Brain drain of health professionals in Zimbabwe and its consequences

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.

There is little concrete evidence about the actual economic and social impact of the brain drain, even in sectors hardest hit.

The reality that most countries in the region have eschewed "brain grain" strategies in the form of proactive immigration policies and search for replacement skills. 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 one of the major forces shaping the 21st century as skilled professional are increasingly migrating from developing to developed or industrialised countries as cited by the World Bank (2000). The 'brain drain', also referred to as 'talent flow' (Hooks et al., 2005) and the 'Diaspora' (Bryant and Law, 2004), is the flow of skilled human capital out of a country at a considerable rate. Africa is faced with this growing problem (Mutizwa-Mangiza, 1996; Bloom & Standing, 2001) and has witnessed decades of wasted development potential, however it has also been experienced in other nations throughout history e.g. USA and Europe and is currently happening in Ireland. This migration has been blamed for worsening the human capital crisis in Africa (Wadda, 2000). The continent has suffered and continues to suffer problems of extreme poverty and lack of both human and institutional capacity. There has been massive influx of emigration from Zimbabwe since the late 90's and this research aims to explore and address this considering the current political situation in Zimbabwe.

Author Stephen Bach points to healthcare professionals as occupying a rather unique position within the brain drain problem. This is to say that Bach argues that healthcare professionals are a very necessary part of a country's infrastructure, and economies and groups of people tend to suffer more from these professionals' departures than from many others. It is easy to understand as healthcare professionals are needed to staff hospitals and clinics and help to guarantee a certain standard of living for the citizens." (Bach, 2008, p.203) Bach (2008) argues that governing bodies in African nations need to identify a clear path toward first keeping the healthcare professionals in country and then attracting more from outside their borders. Building on this assertion, Bach continues to outline some solutions by helping to point to the numbers of registered healthcare professionals within the country's borders as a measure of the health of the industry and numbers of working professionals themselves (Bach, 2008, 205).

1.2 Research Purpose

The purpose of the research in this study is to examine brain drain in South Africa.

1.3 Research Question

The research question addressed in this study is that which asks the question of what is the most important factor of brain drain?

1.4 Research Aim

The aim of this study is to engage in a comparative case study analysis of healthcare professionals to explore the relative significance of economic and political conditions as a motivation for the 'brain drain' problem. As well, this work intends to investigate the political and economical environment as drivers of brain drain.

1.5 Research Objectives

The objectives of the research in this study include:

(i) Investigation of the causes of political instability;

(ii) Evaluation of cause and migration;

(iii) Examination of the push and pull factors determining the movement of health personnel.

1.6 Significance of the Study

The significance of this present study is within the knowledge that will be added to the already existing knowledge base in the study of brain drain and what causes and potentially prevents brain drain in a region or country.

1.7 Theoretical Framework

The primary framework of this research is based on migration theory and literature. The neo-classical economic theory is the oldest theory of migration and has emphasis on wage differences between regions being the main cause for migration (Bauer and Zimmermann, 1995; Borjas, 1989; Massey et al., 1993, 1998). Analyses on migration are such that examines migration as being a strategic familial or group occurrence focused toward diversification of income sources and reduction of household risks. Within this framework international migration is a method used to make up for the absence of certain types of markets in countries that are still developing. In this model, international migration is a way to recompense for the lack of particular types of markets in developing countries. Labor market theory from a dual perspective sets out that low-level worker demand in countries characterized by higher levels of development is the most critical aspect impacting migration on the international level. This model reiterates that migration is initiated by the governmental recruitment policies in destination areas. The other theory for this research is the world-systems approach to international migration. Massey et al. 1993: 444 discusses a global division of regions into a core which rich in capital, raw materials and labor and a semi-periphery that coalesces elements from core and periphery. Migration, according to this approach, is the inevitable result of the issues that are produced by capitalist growth.

Chapter 2: Literature Review

2.1. Introduction

Brain drain is a problem examined, by various writers and researchers. The importance of understanding this phenomena is the fact that brain drain depletes a region or country of its professional practitioners which in turn results in less than optimal outcomes in the society of that country of region due to lack of these professionals in their line of work and in this case specifically are professional health care service providers. According to the IRIN Global News source over fifty percent of those who had responded to a study examining emigration in Zimbabwe stated that they had emigrated for reasons relating to work. (54.5%) The most common stated reason linked to work for emigration is reported as low salaries in Zimbabwe as well as the exchange rate and better career advancement opportunities. The Zimbabwe dollar is reported to have depreciated sharply against major currencies and currencies of Zimbabwe's neighbors. It is reported that 8% of respondents noted political factors as their primary reason for emigration. The report states specifically as follows:

"If the Zimbabwe government does not do something to make staying at home more attractive and rewarding, the brain drain will continue unabated," the study warned. The forces driving people out of the country were as powerful as the opportunities luring them away. There was no alternative but to enact "necessary economic reforms that make staying at home attractive and rewarding" for skilled and educated Zimbabweans. The shrinking economy was not only forcing productive Zimbabweans abroad but had also resulted in what the authors of the report termed an "internal brain drain." The deteriorating economy in Zimbabwe has forced some professors, lecturers, medical doctors, and scientists to operate minibuses, taxicabs or operate beer parlors. It is a form of internal brain drain to have many architects, accountants, and pharmacists underemployed." (IRIN, 2003)

Also stated is that the health and teaching professions are those most impacted by the brain drain and that the examination of professions of those leaving Zimbabwe shows "a sizeable proportion of them are doctors, teachers, and nurses. In fact, the health care sector is the most affected. Many are leaving because health care and education spending cuts across the board have denied them a place to stay and work in Zimbabwe." (IRIN, 2003) The report found that the flight of doctors had been "so overwhelming that the Ministry of Health and Child Welfare has had to recruit hundreds of Cuban doctors who are paid in foreign currency to fill the gap." (IRIN, 2003) It is reported, "Many professionals leave Zimbabwe for the brighter opportunities offered abroad, complaining that Zimbabwe is too corrupt, and needs more politicians of high moral standards. The dilemma is that Zimbabwe will not advance in development if the majority of qualified people continue to leave." (IRIN, 2003) The stated reason why certain professionals are leaving Zimbabwe is because they believe that working at home is synonymous with supporting the current government and not the people. (IRIN, 2003)

