Questions at the heart of the debate on policy options for mitigating the impacts of the skills exodus from South Africa are: Why is it that while many people leave, some stay? And how can those who stay be retained and those who leave be persuaded to return? Or, in the end, is the only solution to cut off the demand in some way?

The negative impacts of health professional migration are well-documented. But recently, some neo-liberal economists in Europe and the US have argued that there is little evidence that this loss of skills is responsible for the poor state of Africa’s healthcare systems and that the migration of health professionals can have positive benefits for their countries of origin. Among their arguments is that members of the diaspora continue to engage with the countries they came from, through remittance transfers, investment and networking, generating offsetting benefits for those countries.

South Africa provides an ideal case for examining conflicting viewpoints on the health brain-drain, given the significant number of doctors who left the country in the past 20 years. A global survey of the location of physicians a decade ago found that as many as 7400 South African-trained doctors (21% of the total number in practice) were living abroad.

The Southern African Migration Programme recently conducted a survey of 415 South African doctors in Canada (20% of the total number in Canada) and found that more than half (58%) had acquired Canadian citizenship since leaving South Africa. Of the rest, about one quarter were permanent residents.

At the same time, 70% still hold South African citizenship. This raised the possibility that they want to retain their 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 the vast majority buy or make South African foods and listen to South African music.

But despite all this evidence of a persistent identity and the maintenance of personal links with the country, only 16% said they were likely to send money for development projects here and 15% said they would participate in educational and other exchanges. Only 10% said they would invest in a business in South Africa.

Despite their high earnings (two-thirds earn more than R1.6m a year), South African doctors in Canada remit infrequently and in small amounts in comparison to their incomes. They differ markedly in their remitting behaviour from doctors from other African countries. In terms of the obstacles to returning to South Africa, 77% of the physicians cited safety and security as a major concern. Factors likely to make them consider returning are changes in the political system (53%), changes in economic conditions and improved job opportunities (48%). However, integration in Canada is likely to provide a major obstacle to return migration. Few said it was likely they would ever return to live and work in South Africa.

South Africa provides an ideal case for examining conflicting viewpoints on the health brain-drain, given the significant number of doctors who left the country in the past 20 years.
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