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Medical
leave: The exodus of health professionals from Zimbabwe, 2005
Southern African Migration Project (SAMP)
Extracted from Migration Policy Series No. 39
2005
http://www.queensu.ca/samp/forms/form.html
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Executive
Summary
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 vast
majority of Zimbabwean health professionals (68.0%) are considering
leaving the country in the near future. In the case of nurses,
the figure is as high as 71%.
- The most
likely destination (MLD) is the United Kingdom (29.0%). However,
a sizable number prefer destinations within Africa (mostly South
Africa followed by Botswana). Other fairly popular intended destinations
include Australia, the US, New
- More than
half of the respondents (54.7%) cited economic factors as a reason
for leaving. These included better remuneration in the intended
country of destination (55%) or the desire to make money to remit
home (54%). Illustratively, Zimbabwean nurses earned an average
of Z$18,000 a month in 2001. This compares extremely unfavourably
with the Z$82,600 to Z$110,625 a month they could earn in Australia
and Z$154,000 a month in the US.
- There is
widespread dissatisfaction with the benefits offered in the public
sector. The respondents argued that the sector does not offer
competitive salaries (87%). Some 68% said they found it difficult
to live on their existing salary and 79% said that it was necessary
to do two or more jobs to make ends meet.
- Professional
reasons influencing potential emigration decisions include the
lack of resources and facilities (42.9%), heavy workloads (39.4%)
and insufficient opportunities for promotion and self-improvement
(32.2%).
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.
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