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

Human Resources for Health

Volumn 13, Issue 1, 2015, Pages

  Labonté, Ronald ^a   Sanders, David ^b   Mathole, Thubelihle ^b   Crush, Jonathan ^c,d   Chikanda, Abel ^e   Dambisya, Yoswa ^f   Runnels, Vivien ^a   Packer, Corinne ^a   MacKenzie, Adrian ^g   Murphy, Gail Tomblin ^g   Bourgeault, Ivy Lynn ^h  

^a UNIVERSITY OF OTTAWA   (Canada)

^b UNIVERSITY OF THE WESTERN CAPE   (South Africa)

^c BALSILLIE SCHOOL OF INTERNATIONAL AFFAIRS   (Canada)

^d UNIVERSITY OF CAPE TOWN   (South Africa)

^e UNIVERSITY OF KANSAS   (United States)

^f East   (Tanzania)

^g DALHOUSIE UNIVERSITY   (Canada)

^h UNIVERSITY OF OTTAWA   (Canada)

Author keywords

Dentists; Health workers; Human resources for health; Migration; Nurses; Pharmacists; Physicians; Policy; Retention; South Africa

Indexed keywords

DENTIST; DOCTOR NURSE RELATION; DRIVER; GOVERNMENT; HEALTH CARE FACILITY; HEALTH CARE PERSONNEL; HUMAN; HUMAN EXPERIMENT; INDIA; INTERVIEW; JAMAICA; PHARMACIST; PHILIPPINES; PROFESSIONAL DEVELOPMENT; SATISFACTION; SOUTH AFRICA; STATISTICAL MODEL; STATISTICS; ADULT; DEVELOPING COUNTRY; EMPLOYMENT; FEMALE; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH PERSONNEL ATTITUDE; JOB SATISFACTION; MALE; MANPOWER; MIDDLE AGED; MIGRATION; MOTIVATION; NURSE; PERSONNEL MANAGEMENT; PHYSICIAN; QUESTIONNAIRE; SALARY AND FRINGE BENEFIT; SUPPLY AND DISTRIBUTION;

ADULT; ATTITUDE OF HEALTH PERSONNEL; DELIVERY OF HEALTH CARE; DENTISTS; DEVELOPING COUNTRIES; EMIGRATION AND IMMIGRATION; EMPLOYMENT; FEMALE; HEALTH POLICY; HUMANS; JOB SATISFACTION; MALE; MIDDLE AGED; MOTIVATION; NURSES; PERSONNEL TURNOVER; PHARMACISTS; PHYSICIANS; SALARIES AND FRINGE BENEFITS; SOUTH AFRICA; SURVEYS AND QUESTIONNAIRES;

EID: 84949221065     PISSN: None     EISSN: 14784491     Source Type: Journal    
DOI: 10.1186/s12960-015-0093-4     Document Type: Article

References (94)

