Educational Barriers for Zimbabweans in South Africa

the southeRn afRiCan migRation PRogRamme

Right to the ClassRoom: eduCational BaRRieRs foR ZimBaBweans in south afRiCa

migRation PoliCy seRies no. 56

Right to the Classroom: Educational Barriers for Zimbabweans in South Africa

Jonathan Crush and Godfrey Tawodzera

Series Editor: Prof. Jonathan Crush

Southern African Migration Programme (SAMP) Open Society Initiative for Southern Africa (OSISA) 2011 Published by Idasa, 6 Spin Street, Church Square, Cape Town, 8001, and Southern African Research Centre, Queen's University, Canada.

Copyright Southern African Migration Programme (SAMP) 2011 ISBN 978-1-920409-68-5 First published 2011 Design by Bronwen Müller

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Bound and printed by Logo Print, Cape Town Contents Page

Executive Summary 1

Introduction 3

The Right to the Classroom 4

Barriers to Admission 9

Study Methodology 11

Accessing the Right to Education 12

Financial Barriers 14

Discrimination and Xenophobia 16

Language Problems 17

Obstacles in the Tertiary Sector 18

Conclusions and Recommendations 21

Endnotes 24

Migration Policy Series 27

Table 1: Refugee Applications and Decisions, 2009 10

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ExeXECUTIVEcutive SSummaUMMARYry

hisealth report workers examines are onethe obstaclesof the categories to access of by skilled Zimbabwean profession- childrenals most and affected students by globalization.to schools and Over tertiary the institutions past decade, in Souththere Africa. has emerged There ais substantiala common bodyassumption of research in South that Africatracks thatpatterns these ofchildren international and students migration have of no health right topersonnel, an educa- THtion in South Africa. In fact, this view contravenes various international assesses causes and consequences, and debates policy responses at global humanand national rights scales.conventions Within to this which literature, South Africa the case is aof signatory. South Africa At the is regionalattracting level, growing it is inconsistentinterest. For withalmost the 15 SADC years EducationSouth Africa Protocol. has been At thethe nationaltarget of level,a ‘global it violates raiding’ the of Southskilled Africanprofessionals Constitution by several as welldevel- as legislationoped countries. and stated How governmentto deal with policiesthe consequences concerning of the the access resultant of all out- childrenflow of health in the professionalscountry to education. is a core policyThe question issue for addressed the national in this gov- reporternment. is whether school boards and principals follow popular sentiment or whetherThis paper they aims honour to to international, examine policy regional debates and and national issues concerningobligations. Thethe migrationreport focuses of skilled specifically health on professionals the case of fromZimbabwean the country migrant and chilto - drenfurnish and new students, insights following on the recruitmentpersistent reports patterns that of they skilled are health regularly per- deniedsonnel. access The objectives to the South of the African paper education are twofold: system. The• Toreport provide shows an that audit school of the boards organization and principals and patterns are caught of recruit- betweenment contradictory of skilled instructionsprofessionals from from the South Departments Africa in ofthe Education health and Homesector. Affairs. The The paper former, draws acting upon ain detailed a way that analysis is consistent of recruitment with the Bill advertisingof Rights, directs appearing that inschools the South should African not deny Medical education Journal to anyfor child, regardlessthe period of 2000-2004their national and origin a series or oflegal interviews status in conductedthe country. with The Departmentprivate recruiting of Home enterprises. Affairs, on the other hand, follows the directives• of the Based 2002 upon Immigration the above Actanalysis which and places additional schools interviews in the position with of having tokey enforce stakeholders immigration in the policy. South This African contradiction health sector, certainly the paper needs to be resolvedoffers aand series there of recommendationsis only one way this for could addressing be done: the by problem amending of the immigrationskilled health legislation migration. and regulations These recommendations to make it clear are that grounded it is not the dutyin of both schools South to denyAfrican an educationexperience to and some an childreninterrogation or to reportof inter- them to nationalthe authorities. debates and ‘good policy’ practice for regulating recruit- Levelsment. of xenophobia are extremely high in South African society. XenophobicThe paper attitudes is organized culminated into five in sections.widespread Section xenophobic Two positions violence in 2008debates that about left overthe migration60 people ofdead skilled and healthtens of professionals thousands displaced within afrom theirwider communities. literature that Among discusses their the number international were many mobility children. of talent. Migrant childrenSection Threewere therefore reviews researchdirectly exposedon the global to the circulation violence and of healthvenom pro- offessionals, xenophobic focusing mobs. in Many particular more uponwould debates have witnessed relating tothese the disturbexperience- ingof countries scenes in inthe the media. developing The other world. question Section addressed Four moves in this the report focus from isinternational whether xenophobia to South permeatesAfrican issues the schooland provides system newas well. empirical In other mate- words,rial drawn once from the obstaclesthe survey to of school recruitment access arepatterns overcome, and key what interviews kind of receptionundertaken do with migrant health children sector receive recruiters from operating South African in South teachers Africa. and pupils.Section Some Five isolatedaddresses case the studies questions have of suggestedchanging thatpolicy non-South interventions African in childrenSouth Africa are not towards made theto feel outflow welcome of skilled in South health African professionals schools andand thatthe therecruitment xenophobic of foreign attitudes health of parents professionals are reproduced to work byin theirSouth children. Africa. The This study affords the opportunity to revisit this question and to ask how

