South African physician emigration and return migration, 1991-2017: a trend analysis

South African Chiropractic Students' Intentions, Motivations, and Considerations for Emigration: A Cross-Sectional Study

Objective

The purpose of this study was to investigate the emigration intentions of South African senior chiropractic students upon graduation, emphasizing motivations and considerations guiding migration decisions.

Methods

A cross-sectional, quantitative, and exploratory approach was employed, utilizing an anonymous and adapted online survey administered to chiropractic students at 2 South African institutions (n = 177) between March 15 and May 19, 2021. Data were analyzed using frequencies, descriptions, and cross-tabulations to identify trends and interrelationships related to students' intentions to emigrate postqualification.

Results

Findings indicate that 75.5% of South African chiropractic senior students intend to emigrate. Motivations for emigration include improved quality of life and seeking of opportunities. Economic instability in South Africa (SA) (82.7%) and concern for the National Health Insurance implementation (57.7%) serve as a significant push factor, whereas economic stability abroad (85.7%) emerged as a key pull factor. Preferred emigration destinations are primarily developed countries with established chiropractic communities.

Conclusion

High emigration intentions among students were driven by diverse push factors in SA, including economic decline, socio-political climates, and safety concerns, contrasting with pull factors abroad, such as better opportunities, living conditions, and economic stability. Concerns regarding healthcare reforms, particularly the National Health Insurance, are also highlighted. Destinations in order of preference such as the United Kingdom, Canada, and Australia offer valuable insights for policy interventions. Understanding these dynamics is crucial for developing effective retention strategies and addressing socio-economic challenges.

Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID-19

BACKGROUND

Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers' experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy.

METHODS

Romanian physicians working in Germany during the COVID-19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n = 21) were collected from mid of September to early November 2022 and content analysis was performed.

RESULTS AND DISCUSSION

Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.

Dynamics and factors influencing return migration to Sub-Saharan Africa: A systematic review

Background

Return migration, the process of migrants returning to their countries of origin, is a vital aspect of migration that has received growing attention in recent years. One area of focus in the study of return migration is understanding the motivations that drive migrants to return home. Conducting a regional literature review on the dynamics and factors influencing return migration can provide valuable insights into this complex and dynamic phenomenon. It can inform policy development, help to address economic and social issues and contribute to our understanding of migration patterns and trends in the region.

Purpose

This study, therefore, aims to understand the dynamics and factors that influence return migration to Sub-Saharan Africa, a region that has experienced significant outflows of migration over the past few decades. This study provides an understanding of the drivers of and barriers to return migration and how far they resonate with factors of mobility and immobility.

Methods

A two-decade systematic literature review was conducted to determine the driving factors and barriers that influence return migration to Sub-Saharan Africa (SSA). Multivariate factors of return migration were examined based on the central question: why do migrants return to their homeland? The multiple-step systematic literature search covers a broad range of factors of return migration to sub-Saharan Africa.

Result

The findings indicate complex scenarios influencing decisions to return to the region, with the interplay of driving factors as well as barriers to return. Social, personal, economic, and policy factors were among the major drivers of return migration, but social and personal drivers were found to be the major motivating factors of decisions to return to SSA, compared to policy and economic issues. The observed drivers and barriers to returning migration in SSA were categorized and discussed under thematic sections considering structural, individual and policy issues.

Conclusion

The study concludes that migrants' decisions to return could be determined by numerous structural factors, such as economic, political, social and environmental circumstances, both at the place of origin and at the destination. Therefore, the review could be a useful contribution to future research, governments, mobility-oriented organizations and policymakers for effective return-migration strategies.

Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review

BACKGROUND

The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs.

METHODS

We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers.

RESULTS

We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions.

CONCLUSION

Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.

South Africa and the Surgical Diaspora-A Hub for Surgical Migration and Training

BACKGROUND

The shortage of trained surgeons, anesthesiologists, and obstetricians is a major contributor to the unmet need for surgical care in low- and middle-income countries, and the shortage is aggravated by migration to higher-income countries.

METHODS

We performed a cross-sectional observational study, combining individual-level data of 43,621 physicians from the Health Professions Council of South Africa with data from the registers of 14 high-income countries, and international statistics on surgical workforce, in order to quantify migration to and from South Africa in both absolute and relative terms.

RESULTS

Of 6670 surgeons, anesthesiologists, and obstetricians in South Africa, a total of 713 (11%) were foreign medical graduates, and 396 (6%) were from a low- or middle-income country. South Africa was an important destination primarily for physicians originating from low-income countries; 2% of all surgeons, anesthesiologists, and obstetricians from low- and middle-income countries were registered in South Africa, and 6% in the other 14 recipient countries. A total of 1295 (16%) South African surgeons, anesthesiologists, and obstetricians worked in any of the 14 studied high-income countries.

CONCLUSION

South Africa is an important regional hub for surgical migration and training. A notable proportion of surgical specialists in South Africa were medical graduates from other low- or middle-income countries, whereas migration out of South Africa to high-income countries was even larger.

A Phenominological Qualitative Study of Factors Influencing the Migration of South African Anaesthetists

Background: The anaesthetic workforce is a scarce resource in South Africa (SA), and the media frequently reports that anaesthetists are leaving the country in search of better opportunities in well-resourced countries. The aim of this study was to explore the factors influencing the migration intentions of South African anaesthetists. Methods: This study utilised a qualitative methodology in the form of virtual interviews. A total of 23 interviews were conducted on purposefully selected participants using a snowball approach. The interviews were transcribed and coded into emerging themes using MAXQDA version 2022. Thematic content analysis was subsequently performed. Results: The study found that all SA-based participants were considering emigrating, while those who had already emigrated had no plans to return to SA in the near future. Push factors prompted the consideration of emigration, and these were related to unsatisfactory living and working conditions in South Africa, such as a high level of crime and corruption, and the country’s overall poor resources and infrastructure. Destination countries were chosen based on their pull factors such as better working conditions and opportunities for professional growth. These pull factors frequently outweighed South Africa’s push factors and are therefore critical in the decision to emigrate. The main recommendations from the participants include facilitating collaboration between the public and private sectors, expanding the available sub-specialties in SA, and recognising fellowships in South African hospitals. The study participants were of the view that South African anaesthesiologists would be motivated to stay by a combination of patriotism and hope for the future. Conclusions and Policy Recommendations: The Anaesthetic workforce in South Africa is at critical risk and is unlikely to stabilise soon. Concerted efforts should be made by all concerned to explore ways of retaining the staff, considering the recommendations of the participants. Relevant key stakeholders in training and regulation of anaesthetics practice such as the Health Professions Council of South Africa, South African Society of Anaesthesiologists, and the Colleges of Medicine of South Africa should collaborate and prioritise mechanisms of monitoring emigration and intervening on modifiable professional and socio-political factors.