Medical Recruits: the Temptation of South African Health Care Professionals
Series Editor: Jonathan Crush
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Health workers are one of the categories of skilled professionals most affected
by globalization. Over the past decade, there has emerged a substantial
body of research that tracks patterns of international migration of
health personnel, assesses causes and consequences, and debates policy
responses at global and national scales. Within this literature, the
case of South Africa is attracting growing interest. For almost 15 years
South Africa has been
This paper aims to to examine policy debates and issues concerning
the migration of skilled health professionals from the country and to
furnish new insights on the recruitment patterns of skilled health personnel.
The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health professionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical material drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The final section provides a short conclusion and specific recommendations related to the recruitment industry.
The main policy issues at national and international levels in relation
to the migration of skilled health professionals concern the monitoring,
management, or regulation of such flows. Although several strategies
have been put forward for national strategies and international co-operative
measures to address the issue of skilled health migration, the realistic
options available for most poor countries are limited. It has been argued,
for example, that in order to manage migration effectively, it is necessary
for governments and other agencies to develop a more strategic approach
towards regulating the flow of health workers between countries. The
international record shows that there are no ‘off the shelf solutions’
or universal panaceas and that each country has to develop its own strategy
for dealing with the issue of migration in its own context. Nevertheless,
the international policy consensus appears to be moving in the direction
of national and global cooperation for the
The empirical research on recruitment points to the urgent need for such policy interventions in South Africa. Over the five-year period 2000-2004 a scan of recruitment advertisements appearing in the South African Medical Journal (SAMJ) records a total of 2522 recruitment initiatives for South African medical personnel. The numbers of advertisements appearing each year fluctuated from a low of 458 in 2004 to a peak of 646 in 2002; overall, the average number of advertisements was 504 per annum across the five-year study period. The advertisements varied from seeking applicants for specific positions available in particular countries to more general recruitment of personnel by international agencies for placement in either designated countries or for opportunities and placements across a range of international destinations.
Moreover, the type of recruitment spanned the entire spectrum of medical
personnel from general doctor to specialist. The most critical set of
findings relates to the international origins of the recruitment initiatives
of South African medical personnel. In terms of individual countries,
the analysis discloses that the greatest volume
As a whole, therefore, these four countries – the United Kingdom,
New Zealand, Australia and Canada – account for 85.9 percent of
all recruitment advertising for South African medical personnel in the
The business of recruitment is dominated by UK-based enterprises such as Global Medics, Medacs Healthcare Services, Corinth Health Care or NES Healthcare UK. Significant players recruiting in South Africa outside the UK include Auckland Medical Bureau for New Zealand, AMAQ Services for Australia, and Northern Medical Services in Canada. Many of the large UK recruitment agencies are long-established and have been in operation for 25 years or more. Most offer placements in both the private sector and the National Health Service of the United Kingdom. From the analysis of the contact details provided on recruitment adver tisements, it is evident that the largest share of advertising in the SAMJ is placed by overseas recruiters. In year 2004, for example, only 15 percent of recruitment advertisements for South African medical personnel included any local contact details. For 85 percent of recruitment the channel of communication was through email or web contacts outside South Africa and overseas telephone/fax communication. This finding is of considerable policy relevance for it points to the weak position and limited room for manoeuvre of the South African gover nment in dealing with the activities of the international recruitment industry. Indeed, looked at from an international industry perspective, the operations of the cluster of recruitment agencies in South Africa are minor players. Enterprises are small in size, often branch operations of UK-based operations, or represent independent niche operators.
From inter views with recruiters, several key policy points emerged.
• South Africa lacks adequate knowledge and data on the numbers
of medical personnel leaving the country.
Overall, the study argues that ‘competing for talent’ is now recognized as an essential element of international competitiveness in the current world economy. In this r egard a central role is played by private and public sector recruitment agencies in shaping the international mobility of talented or skilled individuals. South Africa’s re-integration into the global economy in 1994 exposed the new democracy to the full forces of this new international competition for talent. The initial ad hoc policy responses were weak and failed entirely to comprehend the organizational dynamics and structures that shape the new global movements of professionals. In terms of the health sector, the country hemorrhaged an important segment of its most experienced medical personnel.
Moreover, without the enactment of countervailing replacement strategies
and of a national strategy for managing the country’s human health
resources, South Africa was vulnerable to the activities of ‘global