1. Breier M. A multiple source identification and verification of scarce and critical skills in the South African labour market. South Africa: Department of Labour; 2007.
2. World Health Organization: Density per 1000: data by country. http://apps.who.int/gho/data/node.main.A1444 (2015). Accessed 1 Oct 2015.
3. Lloyd B, Sanders D, Lehmann U. Human resource requirements for National Health Insurance. In: Padarath A, Fonn S, editors. South African Health Review 2010. Durban: Health Systems Trust; 2010. p. 171-8.
4. World Health Organization. The World Health Report 2006: working together for health. Geneva: World Health Organization; 2006.
5. Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra Arias M, Leone C, et al. A universal truth: no health without a workforce. Geneva: World Health Organization; 2013.
6. Bekker LG, Venter F, Cohen K, Goemare E, Van Cutsem G, Boulle A, et al. Provision of antiretroviral therapy in South Africa: the nuts and bolts. Antivir Ther. 2014;19:105-16.
7. Health Systems Trust. The National Health Care Facilities Baseline Audit - National Summary Report 2012. Health Systems Trust; 2012.
8. World Bank. Reducing geographical imbalances of health workers in Sub-Saharan Africa: a labor market perspective on what works, what does not, and why. Washington, DC: World Bank; 2011.
9. Day C, Gray A, Budgell E. Health and related indicators. In: Padarath A, English R, editors. South African Health Review 2011. Durban: Health Systems Trust; 2011. p. 119-30.
10. Versteeg M, du Toit L, Couper I. Building consensus on key priorities for rural health care in South Africa using the Delphi technique. Global Health Action. 2013;6.
11. Hanefeld J, Musheke M. What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll out? A qualitative policy analysis for implementation processes in Zambia. Hum Resour Health. 2009;7:8.
12. Cailhol J, Craveiro I, Madede T, Makoa E, Mathole T, Parsons AN, et al. Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities. Global Health. 2013;9:52.
13. van Rensburg HCJ. South Africa's protracted struggle for equal distribution and equitable access - still not there. Hum Resour Health. 2014;12:26.
14. OECD. The international mobility of health professionals: an evaluation and analysis based on the case of South Africa. In: Trends in International Migration 2003. Paris: OECD; 2004. p. 115-45
15. Siyam A, Dal Poz MR. Migration of health workers: WHO code of practice and the global economic crisis. Geneva: World Health Organization; 2014.
16. George G, Atujuna M, Gow J. Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements. BMC Health Serv Res. 2013;13:297.
17. Awases M, Gbary A, Nyoni J, Chatora R. Migration of health professionals in six countries: a synthesis report. Geneva: World Health Organization; 2004.
18. Bhargava A, Docquier F, Moullan Y. Modeling the effects of physician emigration on human development. Econ & Hum Biol. 2011;9:172-83.
19. Clemens MA, Pettersson G. New data on African health professionals abroad. Hum Resour Health. 2008;6:1.
20. Labonte R, Packer C, Klassen N. Managing health professional migration from sub-Saharan Africa to Canada: a stakeholder inquiry into policy options. Hum Resour Health. 2006;4:22.
21. Pendleton W, Crush J, Lefko-Everett K. The haemorrhage of health professionals from South Africa: a medical opinion. Cape Town: Idasa; 2007.
22. World Bank. Migration and Remittances Factbook 2011. 2nd ed. Washington, DC: The International Bank for Reconstruction and Development / The World Bank; 2011.
23. Xaba J, Phillips G. Understanding nurse recruitment: final report. Pretoria: Democratic Nursing Organization of South Africa (DENOSA); 2001.
24. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19-32.
25. Anarfi J, Quartey P, Agyei J. Key determinants of migration among health professionals in Ghana. Development Research Centre on Migration, Globalisation and Poverty; 2010.
26. Connell J. WHO migration study. Geneva: World Health Organization; 2000.
27. Crush J, Pendleton W. Brain flight: the exodus of health professionals from South Africa. International Journal of Migration, Health and Social Care. 2010; doi:10.5042/ijmhsc.2011.0059.
28. Robinson R. The costs and benefits of health worker migration from East and Southern Africa (ESA): a literature review. EQUINET; 2007.
29. Chabikuli N, Blaauw D, Gilson L, Schneider H. Chapter 8: human resources policies: health sector reform and management of PHC. In: Ijumba P, Barron P, editors. South Africa Health Review 2005. Durban: Health Systems Trust; 2005.
30. Southern African Development Community. SADC Labour Migration Policy Draft. Southern African Development Community; 2013.
31. WorkPermit: South Africa nurses face tough new UK restrictions. http://www.workpermit.com/news/2006_08_17/uk/south_africa_nurses.htm (2006). Accessed 1 Oct 2015.