The work of Nepachem (2009) entitled "The Impact of the Brain Drain on Health Service Delivery in Zimbabwe: A Response Analysis" reports "The poor economic situation prevailing in Zimbabwe has led to multiple and complex migration issues characterized by high levels of brain drain, cross-border mobility and irregular migration. The economic decline over the past five years has precipitated a growing exodus of professionals from the country in search of better economic opportunities." (p.6) The majority of Zimbabweans are reported to migrate to South Africa, the United Kingdom, and Botswana." (Nepachem, 2009, p.6)The worst affected is the health sector in Zimbabwe with both professionals and semi-skilled workers in the sector migrating in search of better employment opportunities." (Nepachem, 2009, p.6) Nepachem states that the 2009 Health Task Force Report "observed that the health sector is characterized by overall failure by public sector hospitals to perform their intended functions; failure to retain local well-trained health care professionals; inability to recapitalize/re-equip the entire health sector; inability to provide reliable and consistent basic supplies of medicines; inability to maintain, upgrade, develop, and implement a sustainable health professional training policy; inadequate coverage of benefits by health care insurance providers and failure to carry out regular preventive vaccinations." (Nepachem, 2009, p.7) The Government of Zimbabwe published a document in 2009 entitled "The Short-Term Emergency Recovery Program (STERP) themed "Getting Zimbabwe Moving Again" which is reported to have "acknowledged the many problems bedeviling the health sector arising from the economic crisis. These include a sharp decrease in funding for the health sector, leading to the loss of experienced health professionals and deterioration of infrastructure, shortages of drugs and drastic decline in the quality of public health services. The STERP notes that high vacancy rates in the health sector have lead to the overburdening of remaining personnel. Consequently there is a rising challenge in dealing with diseases such as malaria, AIDS, cholera, and tuberculosis among others." (Nepachem, 2009, p.7) This information illustrates the extent of the challenges faced by Zimbabwe due to migration of health professionals and the impact that this migration has on the service delivery in Zimbabwe. It is reported that Nepachem's study "identified a critical shortage of staff in the medical field. According to the Ministry of Health and Child Welfare figures for December 2008, Zimbabwe had 1.7 health workers per 1,000 people, which is below World Health Organization (WHO) Africa regional average of 2.6. The critical shortage of staff was also highlighted by the WHO staffing fact sheet of 2008." The doctor-patient ration of 0.16 is reported for health doctors per 1,000 people compared to 0.22 doctors to 1,000 patients for South Africa on the average." (2009, p.8) The following table lists the Zimbabwe WHO core health indicators.

Figure 1

Zimbabwe WHO Core Health Indicators

Source: (Nepachem, 2009)

The Zimbabwe government health trainee capacity is reported and the information stated as shown in the following table.

Figure 2

Zimbabwe government health trainee capacity

Source: Nepachem (2009)

Health worker vacancy trends for Zimbabwe are shown in the following table.

Figure 3

Health Worker Vacancy Trends

Source: Nepachem (2009)

A situational and gap analysis in Zimbabwe's Health Sector revealed the information displayed in the following table.

Figure 4

Situational and Gap Analysis for the Health Sector of Zimbabwe

Source: Nepachem (2009)

The results of the survey show that the flight of health professionals from Zimbabwe "has mainly been driven by "a combination of push-pull factors, both socio-economic and political in character." (Nepachem, 2009) When asked why they had left Zimbabwe it is reported that 82% of respondents cited three or more reasons as follows:

(1) Low salaries in Zimbabwe -- 90%

(2) General economic conditions in Zimbabwe -- 88%

(3) Poor working conditions -- 82%. (Nepachem, 2009)

Other push factors included the following:

Political problems in Zimbabwe -- 65%

Poor working facilities leading to redundancy -- 57%

Bad relations with management -- 54%

Poor workplace safety -- 51%

Pull factors cited included those as follows:

Better advancement opportunities -- 62%

Joining family members -- 27%

Joining friends -- 20% (Nepachem, 2009)

Figure 5

Push and Pull Factors for Leaving Zimbabwe

Source: Nepachem (2009)

In the area of professional advancement of health professionals after Emigration, it is reported that 52% of respondents indicated that they had assumed responsibilities that are more senior after emigration. It is reported that 12% state that their responsibilities following emigration were more or less equal to their responsibilities previous to emigration. Reporting that their responsibilities were junior those following emigration was 27% of respondents. (Nepachem, 2009, paraphrased) In addition there is reported to be a "noticeable salary improvement among respondents after emigration with proportionately more individuals (86%) indicating that they were earning more in host countries than what they used to in Zimbabwe. More than half the respondents also indicated improved changes in benefits (76%) and type of work (57%). Eighty one per cent of respondents had indicated that they earned USD 500 or less in Zimbabwe compared to only 5 per cent earning USD 500 or less in the Diaspora." (Nepachem, 2009) It is reported that the proportion of earnings of "USD 2,001 or more was higher in the Diaspora, 82 per cent compared to 6 per cent when they were still in Zimbabwe. Twenty three per cent of individuals in the Diaspora reported current earnings of over USD 5,000, while only 2 per cent reported earnings of this magnitude before leaving Zimbabwe." (Nepachem, 2009) Respondents in the United States reported earning the highest salaries "with 84 per cent reporting monthly incomes of USD 3,001 or more compared to 71 per cent in Australia, 63 per cent in the UK, 37 per cent in South Africa, and 25 per cent in Botswana for the same salary scale. The highest earning professions were specialist doctors and general practitioners." (Nepachem, 2009) Improvements in other benefits included those in the areas of housing and transport following emigration. Specifically reported is "The proportion reporting housing benefits of over USD 100 or more increased from 10 per cent while still in Zimbabwe to 37 per cent in the Diaspora. Thirty five per cent of respondents reported current transport benefits of over USD 100 a month compared to 6 per cent before emigrating." (Nepachem, 2009)

