Human Resources for Health | |
Health worker migration from South Africa: causes, consequences and policy responses | |
Ivy Lynn Bourgeault2  Gail Tomblin Murphy4  Adrian MacKenzie1  Corinne Packer5  Vivien Runnels5  Yoswa Dambisya3  Abel Chikanda7  Jonathan Crush8  Thubelihle Mathole6  David Sanders6  Ronald Labonté5  | |
[1] WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, B3H 4R2, Nova Scotia, Canada;Telfer School of Management, University of Ottawa, 1 Stewart St., Ottawa, K1N 6N5, Ontario, Canada;East, Central and Southern African Health Community, Arusha, Tanzania;WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, School of Nursing, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, Halifax, B3H 4R2, Nova Scotia, Canada;Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa K1G 3Z7, Ontario, Canada;School of Public Health, University of Western Cape, Bellville, P. B. X17, South Africa;Department of Geography, University of Kansas, Lawrence, KS, USA;University of Cape Town, P/B Rondebosch, South Africa | |
关键词: Policy; Dentists; Pharmacists; Nurses; Physicians; Retention; Human resources for health; South Africa; Migration; Health workers; | |
Others : 1235438 DOI : 10.1186/s12960-015-0093-4 |
|
received in 2015-10-14, accepted in 2015-11-23, 发布年份 2015 | |
【 摘 要 】
Background
This paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries—Jamaica, India, the Philippines, and South Africa—have historically been “sources” of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa.
Methods
The study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically.
Results
There has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself.
Conclusions
In the near past, South Africa’s health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.
【 授权许可】
2015 Labonté et al.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20160120095929724.pdf | 1103KB | download | |
Figure 7. | 24KB | Image | download |
Figure 6. | 20KB | Image | download |
Figure 5. | 22KB | Image | download |
Figure 4. | 18KB | Image | download |
Figure 3. | 18KB | Image | download |
Figure 2. | 17KB | Image | download |
Figure 1. | 16KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
Figure 3.
Figure 4.
Figure 5.
Figure 6.
Figure 7.
【 参考文献 】
- [1]Breier M. A multiple source identification and verification of scarce and critical skills in the South African labour market. Department of Labour, South Africa; 2007.
- [2]World Health Organization: Density per 1000: data by country. http://apps.who.int/gho/data/node.main.A1444 (2015). Accessed 1 Oct 2015.
- [3]Lloyd B, Sanders D, Lehmann U. Human resource requirements for National Health Insurance. In: South African Health Review 2010. Padarath A, Fonn S, editors. Health Systems Trust, Durban; 2010: p.171-8.
- [4]The World Health Report 2006: working together for health. World Health Organization, Geneva; 2006.
- [5]Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra Arias M, Leone C et al.. A universal truth: no health without a workforce. World Health Organization, Geneva; 2013.
- [6]Bekker LG, Venter F, Cohen K, Goemare E, Van Cutsem G, Boulle A et al.. Provision of antiretroviral therapy in South Africa: the nuts and bolts. Antivir Ther. 2014; 19:105-16.
- [7]Health Systems Trust. The National Health Care Facilities Baseline Audit – National Summary Report 2012. Health Systems Trust; 2012.
- [8]Reducing geographical imbalances of health workers in Sub-Saharan Africa: a labor market perspective on what works, what does not, and why. World Bank, Washington, DC; 2011.
- [9]Day C, Gray A, Budgell E. Health and related indicators. In: South African Health Review 2011. Padarath A, English R, editors. Health Systems Trust, Durban; 2011: p.119-30.
- [10]Versteeg M, du Toit L, Couper I. Building consensus on key priorities for rural health care in South Africa using the Delphi technique. Global Health Action. 2013;6.
- [11]Hanefeld J, Musheke M. What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll out? A qualitative policy analysis for implementation processes in Zambia. Hum Resour Health. 2009; 7:8. BioMed Central Full Text
- [12]Cailhol J, Craveiro I, Madede T, Makoa E, Mathole T, Parsons AN et al.. Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities. Global Health. 2013; 9:52. BioMed Central Full Text
- [13]van Rensburg HCJ. South Africa’s protracted struggle for equal distribution and equitable access – still not there. Hum Resour Health. 2014; 12:26. BioMed Central Full Text
- [14]OECD. The international mobility of health professionals: an evaluation and analysis based on the case of South Africa. In: Trends in International Migration 2003. Paris: OECD; 2004. p. 115-45
- [15]Siyam A, Dal Poz MR. Migration of health workers: WHO code of practice and the global economic crisis. World Health Organization, Geneva; 2014.
