Series Editor: Jonathan Crush
Southern African Migration Project
Migration Policy Series No. 34
PLEASE NOTE: Readers are welcome to reproduceand reference
this article as long as appropriate acknowledgments are given.
Zimbabwe is faced with a growing problem of the emigration of its skilled labour. Health professionals in particular are migrating in search of greener pastures outside the country’s borders. This has negatively affected the quality of health care offered in most of the country’s health institutions. This policy paper draws on research work that was conducted in selected health institutions in July 2002. The study aimed to establish the magnitude of migration of health pr ofessionals, its causes and to document the associated impacts on service delivery.
The study is based on a multi-faceted methodology including a representative survey of health professionals in Zimbabwe, focus groups and key informant interviews. Attempts to interview professionals outside the country were less successful.
Zimbabwe has been experiencing a significant brain drain of doctors and nurses with two dimensions. First, within the country, health professionals have been moving from the public to the private sector. Symptomatic of the growing staffing crisis in Zimbabwe’s health sector is the fact that the public health system only had 28.7% of the required number of doctors in the late 1990s. Dentists, pharmacists and even nurses were also in short supply. Of the 1,634 doctors registered in the country in 1997, only 551 (33.7%) were employed in the public sector. As many as 67% of public sector nurses are considering moving to the private sector. Second, the main subject of this paper, there has been an accelerating movement of professionals out of the countr y primarily to the United Kingdom, South Africa and Botswana. Some professionals use the private sector as a stepping stone between the public sector and leaving the country.
The exact numbers and whereabouts of Zimbabwean health professionals working overseas is unknown but the Health Minister noted in 2000 that Zimbabwe was losing an average of 20% of its health care professionals every year to emigration and that each of the country’s five main hospitals was losing 24 senior nurses and three doctors every month. He also claimed that 100 doctors and 18,000 nurses had left since 1998. In 2002, in the United Kingdom alone, 2,346 work permits were issued to nurses from Zimbabwe. Zimbabwe was the UK’s fourth largest supplier of overseas nurses, after the Philippines, India and South Africa. Also unknown is the nature of the linkages Zimbabwean professionals retain with home although remittance flows are thought to be extremely significant in propping up the Zimbabwean economy.
What this study shows is that the outflow of health professionals is unlikely to slow if the push factors do not change. The survey of health professionals showed widespread discontent with working conditions, workloads and salaries, as well as broader economic and political conditions in the country. Amongst the key findings were the following:
The research results showed that most of the country’s public health institutions are grossly understaffed and the skeletal staff that remains are reeling under heavy workloads.
Nearly 80% of the respondents indicated that they lack basic equipment at their health institutions, such as injections and thermometers. The absence of such basic equipment makes it difficult for health professionals to conduct their duties efficiently and this consequently affects their morale. Nearly 40% of the respondents indicated that their health institutions do not take adequate measures to protect them from contracting the AIDS virus. Over 50% of doctors and nurses are constantly worried that they will get infected at work.
The shortage of suitably qualified health professionals in the countr y’s public health institutions has increased the workload of those who remain. For instance, half of the respondents attend to more than 20 patients per shift while only 9.5% attend to less than five per shift. As many as 78% of the health professionals expressed dissatisfaction over patient load which they regard as extremely high and increasing. They blamed emigration for the increase. In this case, the migration of health staff is seen as both a cause of ongoing migration (by increasing workload of remaining health professionals) and its effect (due to the reduction of available health professionals).
The study showed that both urban and rural health institutions have been affected by migration, with those located in rural areas being the most affected. The situation is better in urban areas which have alter native sources of medical healthcare in the form of private health institutions. Besides offering better services to patients, albeit at a higher fee, the private health sector also provides an escape route for the disgruntled public health sector professionals who find the salaries offered by the public sector unattractive. The poor have been negatively affected since they cannot afford the fees charged at private clinics.
The study shows that existing policy responses are not having a sig - nificant impact on the retention and return of health professionals. A speedy resolution to the current economic and political crisis is a prerequisite for curbing the ongoing migration of health professionals from Zimbabwe. Policies aimed at retaining existing and re-attracting emigrant staff are likely to have much greater success in a transformed economic and political environment.