Figure 6

Salary, Benefits, and Type of Work Changes After Emigration

Source: Nepachem (2009)

Figure 7

Non-Monetary Benefits Before and After Emigration

Source: Nepachem (2009)

Training opportunities are reported to have increased after emigration from Zimbabwe with 78% of respondents reporting that they had acquired new skills following emigration. In addition, it is reported that there was an increase in the level of support provided to family members still living in Zimbabwe since the respondents had emigrated from Zimbabwe. Reported specifically is "Forty per cent of respondents indicated supporting family members back in Zimbabwe by contributing at least USD 1,001 a month. This compares to 19 per cent before respondents moved from Zimbabwe. This support to family members in Zimbabwe suggests respondents' strong links to their home country, and might therefore be willing to combine short assignments to Zimbabwe with visits their extended or immediate families." (Nepachem, 2009)

The work of Chimbari, et al. (2008) entitled "Retention Incentives for Health Workers in Zimbabwe" reports a study conducted in various health institutions within Zimbabwe, including public, private, and faith-based health institution. The institutions examined in this study include those listed in the following figure.

Figure 8

Health Institutions Participation in Study reported by Chimbari (2008)

The administrative provinces and major cities in Zimbabwe are listed and shown in the following figure.

Figure 9

Zimbabwe's Administrative Provinces and Major Cities

Chimbari reports that there were five focus group discussions within different trainee groups including primary care nurses and general nurses in addition to environmental health technicians and fifth-year medical students from the University Of Zimbabwe College Of Health Sciences. The focus group discussions focused on the perception of trainees of retention packages. Results of the informant interviews are stated to include that key informants of the government are "generally optimistic about the creation of the ZHSB seeing that their working conditions would improve, with measures to top up salary increments by 20-30%, recognition and pay for postgraduate/basic qualifications, the introduction of a medical allowance and steps to unify the nursing services within public sector. Promotions, especially for those in acting positions, have motivated staff and cases of misconduct were reported to now be dealt with expeditiously." (Chimbari, et al., 2008) It is additionally reported that the lack of clarity "on the division of responsibilities between the ZHSB, MoH&CW and PSC was reported to have delayed action in some cases, and while the ZHSB was felt to have potential, its impact on retention was noted to still be limited. Local authority and private sector key informants, in contrast, were not familiar with the operations of the ZHSB, while those in missions noted that it had had a beneficial effect in harmonizing the health workers' payroll." (Chimbari, et al., 2008) The summary of the views of key informants in regards to the strengths and weaknesses of government policies and strategies in retaining CHPs in Zimbabwe are shown in the following table labeled Figure 10.

Figure 10

Figure 11

Opinions of Key Informants on Financial Incentives

Dodson (2002) writes in the work entitled "Gender and the Brain Drain From South Africa" that South Africa is experiencing a "Substantial 'brain drain' underestimated in official emigration statistics." (p.1) It is reported that no one is yet certain as to why some leave and why some stay. The study reports a survey questionnaire that was focused on motives for emigration. The primary findings of a gender-based analysis include the following findings:

(1) There was remarkable gender agreement in people's level of satisfaction or dissatisfaction with a range of "quality of life" indicators. Economic factors such as taxation and the cost of living, along with social concerns such as safety and security, are the main sources of dissatisfaction for both men and women.

(2) Within this broad overall concurrence, the categories for which skilled women expressed higher levels of dissatisfaction relative to men were employment-related factors such as their job, income, job security and prospects for professional advancement; and aspects of everyday family life such as access to acceptable housing, schooling and medical services.

(3) Overall women seem to be slightly more satisfied with their present quality of life than are men, reinforcing the finding of women's lower emigration potential.

(4) High levels of dissatisfaction on the part of both genders across a number of quality-of-life indicators confirm that there are several push factors that might encourage skilled emigration. Most respondents also anticipate a decline in social and economic conditions over the next five years, especially in education and health care. Such pessimism was higher among men than among women.

(5) The biggest "push" factors for both men and women were crime and lack of security. There was a small gender difference in the relative significance of factors that would encourage people to stay in South Africa: men ranked improved security first, followed by "family" and "patriotism," whereas more women ranked "family" as the primary consideration that would prevent them from emigrating. (Dodson, 2002, p. 1-2)

Reported is that the decision for emigration to South African is dependent upon "the interactions of a host of forces" and that these are experienced and perceived differently depending upon the gender of the individual. (Dodson, 2002, paraphrased) Dodson's study emphasizes two critical factors to understanding migration behavior in relation to brain drain in South Africa:

(1) Migration takes place within social institutions of marriage, family, household, and inter-personal relations. Attitudes and opinions on emigration are the outcome of discussion and negotiation between men and women, particularly life partners.