- [16]George G, Atujuna M, Gow J. Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements. BMC Health Serv Res. 2013; 13:297. BioMed Central Full Text
- [17]Awases M, Gbary A, Nyoni J, Chatora R. Migration of health professionals in six countries: a synthesis report. World Health Organization, Geneva; 2004.
- [18]Bhargava A, Docquier F, Moullan Y. Modeling the effects of physician emigration on human development. Econ & Hum Biol. 2011; 9:172-83.
- [19]Clemens MA, Pettersson G. New data on African health professionals abroad. Hum Resour Health. 2008; 6:1. BioMed Central Full Text
- [20]Labonte R, Packer C, Klassen N. Managing health professional migration from sub-Saharan Africa to Canada: a stakeholder inquiry into policy options. Hum Resour Health. 2006; 4:22. BioMed Central Full Text
- [21]Pendleton W, Crush J, Lefko-Everett K. The haemorrhage of health professionals from South Africa: a medical opinion. Idasa, Cape Town; 2007.
- [22]Migration and Remittances Factbook 2011. 2nd ed. The International Bank for Reconstruction and Development / The World Bank, Washington, DC; 2011.
- [23]Xaba J, Phillips G. Understanding nurse recruitment: final report. Pretoria: Democratic Nursing Organization of South Africa (DENOSA); 2001.
- [24]Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8:19-32.
- [25]Anarfi J, Quartey P, Agyei J. Key determinants of migration among health professionals in Ghana. Development Research Centre on Migration, Globalisation and Poverty; 2010.
- [26]Connell J. WHO migration study. World Health Organization, Geneva; 2000.
- [27]Crush J, Pendleton W. Brain flight: the exodus of health professionals from South Africa. International Journal of Migration, Health and Social Care. 2010; doi:10.5042/ijmhsc.2011.0059.
- [28]Robinson R. The costs and benefits of health worker migration from East and Southern Africa (ESA): a literature review. EQUINET; 2007.
- [29]Chabikuli N, Blaauw D, Gilson L, Schneider H. Chapter 8: human resources policies: health sector reform and management of PHC. South Africa Health Review 2005. Ijumba P, Barron P, editors. Health Systems Trust, Durban; 2005.
- [30]Southern African Development Community. SADC Labour Migration Policy Draft. Southern African Development Community; 2013.
- [31]WorkPermit: South Africa nurses face tough new UK restrictions. http://www.workpermit.com/news/2006_08_17/uk/south_africa_nurses.htm (2006). Accessed 1 Oct 2015.
- [32]Runnels V, Labonté R, Packer C. Reflections on the ethics of recruiting foreign-trained human resources for health. Hum Resour Health. 2011; 9:2. BioMed Central Full Text
- [33]Rispel LC, Blaauw D. The health system consequences of agency nursing and moonlighting in South Africa. Glob Health Action. 2015; 8:26683.
- [34]OECD. The international mobility of health professionals: an evaluation and analysis based on the case of South Africa. In: Trends in International Migration 2003. Paris: OECD, 2004, p. 115–151.
- [35]Kingma M. Nurses on the move: a global overview. Health Serv Res. 2007; 42:1281-98.
- [36]Agunias DR. From a zero-sum to a win-win scenario? Literature review on circular migration. Migration Policy Institute, Washington, DC; 2006.
- [37]Brier M. The shortage of medical doctors in South Africa: Scarce and Critical Skills Research Project. Department of Labour, South Africa; 2008.
- [38]Singh G. Health worker migration in South and Southern Africa. IOM; 2007
- [39]Bezuidenhout M, Joubert G, Hiemstra L, Struwig M. Reasons for doctor migration from South Africa. South African Family Practice. 2009; 51:211-5.
- [40]Reclaiming the resources for health: a regional analysis of equity in health in East and Southern Africa. EQUINET, Weaver Press, Fountain Publishers, Jacana; 2007.
- [41]Sanders D, Lloyd B. Human resources: international context. In: South African Health Review 2005. Ijumba P, Barron P, editors. Health Systems Trust, Durban; 2005: p.76-87.