32. Runnels V, Labonté R, Packer C. Reflections on the ethics of recruiting foreign-trained human resources for health. Hum Resour Health. 2011;9:2.
33. Rispel LC, Blaauw D. The health system consequences of agency nursing and moonlighting in South Africa. Glob Health Action. 2015;8:26683.
34. OECD. The international mobility of health professionals: an evaluation and analysis based on the case of South Africa. In: Trends in International Migration 2003. Paris: OECD, 2004, p. 115-151.
35. Kingma M. Nurses on the move: a global overview. Health Serv Res. 2007;42:1281-98.
36. Agunias DR. From a zero-sum to a win-win scenario? Literature review on circular migration. Washington, DC: Migration Policy Institute; 2006.
37. Brier M. The shortage of medical doctors in South Africa: Scarce and Critical Skills Research Project. South Africa: Department of Labour; 2008.
38. Singh G. Health worker migration in South and Southern Africa. IOM; 2007
39. Bezuidenhout M, Joubert G, Hiemstra L, Struwig M. Reasons for doctor migration from South Africa. South African Family Practice. 2009;51:211-5.
40. EQUINET. Reclaiming the resources for health: a regional analysis of equity in health in East and Southern Africa. Jacana: EQUINET, Weaver Press, Fountain Publishers; 2007.
41. Sanders D, Lloyd B. Human resources: international context. In: Ijumba P, Barron P, editors. South African Health Review 2005. Durban: Health Systems Trust; 2005. p. 76-87.
42. van Dyk AC. Occupational stress experienced by caregivers working in the HIV/AIDS field in South Africa. African J AIDS Research. 2007;6:49-66.
43. de van Niekerk JPV. Where have all the flowers gone? S Afr Med J. 2011;101:281.
44. Ntlale ME, Duma SE. The costs and benefits of nurse migration on families: a Lesotho experience. Curationis. 2011;34:E1-8.
45. Arnold PC. Why the ex-colonial medical brain drain? J R Soc Med. 2011;104:351-4.
46. Kline DS. Push and pull factors in international nurse migration. J Nurs Scholarsh. 2003;35:107-11.
47. Lyndith W. Migration of skills in South Africa: patterns, trends and challenges. Southern African Migration Project; 2006.
48. Redfoot DL, Houser AN. The international migration of nurses in long-term care. J Aging Soc Policy. 2008;20:259-75.
49. World Health Organization. Taking stock: health worker shortages and the response to AIDS. Geneva: WHO Health Systems and Services; 2006.
50. Kingma M. Migration patterns of health professionals. Cah Sociol Demogr Med. 2005;45:287-306.
51. McIntosh T, Torgerson R, Klassen N. The ethical recruitment of internationally educated health professionals: lessons from abroad and options for Canada. Ottawa: Canadian Policy Research Networks; 2007.
52. Crush J, Chikanda A, Bourgeault I, Labonté R, Tomblin Murphy G: Brain drain and regain: the migration behaviour of South African medical professionals. Cape Town: Southern African Migration Programme (SAMP); 2014.
53. Clemens M. The financial consequences of high-skilled emigration: lessons from African doctors abroad. In: Plaza S, Ratha D, editors. Diaspora for Development in Africa. Washington DC: World Bank; 2011. p. 165-82.
54. Taylor JE. The new economics of labour migration and the role of remittances in the migration process. Int Migr. 1999;37:63-88.
55. Oberoi SS, Lin V. Brain drain of doctors from southern Africa: brain gain for Australia. Aust Health Rev. 2006;30:25-33.
56. Crush J, Chikanda A, Pendleton W. The disengagement of the South African medical diaspora in Canada. J South Afr Stud. 2012;38:27-49.
57. Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, et al. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011; doi:http://dx.doi.org/ 10.1136/bmj.d7031.
58. Government of South Africa. Human Resources for Health South Africa 2030: draft HR strategy for the health sector: 2012/13 - 2016/17. Government of South Africa; 2011.
59. Health Systems Trust: health indicators advanced search. http://www.hst.org.za/health-indicators-advanced-search (n.d.). Accessed 1 Oct 2015.
60. Stodel JM, Stewart-Smith A. The influence of burnout on skills retention of junior doctors at Red Cross War Memorial Children's Hospital: a case study. S Afr Med J. 2011;101:115-8.
61. Oosthuizen MJ. An analysis of the factors contributing to the emigration of South African nurses. University of South Africa; 2006.
62. Secretariat C. Commonwealth code of practice for the international recruitment of health workers: transparency, fairness and mutuality of benefits needed when recruiting international health workers. London: Commonwealth Secretariat; 2003.
63. Buchan J. International recruitment of nurses: policy and practice in the United Kingdom. Health Serv Res. 2007;42:1321-35.
64. Martineau T, Willetts A. The health workforce: managing the crisis ethical international recruitment of health professionals: will codes of practice protect developing country health systems? Health Policy (Amsterdam, Netherlands). 2006;75:358-67.