(2) Migration attitudes and behavior are strongly influenced by economic factors such as employment and income status. A focus on skilled migration automatically leads to certain attitudinal similarities within the sample population, regardless of gender. (Dodson, 2002, p.27)

It is reported that women were found to "have a lower emigration potential than men" and that this is due to women "feeling stronger ties to home and family and having less confidence about their own ability to succeed in a new social and economic movement." (Dodson, 2002, p. 27) Permanent partners and family dependents are a factor in emigration of men. Gender relations are stated to be critical factors in determination of a household's emigration potential. Dodson states as follows: "Intuitively, one of the policy implications [of the study reported] might be that greater affirmative action on gender grounds could be an effective strategy for reducing South Africa's brain drain. If women nurses and teachers are less likely to emigrate, the same might be true for women doctors, engineers and IT specialists. Training and employing more women might therefore reduce the risk of losing skills through emigration. However, if affirmative action were to lead to real or perceived disadvantaging of men, the strategy might prove counter-productive, encouraging skilled males to emigrate, taking their female partners with them." (Dodson, 2002, p.27) Dodson reports that a flaw in the "simplistic gender-based strategy to reduce the brain drain is that the gender differences identified in the survey may have been caused by factors other than gender alone. The women in the sample of skilled South African nationals were racially, professionally, socially and economically different from the male sample. More of them were black; fewer of them were married; more of them were in occupations such as teaching and nursing; more of them occupied lower income categories. It may have been these factors, rather than their gender per se, that reduced the likelihood of their emigration." (Dodson, 2002, p.27) 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.3) 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.4) 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." (2003, p.4) 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 developed 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.5) In addition, reported are changes in working hours and conditions, which means 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.5) The following table lists the registered doctors of registration status and county of quantification in selected developing countries as of May 27, 2003.

Figure 12

Source: (Dolvo, 2003)

As shown in the following chart there appears to be many full registration doctors in Africa however, full and specialist registration doctors are much lower with no limited and only 80 provisional registration doctors. Dolvo reports that there are many countries in the Africa region including South Africa that have recruited from other countries outside of the African continent. 27% of South Africa doctors were reported as non-citizens and most of sub-Sahara African countries use the Cuban medical corps. Retirement ages have been changed in some countries with some countries allowing professionals to work past sixty years of age, which is presently a compulsory retirement age. It is also reported that there are a variety of locally designed health professionals in Africa with Clinical Officer in Malawi and Zambia, Surgical and Medical Technicians in Mozambique, and Assistant Medical Officers with surgical and obstetric skills in Tanzania and Medical Assistants in Ghana. (Dolvo, 2003, p.6) Dolvo states that the traditional health professions have been slow to accept these substitutes. (Dolvo, 2003, p.6) Professionals have been encouraged by the International Organization for Migration with a focus appearing on the affordability of the limited or temporary returns by professionals to offer skills and services. (Dolvo, 2003, p.6) Arguments state that migration results in benefits to donating countries. Training strategies are reported to have been proposed including the use of quotas or geographical criteria in candidate selection for training of health professionals. It is reported that academic merit has been criticized in African for the production of elitist professionals as rural candidates many times attend schools that have infrastructure that is poor or whom cannot be under expectations to compete with high schools in cities with elite attendance. (Dolvo, 2003, paraphrased) In addition, it is reported that community-based "student-cantered problem solving and other approaches to health professional education and most particularly medical education have been held up as producing professionals with locally relevant skills and a community service orientation." (Dolvo, 2003, p. 6) There is reported to be a large and difficult need for reorientation of educators in medical and health care to modify existing educational traditions that place emphasis on euro-centric or international standards and methods of health professional education. (Dolvo, 2003, p.7) This is reported to been the primary and quick response to brain drain. It is stated that the expansion of production while failing to seal the leak is not a response that is efficient and that due to the infrastructure being rustic and the loss of lecturers the larger numbers in training groups is likely to result in quality of products that are poor and emigration increases. (Dolvo, 2003, paraphrased)

The work of Labonte et al. (2006) states that Sub-Saharan Africa has seen a "resurgence of various diseases that were thought to be receding and public health systems are still inadequately staffed with a need for more than 700,000 physicians stated. Many of the health professions that remain are not motivated due to the workload, poor pay, being poorly equipped with career opportunities that are limited. (Labonte, et al., 2006, paraphrased) A large body of research exists documenting the fact that the migration of the skilled professionals from developing countries to developed countries is large and that the number is rapidly rising. It has been concluded by the Joint Learning Initiative on Human Resources for Health "the future of global health and development in the 21st century lies in the management of the crisis in human resources for health." (Labonte, et al., 2006, p.1) The Joint Learning Initiative has indicated that there will be at least one million health workers needed over the next ten years for delivering basic health interventions in SSA. The 2005 UK Commission for Africa has called for the world's richest nations for the provision of $7 billion in developing Africa's health infrastructure. Stated specifically is "The overall impact of international recruitment and retention difficulties in SSA source countries is difficult to assess because of the absence of reliable data. However, the summary country profiles below allow us to form a general picture." (Labonte, et al., 2006, p.2) The figures shown in the following table labeled Figure 2 in this study show the extent of physician shortages and nurses in Sub-Saharan African countries.

Figure 13

Source: Labonte, et al. (2006)

South Africa is stated to be in a "new and unenviable position. It has traditionally been a country that both sends and receives migrants, but its rate of export of human capital is now far higher than its rate of import." (Labonte, et al., 2006, p. 8) It is estimated by the South African Medical Association that at least 5,000 South African doctors moved abroad in 2002.23 According to DENOSA, the largest nursing union in the country, 300 nurses leave South Africa each month." (, p.8) The head of National Nursing Services for Netcare, Eileen Brannigan, one of the largest South African private hospitals states that more than 25% of the 90,000 registered nurses in South Africa left the country in 2002 alone." (Labonte, et al., 2006, p. 8)

Brannigan additionally relates that the South African Nursing Council receives approximately, "300 queries a month from nurses who have registered or who are querying about registration overseas." (Labonte, et al., 2006, p.8) It was reported by BBC in May 2005 on the extent to which South Africa's health service has been hit by an exodus of nurses seeking better pay in countries such as the UK and Saudi Arabia. Through DENOSA, nurses went on strike on 2 May 2005 demanding better pay, including a basic uniform allowance of R1, 500 (U.S.$241)." (Labonte, et al., 2006, p.8) South Africa's Health Attache to the IOM has encouraged the use of bilateral arrangements to manage migration of health care workers, using the example of the Memo of Understanding between South Africa and the UK.27." (Labonte, et al., 2006, p. 8)