- [42]van Dyk AC. Occupational stress experienced by caregivers working in the HIV/AIDS field in South Africa. African J AIDS Research. 2007; 6:49-66.
- [43]de van Niekerk JPV. Where have all the flowers gone? S Afr Med J. 2011; 101:281.
- [44]Ntlale ME, Duma SE. The costs and benefits of nurse migration on families: a Lesotho experience. Curationis. 2011; 34:E1-8.
- [45]Arnold PC. Why the ex-colonial medical brain drain? J R Soc Med. 2011; 104:351-4.
- [46]Kline DS. Push and pull factors in international nurse migration. J Nurs Scholarsh. 2003; 35:107-11.
- [47]Lyndith W. Migration of skills in South Africa: patterns, trends and challenges. Southern African Migration Project; 2006.
- [48]Redfoot DL, Houser AN. The international migration of nurses in long-term care. J Aging Soc Policy. 2008; 20:259-75.
- [49]Taking stock: health worker shortages and the response to AIDS. WHO Health Systems and Services, Geneva; 2006.
- [50]Kingma M. Migration patterns of health professionals. Cah Sociol Demogr Med. 2005; 45:287-306.
- [51]McIntosh T, Torgerson R, Klassen N. The ethical recruitment of internationally educated health professionals: lessons from abroad and options for Canada. Canadian Policy Research Networks, Ottawa; 2007.
- [52]Crush J, Chikanda A, Bourgeault I, Labonté R, Tomblin Murphy G: Brain drain and regain: the migration behaviour of South African medical professionals. Cape Town: Southern African Migration Programme (SAMP); 2014.
- [53]Clemens M. The financial consequences of high-skilled emigration: lessons from African doctors abroad. In: Diaspora for Development in Africa. Plaza S, Ratha D, editors. World Bank, Washington DC; 2011: p.165-82.
- [54]Taylor JE. The new economics of labour migration and the role of remittances in the migration process. Int Migr. 1999; 37:63-88.
- [55]Oberoi SS, Lin V. Brain drain of doctors from southern Africa: brain gain for Australia. Aust Health Rev. 2006; 30:25-33.
- [56]Crush J, Chikanda A, Pendleton W. The disengagement of the South African medical diaspora in Canada. J South Afr Stud. 2012; 38:27-49.
- [57]Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, et al. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011; doi:http://dx.doi.org/10.1136/bmj.d7031.
- [58]Government of South Africa. Human Resources for Health South Africa 2030: draft HR strategy for the health sector: 2012/13 – 2016/17. Government of South Africa; 2011.
- [59]Health Systems Trust: health indicators advanced search. http://www.hst.org.za/health-indicators-advanced-search (n.d.). Accessed 1 Oct 2015.
- [60]Stodel JM, Stewart-Smith A. The influence of burnout on skills retention of junior doctors at Red Cross War Memorial Children’s Hospital: a case study. S Afr Med J. 2011; 101:115-8.
- [61]Oosthuizen MJ. An analysis of the factors contributing to the emigration of South African nurses. University of South Africa; 2006.
- [62]Secretariat C. Commonwealth code of practice for the international recruitment of health workers: transparency, fairness and mutuality of benefits needed when recruiting international health workers. Commonwealth Secretariat, London; 2003.
- [63]Buchan J. International recruitment of nurses: policy and practice in the United Kingdom. Health Serv Res. 2007; 42:1321-35.
- [64]Martineau T, Willetts A. The health workforce: managing the crisis ethical international recruitment of health professionals: will codes of practice protect developing country health systems? Health Policy (Amsterdam, Netherlands). 2006;75:358-67.
- [65]WHO global code of practise on the international recruitment of health personnel. World Health Organization, Geneva; 2010.
- [66]South African Development Community. Protocol on the facilitation of movement of persons. South African Development Community; 2005.
- [67]Oucho JO, Crush J. Contra Free Movement: South Africa and the SADC Migration Protocols. Africa Today. 2001; 43:139-58.
- [68]Tjadens F, Weilandt C, Eckert J. Mobility of health professionals - health systems, work conditions, patterns of health workers’ mobility, and implications for policy makers. Springer, Berlin Heidelberg; 2013.
- [69]Department of Health, South Africa: Recruitment and employment of foreign health professionals in the Republic of South Africa. Southern African Development Community; 2006.
