy…" is working toward the development of a "broad-based and multi-faceted set of interventions which includes addressing social and economic push factors. Ironically, this strategy cannot address a major cause of emigration (crime and personal insecurity). And it makes no comment on the desirability of developing a strategy for replacement immigration. Restrictions on outward movement are not generally feasible in states that guarantee freedom of movement to citizens. Instead, Southern African states have also sought to exercise leverage over the pull factors by (ineffectual) appeals to the morality of industrial countries or entering into bilateral or multi-lateral agreements with western governments to control recruiting or hiring of professionals on a sectoral basis. The effectiveness of such agreements has yet to be properly tested." (SAMP, 2010) South African media is reported to have been "profiling what it calls the 'brain gain' of returning South Africans. There is little concrete evidence, however, that this return is either large or sustainable. The only attempt to tap the Diaspora to date is the SANSA project, set up by the University of Cape Town and taken over by the National Research Foundation. SANSA was designed to match diasporac South Africans with local employers for short-term assignments and employment. The intention was never to encourage permanent return. " (SAMP, 2010) SAMP reports that the initiative's success is presently unknown. Other initiatives have been reported to seek "to encourage the return of the disasporic citizens by offering incentives and job-matching programs and specifically the 'Return and Reintegration of Qualified African Nationals (ROAN) Program' of the IOM which was inclusive of Zimbabwe and which served to assist the return of a miserly total of 2,009 professionals to Africa as a whole over a 17-year period. On the evidence of ROAN, these kinds of programs are likely to be rather ineffectual at best." (SAMP, 2010) The IOM is reported to have "initiated a more flexible skills transfer program called MIDA (Migration for Development in Africa) with the IOM acting as a kind of "go-between." While this program seems, in principle, to have a higher likelihood of success, its effectiveness has yet to be tested. In general, it seems likely that formalized skills return or linkage schemes coordinated by international organizations are not going to have a major impact in reversing or ameliorating the effects of the brain drain." (SAMP, 2010) While South Africa could use replacement recruitment strategies that leaves South Africa in a quandary because "In order to mount a case against other countries recruiting its health professionals, it needs not to be seen as a poacher in other fields. Hence, in late 2001, South Africa undertook not to recruit any physicians or nurses, except under specific agreements with countries of origin. At the same time, the country has concluded agreement with Cuba and Germany for the temporary import of doctors. There are now close to 500 Cuban doctors practicing in rural areas and townships. The country is also seeking to negotiate bilateral and multilateral agreements with destination countries to stop recruiting of health professionals in South Africa." (SAMP, 2010) SAMP reports that while there has been a great deal of focus on the South African brain drain that this area of study can be noted due to the absence of good research on which policy matter can be based that would bring about necessary changes for those who are poverty level. Reported is the need for an effort that is "more systematic and comprehensive" in order to (a) document the extent of the brain drain by examining data in the region and in major host countries;

(b) inventory the overseas skills base and, through survey work, determine the potential for return and the nature of backward linkages (financial and social);

(c) a systematic assessment of the economic impact and resource implications of the brain drain by sector (with particular emphasis on health implications for the poor); and (d) working with government and private industry to develop retention, replacement, brain train and attraction strategies to mitigate the impact of skills loss on development prospects." (SAMP, 2010)

1.1 Research Background

The brain drain problem is…