Methodology for Analyzing Literature

The methodology utilized in this study involves an examination of push and pull factors that impact emigration of Zimbabwe health care workers in what is a synthesis of the literature on health care worker emigration in Zimbabwe. The work of Thielemann (2011) states Underlying some of the most prominent theories and models of international migration (Massey et al., 1993) is the so-called 'push -- pull model'. It is a conceptual framework that suggests that there are push factors in countries of origin that cause people to leave their country and pull factors that attract migrants to certain receiving countries." Pull factors are described as "circumstances in the home environment that make a person think about leaving his normal place of abode for another part of the same country, neighbouring countries or for a more distant place like the United Kingdom or the United States. (Smyke, 2001) Push factors are described as factors that "...draw people to particular destinations." (Chimanikire, 2005) The work of Haas (2008) entitled "Migration and Development: A Theoretical Perspective" reports that over the last century there have been several theoretical perspectives on migration which have evolved however, these views have "evolved in isolation from one another, and shown important differences in their level of analysis as well as paradigmatic and thematic orientation." (Smyke, 2001) Stated as one reason for the "lack of coherence" is the fact that migration "has never been the exclusive domain of one of the social sciences, but has been studied by most of them. Differences in disciplinary and paradigmatic orientation and level of analysis have led to widespread controversy on the nature, causes, and consequences of migration." (Smyke, 2001) Smyke (2001) notes that Massey et al. (1993) reported that contemporary views on international migration is such that remains "mired in nineteenth-century concepts, models and assumptions...a full understanding of contemporary migration processes will not be achieved by relying on the tools of one discipline alone, or by focusing on a single level of analysis. Rather, their complex, multifaceted nature requires a sophisticated theory that incorporates a variety of perspectives, levels, and assumptions." (Smyke, 2001) There has been an emphasis placed by researchers on the lack of a migration theory that is comprehensive in nature with many calls going out for the development of a general migration theory. It is difficult to generalize about the causes of migration and the consequences as well due the complexity and diversity of the problem and the complexity in the separation of migration from other processes that are political and socioeconomic in nature. Until the early 1980s, it is reported that the theoretical debate on migration had a tendency to be "rather polarized with neo-classical views on the one hand and historical-structuralist views (neo-Marxist, dependency, world systems) on the other. Since then, however, under the influence of postmodernism, the debate has become less polarized and has been characterized by increasing synergy between migration theorists from different disciplines and paradigmatic backgrounds. Moreover, it has been frequently argued that it is possible to (eclectically) combine and integrate different theoretical perspectives on migration, which are not necessarily mutually exclusive (Massey et al. 1993)." (Smyke, 2001) The push-pull framework is reported to be "of much analytical use..." (Smyke, 2001) The push-pull framework is a descriptive model therefore this study has used a qualitative methodology and specifically that of collecting and analyzing secondary data in the form of a literature review which is appropriate for use in this type of study or that of attempting to understand a social problem such as emigration of Zimbabwe health care professionals.

Limitations

The push-pull framework is a descriptive model and as such "tend to have the character of ad-hoc explanations forming rather ambiguous depository of migration determinants." (Smyke, 2001) The push-pull model also has a tendency to confuse different scales of analysis ranging from individual to global therefore not allowing for assignation of relative weights to the various factors affecting migration decisions." (Smyke, 2001)

Summary of the Literature Review

The reasons for migration of the majority of health professionals were socio-economic and political reasons as well as self-advancement and specifically for furthering their education and seeking better conditions for work and study opportunities. The goals for emigration of health professionals is due to better pay and because they are able to assume more senior responsibilities and undergo specialist training to receive better remuneration. Findings additionally show that health professionals who have migrated would given consideration to returning to Zimbabwe however, unless the combined factors that pushed them toward emigration are addressed in Zimbabwe, these individuals do not think they would consider returning on a permanent basis. The health sector in Zimbabwe is characterized by overall failure of the public sector hospitals to conduct their functions as intended including failure to retain local well-trained health professionals, the inability to recapitalize and re-equip the healthcare sector, the inability to provide reliable and consistent basic medicine supplies and the inability to maintain as well as upgrade, develop and implement a sustainable health professional training policy. Finally, the healthcare sector in Zimbabwe is unable to provide coverage of health insurance benefits and to carry out regular preventive vaccinations. Personnel who remain employed in the Zimbabwean health care sector are overburdened due to the shortage of health care workers. Health care worker migrations also are impacted and driven by the challenge of dealing with diseases including malaria, AIDS, cholera, and tuberculosis. The push and pull factors are found in the literature reviewed in this study to have an equal impact on migration of Zimbabwe health workers.

Brain Drain of Health Professionals in Zimbabwe

Chapter 3

Methodology

This chapter will describe and discuss the various methods of gathering data and the advantages and disadvantages as well as the preferred method in each case that will be undertaken. The research in this study is both qualitative and quantitative research including primary research based on interview and questionnaires and secondary data analysis. Both qualitative and quantitative research methods have their own inherent strengths and weaknesses.

Research Methods

The methods used for research in this study include the problem having been defined and secondary sources having been reviewed including previous studies on brain drain, theoretical papers, and academic books and journals the objectives of the research serves to form the basis of the research methods.