- [70]Foreign Workforce Management Programme, National Department of Health. Policy: recruitment and employment of foreign health professionals in the Republic of South Africa. Pretoria; South African National Department of Health; 2006.
- [71]Parliamentary Monitoring Group. Report of the Portfolio Committee on International Relations and Cooperation on the dialogue on South Africa-Cuba relations: successes and challenges towards the implementation of processes aimed at kick-starting economic processes in Cuba. Parliamentary Monitoring Group; 2013.
- [72]Department of International Relations and Cooperation. The Cuban Five to undertake a visit to South Africa [media statement]. Pretoria: Republic of South Africa; 21 Jun 2015.
- [73]Molope K. SA-Cuba medical doctor programme to increase output. SABC News. 13 Sep 2014.
- [74]Reed G, Torres J. Training and retaining more rural doctors for South Africa. MEDICC Rev. 2008; 10:1.
- [75]Office of U.S. Global AIDS Coordinator and the Bureau of Public Affairs: Medical Education Partnership Initiative (MEPI). http://www.pepfar.gov/partnerships/initiatives/mepi/index.htm (n.d.). Accessed 1 Oct 2015.
- [76]PEPFAR. PEPFAR’s Medical and Nursing Education Partnership Initiatives. PEPFAR; 2013.
- [77]The Office of the U.S. Global AIDS Coordinator (OGAC): Stellenbosch Univ Rural Medical Education Partnership Initiative. http://www.pepfar.gov/partnerships/initiatives/mepi/network/southafrica/index.htm (n.d.). Accessed 1 Oct 2015.
- [78]Mullan F, Frehywot S, Omaswa F, Sewankambo N, Talib Z, Chen C et al.. The Medical Education Partnership Initiative: PEPFAR’s effort to boost health worker education to strengthen health systems. Health Aff (Millwood). 2012; 31:1561-72.
- [79]Flanagan L. New Gauteng medical varsity to open soon. IOL News. 11 Nov 2013.
- [80]Hall W, Ford-Ngomane T, Barron P. The health act and the district health system. In: South African Health Review 2005. Ijumba P, Barron P, editors. Health Systems Trust, Durban; 2005: p.44-57.
- [81]Matsoso MP, Strachan B. Human resources for health for South Africa: HRH strategy for the health sector 2012/13-2016/17. In: Padarath A, English R, editors. South African Health Review 2011. Durban: Health Systems Trust; 2011. p. 50.
- [82]Cooke R, Couper I, Versteeg M. Human resources for rural health. In South African Health Review 2011. In: Padarath A, English R, editors. Durban: Health Systems Trust; 2011. p. 107-118.
- [83]Zachariah R, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V et al.. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg. 2009; 103:549-58.
- [84]Doherty J, Conco D, Couper I, Fonn S. Developing a new mid-level health worker: lessons from South Africa’s experience with clinical associates. Glob Health Action. 2013.
- [85]Boschmans SA, Fogary TL, Schafermeyer KW, Mallinson RK. Practice analysis for mid-level pharmacy workers in South Africa. Pharm Educ. 2015; 15:31-8.
- [86]Global Health Workforce Alliance: Africa Health Placements. http://www.who.int/workforcealliance/members_partners/member_list/ahp/en/ (2015). Accessed 1 Oct 2015.
- [87]Ditlopo P, Blaauw D, Rispel L, Thomas S, Bidwell P. Policy implementation and financial incentives for nurses in South Africa: a case study on the occupation specific dispensation. Glob Health Action. 2013; 6:138-46.
- [88]George G, Rhodes B. Is there really a pot of gold at the end of the rainbow? Has the Occupational Specific Dispensation, as a mechanism to attract and retain health workers in South Africa, leveled the playing field? BMC Public Health. 2012; 12:613. BioMed Central Full Text
- [89]Pillinger J. South Africa National Report. Public Services International, Ferney-Voltaire; 2011.
- [90]Naidoo S. The South African national health insurance: a revolution in health-care delivery! J Public Health. 2012; 34:149-50.
- [91]Baleta A. South Africa rolls out pilot health insurance scheme. Lancet. 2012; 379:1185.
- [92]Republic of South Africa. National Health Insurance in South Africa Policy Paper. Republic of South Africa; 2011.
- [93]Kahn T. Mass TB tests ‘would save billions’. Business Day. 26 Mar 2014.
- [94]Makholwa A. Robust returns on big health spend. Financial Mail. 27 Feb 2014.