Migration Policy Series
Balsillie School of International Affairs
Despite the well-documented negative impacts of the ‘brain drain’ of health professionals from Africa, there is an argument that their departure is not an absolute loss and that transnationally-oriented medical migrants (or diasporas) can act as development agents in their home countries. Financial remittances, in particular, are said to have significant transformative development potential. African countries are also expected to benefit from knowledge and skills transfer through the return of health professionals from abroad. Other diaspora engagement initiatives that do not require permanent return (such as short term work assignments, technological transfer to country of origin and ‘virtual’ participation of the diaspora involving the use of communication technologies) are seen as another positive feedback mechanism, mitigating the negative impact of out-migration.
Zimbabwe’s economic and political crisis has led to the emigration of many physicians over the last twenty years as the skills and experience which they possess are valued in countries in the North as well as in South Africa. Previous studies have focused on the magnitude and damaging impact of this exodus on the Zimbabwean health system. This is the first study to focus exclusively on physicians in the diaspora. The study is based on a global email survey of physicians and in-depth interviews with Zimbabwean doctors living and working in South Africa. The results of the survey and interviews provide new insights into the nature of the Zimbabwean medical diaspora, their motivations for leaving the county, the links which they maintain with Zimbabwe, the prospects of them returning to Zimbabwe and their interest in making their skills, knowledge and resources available to the country in the future.
The conventional wisdom on the brain drain is that skilled professionals move directly from a country of origin to a country of destination. The impacts of this movement for both countries are then assessed. However, this fails to capture the complexity of the migration patterns of Zimbabwean physicians. Only 42% of those surveyed had moved directly from Zimbabwe to their current country of residence. Seventy one percent of the Zimbabwean doctors in South Africa came directly from Zimbabwe. The rest had first been to a variety of other destinations including the United Kingdom, Australia, Asia and elsewhere in Africa. This suggests that there has been “return migration” from overseas, but benefitting South Africa not Zimbabwe.
A common feature of studies on the causes of skills migration is to ask respondents to identify discrete “causes” of migration and then to rank them. In this study, respondents were presented with a set of possible reasons for leaving and then asked to rate the importance of each of them to the decision-making process on a five point scale from ‘strongly agree’ to ‘strongly disagree.’ The three factors with the highest levels of concurrence were the bad political environment (74% in agreement), lack of opportunities for career advancement (73% agreed) and poor economic conditions in Zimbabwe (71% agreed). Other factors cited by the majority of respondents were unsatisfactory working conditions, inadequate remuneration and benefits, the collapse of the health care system and a better future for their children. The relative importance of each of these factors varied with race and the year when the physician left.
Another 30% of the respondents moved first from Zimbabwe to South Africa and then joined the “brain drain” from South Africa and migrated onwards to a variety of overseas destinations. Less than half of the doctors who had migrated to the UK did so directly from Zimbabwe. Only 5% of the Zimbabwean doctors in the USA, Australia, Canada and New Zealand came direct from Zimbabwe. South Africa and the UK are clearly the main transit countries for medical doctors from Zimbabwe. These two intermediary destinations seem to act as “stepping stones” to get to the ultimate destination. The intermediate point allows them to specialise in their chosen field which then increases their chances of gaining entry to their ultimate destination. Furthermore, it enables them to develop networks with similar professionals located elsewhere who can assist them in making an onward move. Eventually, a migration chain develops linking the emigrant Zimbabwean medical doctors in an intermediate country to their counterparts located in a more attractive destination.
Previous surveys have shown that migrant remittances play a major role in ensuring household survival in Zimbabwe. We do not know if physicians are distinctive in their remitting behaviour or whether they follow the general pattern. This study therefore focused on whether physicians, who are amongst the highest earning occupational category in the Zimbabwean diaspora, display different remitting practices than other Zimbabweans. The survey found the following:
- 60% of the diaspora physicians send money to Zimbabwe while 40% never do so. The propensity to remit was highest among medical doctors working in South Africa, with 79% sending money to Zimbabwe. Two thirds of doctors in the USA remit but only 42% in the UK and a third of those in Canada. To put these figures in context, various surveys of Zimbabweans in South Africa have found that 85-95% of migrants remit money home. Another study of Zimbabweans in the UK found that 80% remitted funds to Zimbabwe.
- the propensity of physicians to remit varies with the year of emigration (with 95% of those who left after 2000 remitting) and race (only a third of white doctors remit compared to 100% of black doctors.)
- around 50% of those who remit do so at least once a month. Amongst the general Zimbabwean migrant population in the UK, around 41% remit at least once a month. Remitting frequencies from South Africa are higher; 60-75% at least once a month. There is thus nothing particularly unusual about the frequency with which physicians remit.
- the vast majority of Zimbabwean migrants (over 90%) use various informal channels when remitting to Zimbabwe. Highly-educated, middle-class migrants such as physicians might be expected to make more use of formal remitting channels such as banks and money transfer companies. In fact, at the time of the survey (2008), most physicians were also using informal channels and stayed away from the banks.
- the research on Zimbabwean remittances clearly shows that the bulk of it is spent on household survival needs with very little investment of the proceeds. The question is whether remittances from physicians are any different. The answer is no. Over 90% of the respondents who send cash remittances do so to meet the day to day expenses of family members in Zimbabwe including food purchase, rent and the cost of electricity and water.
- the only thing that really distinguishes the physicians’ remitting behaviour is the volume sent (which is well above average). However, even if the average physician remittance figure of US$2,616 p.a. was sustained over a 30 year period, the total remittances from one individual would still not compensate for their training costs in the first place.
Considerable international enthusiasm surrounds the idea of “return migration.” In the case of Zimbabwean physicians outside the country, the probability of permanent return migration is generally low but varies with race, age, year of emigration and location:
- 53% of black physicians said they are likely to return compared to only 11% of white physicians. Conversely, 70% of the whites said they would never return compared to only 16% of the blacks. In other words, the potential for return is higher amongst black physicians and only a small minority (16%) definitely ruled out the possibility.
- the possibility of return is highest amongst the younger doctors: 78% in the 31-40 age group said they are likely to return, compared to 23% in the 41-50 age group, 10% in the 51-60 age group and none over the age of 60.
- the year of emigration is positively correlated with the possibility of return: 12% of those who left in the 1980s said they might return compared to 30% of those who left in the 1990s and 79% of those who left after 2000.
- possibility of return varies with a doctor’s current country of residence. Return was more likely among those located in South Africa (40%) than amongst those in the UK (21%) or in the USA (13%).
Diaspora engagement has been increasingly advanced as a possible solution to the skills problems facing developing countries. In Zimbabwe, the diaspora option arguably offers the most sensible policy prescription since it entails the use of the skills of the diaspora without requiring them to return home permanently. Options proposed by the physicians and discussed in this report include: medical training, short-term medical visits, raising funds, sourcing supplies and telemedicine. In each case the opportunities and obstacles to the particular form of engagement are discussed.
Chikanda, A. (2011). The Engagement of the Zimbabwean Medical Diaspora (rep., pp. i-55). Waterloo, ON: Southern African Migration Programme. SAMP Migration Policy Series No. 55.