Theoretical Framework

The expression Brain Drain was first coined by the British Royal Society in the 1950s with the first studies that analyzed this problem focused on the political and social effects of brain drain. The study results show that the primary motivations for migration were political and social in nature and that the effects of the migrations are negative for the welfare or the social structure of the country from which individuals were leaving. The solution stated was the need to create and solidify the role of the International Organizations and Institutions that had the capacity to manage the flows of migration. (Giannoccolo, 2006)

Sriskandarajah (2005) states that brain drain presents two primary research challenges and specifically first stated is "to devise methodologies for differentiating between brain drain per se and a subset of cases that might best be termed 'brain strain'. The latter are cases in which the net outflow of highly skilled workers from a particular sector in a particular country is actually hampering or is very likely to hamper economic development or the pursuit of important socioeconomic goals."

Sriskandarajah goes on to state that the second challenge is to devise "a more robust methodology for understanding the overall net impacts of migration. The rationale for why such a methodology is needed is clear: if brain strain occurs when the negative impacts of migration outweigh the positive impacts of migration, then finding a way of calculating these impacts is imperative." (2005) Sriskandarajah states that the development of such a methodology will make a requirement of a "massive, multidisciplinary effort" and further will involve the "collection of considerable, context-specific evidence such as information on vacancy rates in key sectors, historical and comparative changes in the distribution of certain key workers, the size and nature of the sending economy, and the migration experience of those who leave." (2005) Sriskandarajah states that involved will be "quantitative as well as qualitative methodologies: modeling demand/growth in training for particular sectors, modeling the rate of growth in wages and conditions, and surveying migration and return intentions. It will rely as much on econometric methods for isolating migration's impacts -- for instance, within the context of sub-Saharan Africa's HIV pandemic and health care systems -- as on a broad understanding of the obstacles to economic development in the countries in question." (2005) Sriskandarajah goes on to state that this type of model will be complex in nature and will necessarily take into account "…returns as well as new inflows and outflows of people. It will also need to be comparative and look at progress towards achieving key public policy targets, such as reducing mortality or increasing literacy in comparable cases where emigration has not been as important. And it will also need to be dynamic, examining current as well as future scenarios." (2005) Sriskandarajah states that the dual task of "identifying cases of brain strain and calculating the overall impacts of migration are daunting to say the least." (2005)

Qualitative Research

The strength of qualitative research is reported as its ability to make provision of "complex textual descriptions of how people experience a given research issue." (Qualitative Research Methods: A Data Collector's Field Guide, nd) Qualitative research is a type of scientific research and as such consists of an investigation that:

(1) attempts to answer questions;

(2) systematically uses a predefined set of procedures to answer the question;

(3) collects evidence;

(4) produces findings that were not determined in advance;

(5) produces findings that are applicable beyond the immediate boundaries of the study. (Qualitative Research Methods: A Data Collector's Field Guide, nd)

Qualitative research additionally "seeks to understand a given research problem or topic form the perspectives of the local population it involves" and it particularly effective in gaining culturally specific information concerning the "values, opinions, behaviors, and social contexts of particular populations." (Qualitative Research Methods: A Data Collector's Field Guide, nd) Qualitative research makes provision of information concerning the 'human' side of an issue or in other words, "the often contradictory behaviors, beliefs, opinions, emotions and relationships of individuals." (Qualitative Research Methods: A Data Collector's Field Guide, nd) In addition, qualitative methods are effective in providing identification of features that are intangible including such as "social norms, socioeconomic status, gender roles, ethnicity, and religion." (Qualitative Research Methods: A Data Collector's Field Guide, nd)

Qualitative research seeks to explore phenomena and is descriptive in nature. The advantages of qualitative research include that open-ended questions used in qualitative research have the ability to evoke responses that are "meaningful and culturally salient to the participant" and that are "unanticipated by the researcher" as well as that are "rich and explanatory in nature." (Qualitative Research Methods: A Data Collector's Field Guide, nd)

The primary ethical considerations for qualitative research include

(1) Respect for persons requires a commitment to ensuring the autonomy of research participants, and, where autonomy may be diminished, to protect people from exploitation of their vulnerability. The dignity of all research participants must be respected. Adherence to this principle ensures that people will not be used simply as a means to achieve research objectives.

(2) Beneficence requires a commitment to minimizing the risks associated with research, including psychological and social risks, and maximizing the benefits that accrue to research participants. Researchers must articulate specific ways this will be achieved.

(3) Justice requires a commitment to ensuring a fair distribution of the risks and benefits resulting from research. Those who take on the burdens of research participation should share in the benefits of the knowledge gained. Or, to put it another way, the people who are expected to benefit from the knowledge should be the ones who are asked to participate. (Qualitative Research Methods: A Data Collector's Field Guide, nd)

The work of Valenzuela and Strivastava (nd) states that the qualitative research interview "seeks to describe and the meanings of central themes in the life world of the subjects." The primary task in interviewing is reported in the work of Kvale (1996) "to comprehend the meaning of what the interviewees say." (cited in: Valenzuela and Strivastava, nd) McNamara (1999) states that interviews are "particularly useful for getting the story behind a participant's experiences. The interviewer can pursue in-depth information around the topic. Interviews may be useful as follow-up to certain respondents to questionnaires, to further investigate their responses." (McNamara, 1999 cited in: Valenzuela and Strivastava, nd)

Research Instrument: Questionnaire

. The questionnaires have been designed and distributed to one hundred Zimbabwean nationals living in the United Kingdom in various professions. The response rates in this study was 60%, which is enough of a response to provide a good picture of the issues being researched. The respondents were chosen on the basis of their being skilled migrants who had a career in their home country of Zimbabwe and who then left the country. The respondents are not of any specific age. This study specifically examines the causes of political instability factors and the impact of these factors on the brain drain in Zimbabwe.

the clarification and examination of the causes of political instability factors and their impact on brain drain and the data collected to test the existing theory. Questionnaires are effective in collecting data as respondents participate anonymously which consequently encourages honest responses to the questions asked. Questionnaires are also an inexpensive method for reaching a large sampling of a population and are easily designed and distributed. This method was chosen for this study because it is an inexpensive method of reaching a large number of individuals quickly and it is easy to create and distribute the questionnaires. This method additionally avoids interviewer bias and avoids leading questions being asked which might affect the validity and reliability of data collection. Each respondent in this study will be given an identical set of questions written in the same way so data is consistent and easy to analyze.

