Zimbabwe's Exodus: Crisis, Migration, Survival

Chapter Five. Nursing the Health System: The Migration of Health Professionals from Zimbabwe

Chapter Five Nursing the Health System: The Migration of Health Professionals from Zimbabwe abel Chikanda The brain drain of health professionals from Zimbabwe has had a crippling effect on the country’s public health system.1 The migration of doctors and nurses has been driven by a marked deterioration in working conditions and job prospects at home and unprecedented global opportunities for professional mobility. The poor salaries paid to local professionals compared to those in developed countries have hastened the exodus. By 2000, Zimbabwe had become a leading source country for health professionals, with 51 percent of locally-trained doctors and 25 percent of locally-trained nurses practising abroad.2 The growing migration of nurses has had a particularly negative impact on primary patient care. Nurses form the backbone of any health service delivery and their out-migration exacerbates the primary health care crisis in sending countries like Zimbabwe. In Zimbabwe, the quality of care declined markedly as nurses left the country in growing numbers.3 Patient waiting times increased and the nurses that remained had to cope with heavier workloads. Nurses working in rural areas have been forced into an expanding role, taking on the responsibilities of pharmacist, doctor, physiotherapist and so forth.4 Heavy workloads, besides being a manifestation of poor staffing levels, have been an additional motivation to migrate. Nurse migration leads to the appointment of ZIMBABWE’S EXODUS: CRISIS, MIGRATION, SURVIVAL 134 replacement workers in positions for which they are not trained. Other negative impacts include heavy workloads resulting in poor service provision to the public and the loss of financial investments made in educating the nurses.5 The stress of handling HIV and AIDS-related deaths on a daily basis also takes its toll on the nurses who remain.6 This chapter examines the causes, dimensions and impacts of nurse migration from Zimbabwe during the period of the late 1990s and early 2000s, drawing on research conducted by the author for the World Health Organization. The research sought to examine the magnitude of, and trends in, the migration of nurses and midwives from the country, establish the effects of the migration on the country’s quality of healthcare, identify the causes of migration, and recommend measures for reducing out-migration. All of the evidence suggests that the trends in nurse migration identified in this period have intensified since the research was conducted. treNdS iN NUrSe MigratiON Two main survey instruments were used to collect data for this study. The first aimed to collect information on staffing patterns and workloads at health institutions. Stratified random sampling was employed in selecting healthcare facilities. Seven of Zimbabwe’s 10 provinces were randomly selected. In each of these provinces, the main provincial town or city was chosen together with one district health institution and one health centre . In addition, two schools of Nursing and Midwifery were selected; these are located at Harare and Mpilo Central Hospitals. A questionnaire was distributed to each of the health institutions for completion by the hospital superintendent. Only 10 of the 21 health institutions provided information on both staffing patterns and the workload of nursing professionals. The second research instrument was designed to collect information from individual nursing professionals on a wide range of issues including general working conditions and migration intentions. The individual nurses were drawn from the selected health institutions using stratified random sampling. The number of nurses from each health institution was proportional to the total number employed there. One hundred and fiftyseven questionnaires were administered (Table 5.1). The vast majority of the respondents were nurses (87 percent). The rest were midwives. Both had been trained at nurse training centres scattered throughout the country and most held diploma qualifications. CHAPTER FIVE NURSING THE HEALTH SYSTEM 135 Only 3 percent were holders of a Bachelor’s degree qualification and 1 percent a Master ’s degree. Twenty percent of the respondents were male, and 80 percent were female showing the dominance of women in the nursing profession in Zimbabwe. The majority of the respondents were married (68 percent) while 21 percent were single, 6 percent widowed and 5 percent divorced. Only 31 percent of the sample were younger than 30. In other words, the majority of those surveyed were experienced professionals with strong family ties to Zimbabwe. Table 5.1: Profile of Nurses % Sex Male 20 Female 80 Marital Status Married 68 Divorced 5 Single 21 Widowed 6 Age Group...