65. World Health Organization. WHO global code of practise on the international recruitment of health personnel. Geneva: World Health Organization; 2010.
66. South African Development Community. Protocol on the facilitation of movement of persons. South African Development Community; 2005.
67. Oucho JO, Crush J. Contra Free Movement: South Africa and the SADC Migration Protocols. Africa Today. 2001;43:139-58.
68. Tjadens F, Weilandt C, Eckert J. Mobility of health professionals - health systems, work conditions, patterns of health workers' mobility, and implications for policy makers. Berlin Heidelberg: Springer; 2013.
69. Department of Health, South Africa: Recruitment and employment of foreign health professionals in the Republic of South Africa. Southern African Development Community; 2006.
70. Foreign Workforce Management Programme, National Department of Health. Policy: recruitment and employment of foreign health professionals in the Republic of South Africa. Pretoria; South African National Department of Health; 2006.
71. Parliamentary Monitoring Group. Report of the Portfolio Committee on International Relations and Cooperation on the dialogue on South Africa-Cuba relations: successes and challenges towards the implementation of processes aimed at kick-starting economic processes in Cuba. Parliamentary Monitoring Group; 2013.
72. Department of International Relations and Cooperation. The Cuban Five to undertake a visit to South Africa [media statement]. Pretoria: Republic of South Africa; 21 Jun 2015.
73. Molope K. SA-Cuba medical doctor programme to increase output. SABC News. 13 Sep 2014.
74. Reed G, Torres J. Training and retaining more rural doctors for South Africa. MEDICC Rev. 2008;10:1.
75. Office of U.S. Global AIDS Coordinator and the Bureau of Public Affairs: Medical Education Partnership Initiative (MEPI). http://www.pepfar.gov/partnerships/initiatives/mepi/index.htm (n.d.). Accessed 1 Oct 2015.
76. PEPFAR. PEPFAR's Medical and Nursing Education Partnership Initiatives. PEPFAR; 2013.
77. The Office of the U.S. Global AIDS Coordinator (OGAC): Stellenbosch Univ Rural Medical Education Partnership Initiative. http://www.pepfar.gov/partnerships/initiatives/mepi/network/southafrica/index.htm (n.d.). Accessed 1 Oct 2015.
78. Mullan F, Frehywot S, Omaswa F, Sewankambo N, Talib Z, Chen C, et al. The Medical Education Partnership Initiative: PEPFAR's effort to boost health worker education to strengthen health systems. Health Aff (Millwood). 2012;31:1561-72.
79. Flanagan L. New Gauteng medical varsity to open soon. IOL News. 11 Nov 2013.
80. Hall W, Ford-Ngomane T, Barron P. The health act and the district health system. In: Ijumba P, Barron P, editors. South African Health Review 2005. Durban: Health Systems Trust; 2005. p. 44-57.
81. Matsoso MP, Strachan B. Human resources for health for South Africa: HRH strategy for the health sector 2012/13-2016/17. In: Padarath A, English R, editors. South African Health Review 2011. Durban: Health Systems Trust; 2011. p. 50.
82. Cooke R, Couper I, Versteeg M. Human resources for rural health. In South African Health Review 2011. In: Padarath A, English R, editors. Durban: Health Systems Trust; 2011. p. 107-118.
83. Zachariah R, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg. 2009;103:549-58.
84. Doherty J, Conco D, Couper I, Fonn S. Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates. Glob Health Action. 2013. doi: 10.3402/gha.v6i0.19282.
85. Boschmans SA, Fogary TL, Schafermeyer KW, Mallinson RK. Practice analysis for mid-level pharmacy workers in South Africa. Pharm Educ. 2015;15:31-8.
86. Global Health Workforce Alliance: Africa Health Placements. http://www.who.int/workforcealliance/members_partners/member_list/ahp/en/ (2015). Accessed 1 Oct 2015.
87. Ditlopo P, Blaauw D, Rispel L, Thomas S, Bidwell P. Policy implementation and financial incentives for nurses in South Africa: a case study on the occupation specific dispensation. Glob Health Action. 2013;6:138-46.
88. George G, Rhodes B. Is there really a pot of gold at the end of the rainbow? Has the Occupational Specific Dispensation, as a mechanism to attract and retain health workers in South Africa, leveled the playing field? BMC Public Health. 2012;12:613.
89. Pillinger J. South Africa National Report. Ferney-Voltaire: Public Services International; 2011.
90. Naidoo S. The South African national health insurance: a revolution in health-care delivery! J Public Health. 2012;34:149-50.
91. Baleta A. South Africa rolls out pilot health insurance scheme. Lancet. 2012;379:1185.
92. Republic of South Africa. National Health Insurance in South Africa Policy Paper. Republic of South Africa; 2011.
93. Kahn T. Mass TB tests 'would save billions'. Business Day. 26 Mar 2014.
94. Makholwa A. Robust returns on big health spend. Financial Mail. 27 Feb 2014.