Another reason for this chosen research method is that it is an inexpensive way of reaching a large proportion of people and can be quick and easy to create as the researcher will design and distribute the questionnaires. Data analysis can begin instantaneously which makes it time effective and avoids interviewer bias or leading questions, which can affect the validity and reliability of data collection. Each respondent will be given an identical set of questions written in the same way so data is consistent and easy to analyze.

Interviews are valuable for obtaining the story behind the experience of the participants and will therefore be used in this project as a follow-up to certain responses to the questionnaire. This method allows for discussion of factors that cannot be observed directly and allows for in-depth views on outward behaviors of respondents. Ten respondents were interviewed based on the answers provided in the questionnaire and the main points and quotes from the interviews have been transcribed and related in the findings of this study

Limitations

There are limitations in this type of research method. The first limitation is that the questionnaire answers must be clearly and concisely answered and must therefore be stated clearly and concisely. In addition, if the questions are not clearly perceived by the respondents there may be different interpretations of what is being asked in the questions.

The questionnaire format may make it difficult for the researcher to examine intricate issues and opinions and can also be difficult to gather rich in-depth and detailed information as answers are limited.

The limitations to interviews includes that interviews can be greatly time consuming and costly. This has been addressed by the process beginning early in the project and enough time being allowed for the process. Skilled migrants in the UK have been interviewed in the locality of the researcher in this study

Other methods have been considered in the process of this study however, these methods are not appropriate to the investigation of the issues and specifically the two variables of cause and effect.

Data Analysis

After the collection of questionnaires the responses will be examined in order to highlight the relationship between political instability and brain drain and the drivers for this problem in Zimbabwe. This will be done through SPSS to help analyze the data. Averages will be taken from answers in order to further elucidate this information and to also cross relay and uncover trends. The interviews will further clarify ambiguities and incomplete answers derived from the administered questionnaire respondents. SPSS or Statistical Package for the Social Sciences (SPSS) quantitative method of analysis is used in this study in order to fathom the economic impact of the brain drain on Zimbabwe. The SPSS package was originally designed for use by social scientists "to analyze data from surveys. SPSS can perform a variety of data analysis and presentation functions, including statistical analyses and graphical presentation of data. Among its features are modules for statistical data analysis, including descriptive statistics, such as plots, frequencies, charts, and lists. It also uses sophisticated inferential and multivariate statistical procedures, such as analysis of variance (ANOVA), factor analysis, cluster analysis, and categorical data analysis. SPSS is particularly well-suited for application to survey research, though by no means is it limited to just this topic of investigation." (Chetsanga and Muchenje, nd)

Interviews

As stated earlier in this report, the interviews were conducted with ten individuals who have migrated from Zimbabwe and who are health care service delivery professionals. Statements gained during the course of the interviews of importance include the following:

(1) Interviewee #4 -- the working conditions in the health care sector in Zimbabwe was the most definitive factor in my emigrating from Zimbabwe. We never had the supplies we needed to provide proper treatment for patients and moreover, the lack of sufficient medical staff mean that we were overworked and exhausted before our shift ever ended. It was really harrowing work conditions.

(2) Interviewee #2 -- I was not able to further develop my skills and advance in the health care sector in Zimbabwe, it was really holding my career back as well as my earning potential.

(3) Interviewee #6 -- You cannot imagine what it was like to see patients die because we did not have what we needed to treat them.

(4) Interviewee #1 -- Frustrating, stagnating, those are the words that describe my career in the health care sector of Zimbabwe.

(5) Interviewee #7 -- there is no such thing as planning a day off much less planning a family vacation if you are a health care worker in Zimbabwe because the medical facilities are so understaffed that rarely is a day off really a day off because you can be sure you will be called to come into work. Quite simply, I experienced a severe case of burnout as a nurse in the Zimbabwe health care sector.

(6) Interviewee #9 -- All of my life I dreamed of helping sick individuals and even of saving lives but instead I feel helpless to provide the needed help and even more helpless to prevent unnecessary death due to lack of what is needed to give proper treatment to our patients.

(7) Interviewee #3 -- Work environment quality, better pay, and benefits, more potential to advance -- all of these are reasons that I am working elsewhere other than Zimbabwe as a medical doctor.

Analysis of Interviews

It is clear that lack of proper supplies, facilities, staff, pay, benefits, and lack of quality in the health care sector work environment all play a role in the loss of Zimbabwe health care workers as they leave to work in other countries. Health care workers in Zimbabwe clearly feel limited by not only their capacity to assist those who are in need of health care services these professionals also clearly feel impotent in furthering their career progression as well as in attaining higher positions of authority and increases in pay. Intrinsic or inner satisfaction as well as extrinsic or 'outer' satisfaction appears to elude health care workers in Zimbabwe as they are able to feel no inner satisfaction for a job well done and neither do they receive outside recognition for their work because the conditions in the health care sector are such that bars these workers form achievement in their career.

INFORMED CONSENT FORM

Questionnaire on Skilled Migration for Zimbabwe Overseas

This survey is being conducted on the impact of migration on the local labour market and the purpose of this questionnaire is to gain insight on the motivations and reasons qualified Zimbabwe professionals choose not to return to Zimbabwe to work upon graduation from tertiary studies. The results of this questionnaire will provide feedback for our study and propose solutions intending to reverse brain drain.

Confidentiality Clause: The information provided in this survey will be used for the purpose of the study only. The survey will remain confidential and will not be distributed. Anonymity will remain at all times.

