The Disengagement of the South African Medical Diaspora

Series Editor: Jonathan Crush
Author: Jonathan Crush and Abel Chikanda

Migration Policy Series No. 58

Executive Summary

Conventional wisdom holds that the 'brain drain' of health pro­fessionals from Africa is deeply damaging to the continent. Recently, a group of North American and European neo-liberal economists has challenged this conventional wisdom, variously arguing that the negative impacts are highly exaggerated and the com­pensating benefits many. The benefits include various forms of "diaspora engagement" in which those who have left then engage through send­ing remittances, direct investment, knowledge and skills transfer, return migration and involvement in diaspora associations. A previous SAMP study of Zimbabwean physicians outside the country provided clear evidence for the "diaspora engagement" hypothesis (see No 56 in this series). This paper examines the case of South African physicians who have left South Afrca.

South Africa provides an ideal case for examining the conflicting viewpoints on the health brain drain given the significant loss of physi­cians the country has experienced over the past two decades. A 2000 global survey of the location of physicians found that as many as 7,363 South African-trained doctors (or 21% of the total number in practice) were living and practising abroad. In 2005, the OECD estimated that more than 13,000 South African trained physicians were working in OECD countries, of whom 7,718 were in the United Kingdom, 2,215 in the United States, 1,877 in Canada and 1,022 in New Zealand. More recent data from Canada indicates that there were 2,193 South African physicians in that country in 2009. The research reported in this paper consists of a survey of 415 South African doctors in Canada conducted in 2009-10 (representing almost 20% of the total number working in Canada.)

More than half of the survey respondents (58%) had acquired Canadian citizenship since leaving South Africa. Of the rest, around one quarter (26%) were permanent residents in Canada and only 16% were on work permits. At the same time, 70% still hold South African citi­zenship. This raised the possibility that they want to retain their South African citizenship because they feel a strong affinity with South Africa. Nearly 90% agreed with the statement that "being from South Africa is an important part of how I view myself" and 81% with the statement that "I feel strong ties with people from South Africa." The vast major­ity (over 80%) buy or make South African foods, listen to South African music and want their children to know about South Africa. Some 80% regularly consult South African newspapers online. As many as 60% want their children to learn a South African language. Forty percent say that their best friends in Canada are South Africans. Family links with South Africa also remain strong. As many as 81% have siblings still living in South Africa and 71% still have parents there. About 95% of the respondents had visited South Africa since migrating to Canada. More than 75% visit South Africa at least every 2-3 years, with 28% visiting once a year. However, despite all this evidence of a persistent South African identity and the maintenance of strong links with the country, the vast majority (80%) disagreed with the statement that they had "an important role to play in the development of South Africa." Only 16% said they are likely to send money for development projects in South Africa, 15% said they would participate in educational and other exchanges with South Africa, while 13% would participate in fundraising projects in South Africa. Only 10% said they would invest in a business in South Africa and just 8% might work for a period of time in South Africa.

By most standards, the physicians surveyed were high income earners. As many as two-thirds earn above CAN$200,000 (ZAR 1.6 million) per annum and fewer than 5% earn less than CAN$100,000 (ZAR 800,000) annually. In general, remitting is often positively correlated with income: the more a migrant earns the greater the amount that they tend to remit. However, despite their high earnings South African physicians in Canada are not significant remitters:

  • Only half (52%) had sent money to South Africa in the previous year and only 19% can be considered regular remitters who send money to South Africa at least once a month. A considerable number do not remit regularly (21% do so less than once a year) and 28% have never sent remittances to South Africa.
  • Less than a third (27%) had sent more than CAN$5,000 (ZAR40,000) to South Africa. The median amount sent by remit­ters was only CAN$4,250 (ZAR 33,000) per annum, which falls to only CAN$1,000 (ZAR8,000) per annum for the whole sam­ple. Such small amounts are unlikely to yield significant develop­ment outcomes in the country of origin or compensate the coun­try for the loss of skills incurred in the brain drain.
  • The majority of the remitters (82%) send money to their imme­diate family members. About a third send money to a personal bank account for their own future use. Only 11% send money to community groups or organisations in South Africa.
  • In terms of the reasons for remitting, 29% identified meeting day to day household expenses in South Africa as the major purpose followed by paying for medical expenses (26%), covering costs for special events (20%), buying food (19%) and educational expens­es (13%). Buying property was cited by only 5% of remitters and investing in business by only 3%.
  • As regards remittances of goods, only a quarter of the respond­ents had sent goods to South Africa at least once in the previous year and 54% had not sent any goods at all. The most popular items sent included books/educational materials, clothing and household goods and appliances. The value of the goods remitted to South Africa is significantly lower than that of cash remittanc­es. Less than 10% of the physicians sent goods valued at more than CAN$1,000 (ZAR8,000) annually. The mean value of goods sent by the physicians was CAN$340 (ZAR2,430)annually.

In other words, the amounts remitted by South African physicians are small in comparison to their incomes and remitting is infrequent. The South African physicians differ markedly in their remitting behaviour from physicians from other African countries and from African diasporas in general.

Further evidence of the disengagement of the South African physician diaspora is provided by patterns of property ownership and other invest­ments in South Africa. As many as 57% of the physicians maintain an active bank account in South Africa but these are funds ostensibly for use during their visits. Only 25% have substantial savings in their bank accounts. At the same time 17% own property, 35% have investments and 27% have a house in South Africa. However, these are generally acquired before leaving. Only 5% had bought a house or property in South Africa and only 4% had invested in a South African business in the year prior to the survey. The vast majority of those still holding these assets in South Africa are recent (post 2000) immigrants to Canada. There is a consistent pattern of decline in South African asset ownership over time as the physicians sell their property, close their bank accounts and disinvest.

In order to gauge the potential for return migration, the respondents were asked whether they had considered returning to South Africa. About 36% have never considered the possibility of returning while 21% had given it hardly any thought. About 43% indicated that they have considered returning to South Africa. However, only 7% said they are likely to return within the next two years and another 10% within the next five years. Few had taken any concrete steps to return. Less than 2% had applied for a job in South Africa in the previous year.

While this group of South African professionals are proud to think of themselves as South African and take a relatively keen interest in events in that country, they are disengaged from any serious diasporic interest in and commitment (beyond contact with and some limited support for family members who remain). Almost without exception, they paint a very negative picture of life in South Africa and they do not see any role for themselves in helping address South Afrca's deep social and economic inequalities and needs. Neo-liberal economists and proponents of dias­pora engagement will find little to support their arguments in the views of this particular component of the South African diaspora.

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