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1. Introduction The World Bank (2000) cites the migration of skilled professionals from developing to industrialised countries (the so-called ‘brain drain’) as one of the major forces shaping the landscape of the 21st century. Africa is faced with this large and growing problem (Mutizwa-Mangiza, 1996; Bloom & Standing, 2001). While a number of factors have been blamed for such movement, recent studies have shown that economic push factors are largely responsible for the outflow of skilled professionals from the continent (Gaidzanwa, 1999). This migration has been blamed for worsening the human capital crisis in Africa (Wadda, 2000). For instance, by the late 1980s Africa had lost nearly one-third of its skilled workers, with up to 60 000 middle- and high-level managers migrating to Europe and North America between 1985 and 1990 (World Bank, 2000). In the mid-1990s, Africa was losing about 23 000 professionals annually who were in search of better working conditions in the developed world (World Bank, MEDICAL MIGRATION FROM ZIMBABWE: MAGNITUDE, CAUSES AND IMPACT ON THE POOR ABEL CHIKANDA 3 Chapter|50| 1995). The figures show a steady increase in the number of skilled professionals migrating from developing countries. This migration is often a response to the lack of opportunity in the professionals’ home country and the availability of opportunity and deliberate promotion of immigration in the other (Saravia & Miranda, 2004). Hence, a significant ‘brain drain’ of key professionals has been witnessed in Africa, such as engineers and information technologists (Johnson & Regets, 1998), doctors (Grant, 2004) and nurses (Buchan & Sochalski, 2004). These professionals are sometimes replaced by high-cost expatriate professionals: it is estimated that African countries spend nearly $4 billion annually on replacing the professionals lost through migration with expatriates from the west (Commission for Africa, 2005). Expatriates are more expensive to hire than locally trained professionals and the fact that they are prepared to work in the host country for only a limited period makes sustainable economic development even more difficult to achieve. In Zimbabwe, the increase in the scale of migration of skilled professionals can partly be linked to the adoption of the Economic Structural Adjustment Programme (ESAP) by the government in the early 1990s (Republic of Zimbabwe, 1999). The widely acknowledged failure of this programme saw the standard of living of skilled professionals falling, as salary benefits could not keep pace with the escalating cost of living. Faced with this situation, most professionals adopted a wide range of livelihood strategies, with some resorting to long-distance international migration. However, no studies to date have attempted to establish the link between migration and poverty in the country. This study seeks to provide the missing link by showing how poverty is influencing the migration of healthcare professionals from Zimbabwe, and how such movement has affected the poor. Zimbabwe’s health sector has been badly affected by the brain drain, with unprecedented opportunities for mobility globally and a marked deterioration in working conditions and prospects at home. In particular, the country’s prevailing political and economic situation is generally seen as a major factor precipitating out-migration. Most of the healthcare professionals who have left Zimbabwe have migrated to countries where their qualifications are recognised, such as the UK, South Africa and Botswana. The relatively poor salaries that Zimbabwe’s healthcare professionals in the country are paid compared to those offered to their counterparts in more developed countries have hastened the emigration of health staff. According to a report by a commission tasked to review the country’s health services, salaries in the public sector are grossly uncompetitive (Republic of Zimbabwe, 1999). The report shows that a newly qualified doctor in South Africa earns more than twice the salary of the most senior doctor in Zimbabwe (Republic of Zimbabwe, 1999). On the national scale, the World Bank estimated in 1997 that the private to public sector salary ratios were about 2:1 for nurses and at least 6:1 for doctors (cited in Republic of Zimbabwe, 1999). Consequently, there have been huge outflows of healthcare professionals from public health institutions to the private sector and beyond the country’s borders. Healthcare professionals in Zimbabwe frequently express their dissatisfaction with their remuneration and working conditions by going on strike, but the government has not been able to effect the required salary hikes because of the current harsh economic climate. In MEDICAL MIGRATION FROM ZIMBABWE: MAGNITUDE, CAUSES AND IMPACT ON THE POOR|51| 2001, former Health Minister Dr Timothy Stamps noted that Zimbabwe had...


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