QUESTIONNAIRE

Section A

Social and demographic characteristics and education

(1) How old are you? Years

(2) Sex

Female ( )

Male ( )

(3) What is the highest level of education you have completed?

a) Primary Education ( )

b) Secondary Education ( )

c) Post Secondary Education ( )

d) Undergraduate Degree ( )

e) Post Graduate Degree ( )

f) Masters ( )

g) PHD ( )

(4) What was your field of Study?

(5) In which country did you go to university? Name the university you attended

(6) In which country are you currently residing?

Section B - Employment Background

(7) What is your current activity?

a) Student ( )

b) In Employment ( )

c) Unemployed ( )

(8) If you are in employed please state in what sector? E.g. Education

(9) Is your job relevant to the qualification you have obtained? If Yes or No state the reasons why

(10) If you are a student please state the name and level of the course you are taking? E.g. Msc English

(11) Please state three main reasons in order of their importance that pushed you to:

either remained in the current host country to seek employment after graduation or leave your local job to migrate abroad

Reasons

1)

2)

3)

(12) Are you planning to return to Zimbabwe in the near future?

Yes ( )

No ( )

Don't Know ( )

(13) What conditions you would encourage to be put in place in Zimbabwe that will motivate you or other skilled migrants to come back permanently?

Thank you very much for your cooperation.

Findings of Data Analysis

The percentages of health care professionals of Zimbabwe in other countries include the percentages shown in the following chart for the country listed with each percentage.

Figure 12

Percentages of health care professionals of Zimbabwe in other countries.

It can be observed that the majority of Zimbabweans leaving since 1990 are in Botswana and Britain with only a small percentage in South Africa, Canada, and the United States.

National Status Before Leaving

The study sought to determine if the Zimbabweans held citizenship in Zimbabwe by birth or naturalization. The following are findings:

National Status Frequency Percent

Zimbabwean by birth 162 92.1

Zimbabwean by naturalization 10 5.5

Total 172 100

The table above shows that the majority of individuals emigrating were of Zimbabwe birth and only 5.5% of the individuals were naturalized citizens.

The greater provinces of Zimbabwe that the individuals had emigrated from are shown in the following chart.

Figure 12

Figure 13

Level of educational training

Field of Study Frequency Percent

Medical Doctor 5-19.5

Nurse 22-23.3

The methodology in this study sought to specifically identify the reason or conditions under which migration to other country destinations occurred and findings are shown in the following chart.

Figure 14

How Visa was obtained by respondent

How respondent obtained visa Frequency Percent

Employer 78-53.4

Personally 44-30.1

Consultant/agent 18-13.0

Not Stated 6-4.1

Point of Entry 2-1.4

Figure 15

Basis of Admission in Country of Destination

Teacher 32-24.2

Engineer/Scientist 34-26.2

Pharmacist 8-6.8

Figure 16

Source of Funding

Primary reason for leaving Zimbabwe

Work Factors 82-52.5

Education Factors 40-26.4

Marriage/relationship 18-12.4

Political Factors 14 7.2

Travel 4-2.8

Did you move to gain a better position?

Yes

No

Did you move to get better pay?

Yes

No

Did you move to gain and/or develop skills?

Yes

No

Did you move to gain better opportunities for advancement?

Yes

No

Did you move for better benefits?

Yes

No

Method of locating job for emigration

Advertisements 24.2%

Personal connections 38.8%

Random application 16.6%

Agency Recruitment 28.3%

Figure 17

Intention to return to Zimbabwe

Figure 18

Age Distribution among Zimbabwean Emigrant Health Care Workers

Age Group

Frequency

Percent

20-29

62

40.8

30-39

38

25

40-49

16

10.5

50+

36

23.7

This study sought to determine when respondents in the study intended to return to Zimbabwe. The findings are as follows:

Figure 19

How long do you intend to wait to return to Zimbabwe?

Years Gone from Zimbabwe Frequency Percent

Within two years 20-22.5

Three to Five years 18-20.2

After Five Years 16-18.7

Unknown 34-38.6

Figure 19

Do you have children in Zimbabwe?

Figure 20

Do you own property in Zimbabwe?

Figure 20

Reasons for Leaving Zimbabwe

Figure 21

Respondents by profession and intention to return to Zimbabwe someday.

Figure 22

Reasons for Leaving Zimbabwe

The brain drain is Zimbabwe is not a new occurrence but instead it is just part of an ongoing process of relocation and translocation of human beings. The Zimbabwe government must do something to motivate health care workers to remain in Zimbabwe and the acknowledgement of this has resulted in a call going out on a widespread basis for policy responses to the brain drain crisis. The push and pull factors appear to be equal factors in the ongoing brain drain problem. Economic factors have been found in this study to be the primary reason that the brain drain problem is ongoing. A great many of Zimbabweans who emigrate to other countries in the South African region at first move temporarily and then upon expiration of their permits they either settle formally or informally in the host country. It's not just the number of workers that are being lost but as well the loss of the highest paid and most experienced workers is dominant in the health care sector. Professionals who are talented including those who have just graduated and those with a great deal of experience seek the best possible opportunities for personal development. Work conditions were cited in this study and in other studies it has been emphasized that there are individual leaving Zimbabwe because the countries where they are going supplies the health care sector workforce with the latest technology and high levels of funding for research purposes. It is critical that health care sector workers are employed in their particular procession instead of in low-wage and low-status jobs for which they are over-qualified. Universities in Zimbabwe turn out graduates and then these individuals leave Zimbabwe with those skills taking them to other countries.

Recommendations

Recommendations arising from this study include that the government of Zimbabwe should invest in its professionals both in terms of their education and their career and even focusing on the retirement of these individuals. Many individuals who travel abroad to work intend to retire in their home country of Zimbabwe. It is vital that Zimbabwe invest in its professionals, their employment and career, advancement in their career, better rates of pay and better benefits as well as in other critical areas highlighted in this study.