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EXECUTIVE SUMMARY Zimbabwean children are treated by their fellow learners and by teachers in the classroom and playground. ealth workers are one of the categories of skilled profession- The report is based on research in six communities in Cape Town and als most affected by globalization. Over the past decade, Johannesburg conducted in September 2010 and examines the experi- there has emerged a substantial body of research that tracks ences of Zimbabwean migrant parents, children and students who seek to patterns of international migration of health personnel, gain admission to public schools and tertiary institutions in South Africa. H The report first examines the constitutional and legal rights of foreign assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is migrants to an education in South Africa. The next section reviews attracting growing interest. For almost 15 years South Africa has been the findings of previous studies that suggest that migrant children and the target of a ‘global raiding’ of skilled professionals by several devel- students face significant difficulties and prejudice in South Africa. The oped countries. How to deal with the consequences of the resultant out- ensuing sections of the report present and discuss our research findings flow of health professionals is a core policy issue for the national gov- on the current experiences of Zimbabwean migrants with the South ernment. African educational system. Finally, the report makes recommendations This paper aims to to examine policy debates and issues concerning on how the situation can be improved. the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: • To provide an audit of the organization and patterns of recruitment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. • Based upon the above analysis and additional interviews with key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded in both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruitment. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health professionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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IEntXECUTIVEroductionSUMMARY

heealth eminent workers South are African one of theeducationalist categories ofand skilled Vice-Chancellor profession- ofals the most University affected of by the globalization. Free State, Professor Over the Jonathan past decade, Jansen, recentlythere has surprised emerged many a substantial South Africans body ofwhen research he wrotein that tracks thepatterns Sunday of Times international that the migrationgovernment of educationhealth personnel, system in THZimbabwe was superior to that in South Africa with dedicated, profes- assesses causes and consequences, and debates policy responses at global sionaland national and hardworking scales. Within teachers this wholiterature, placed the children’s case of Southinterests Africa above is 1 theirattracting own. growing “If I were interest. a desperate For almost (South 15 African) years South township Africa parent has been who couldthe target not getof amy ‘global child raiding’ into the of fancy skilled schools professionals in the suburbs” by several wrote devel- Jansenoped countries. “I would Howtake theto deal risk withof being the anconsequences illegal immigrant of the and resultant flee across out- theflow border of health in the professionals opposite direction is a core – policy into Zimbabwe. issue for the Yes national they have gov- a tyranternment. for a president, and sometimes they lack bread in the shops, but at leastThis the paperschools aims work to andto examine the teachers policy teach.” debates and issues concerning theProfessor migration Jansen’s of skilled argument health standsprofessionals popular from South the African country wisdom and to onfurnish its head. new Thereinsights is ona widespread the recruitment assumption patterns amongst of skilled South health Africans per- thatsonnel. the Thecountry objectives has been of theflooded paper by are millions twofold: of desperate Zimbabweans 2 who• are Toplacing provide an anintolerable audit of strainthe organization on public services. and patterns In this of recruit-view, thecrisisment in Zimbabwe of skilled destroyed professionals the country’sfrom South economy Africa andin the health health and educationalsector. systems, The paper pushing draws teachers upon aand detailed pupils analysis out of the of recruitmentcountry in droves. Southadvertising African appearing schools, in in the turn, South are supposedlyAfrican Medical inundated Journal with for desperatethe Zimbabwean period 2000-2004 parents and in search a series of of an interviews education conducted for their chil with- dren. Jansen’sprivate point recruiting is not enterprises.that the Zimbabwean school system has been spared• the Based economic upon the meltdown above analysis in the country. and additional Rather, interviewshe is highlight with- 3 ing the oftenkey stakeholders shambolic state in the of Southgovernment African schools health in sector, South the Africa. paper In theseoffers circumstances, a series of whyrecommendations would Zimbabweans for addressing want to thesubject problem their of childrenskilled to a demonstrably health migration. inferior These system? recommendations In fact, there is are very grounded little evidencein at both the Southprimary African and high experience school level and that an interrogationthe search for of educa inter-- tion is anational motivation debates for Zimbabwean and ‘good policy’ migration practice to South for regulating Africa although recruit- therearement. indications of a recent increase in the migration of unaccompa- 4 niedThe minors” paper from is organized Zimbabwe into to fiveSouth sections. Africa. Section Most adult Two positionsmigrants tend todebates leave abouttheir children the migration at home of inskilled Zimbabwe health with professionals relatives whenwithin they a comewider toliterature South Africa. that discusses At the samethe international time, thevolume mobility of migration of talent. from ZimbabweSection Three to South reviews Africa research has certainly on the globalincreased circulation significantly of health in recent pro- yearsfessionals, and some focusing migrants in particular do bring upon their debateschildren relating with them to the when experience they 5 comeof countries to work in in the South developing Africa. world. Others Section have children Four moves born theto them focus in from Southinternational Africa. to South African issues and provides new empirical mate- rialThis drawn report from is the based survey on research of recruitment in six communities patterns and in key Cape interviews Town andundertaken Johannesburg with health in September sector recruiters 2010 and operating examines in the South experiences Africa. of ZimbabweanSection Five migrantaddresses parents, the questions children of and changing students policy who interventions seek to gain in admissionSouth Africa to public towards schools the outflow and tertiary of skilled institutions health professionalsin South Africa. and the Therecruitment report first of foreignexamines health the constitutionalprofessionals toand work legal in rights South of Africa. foreign The migrants to an education in South Africa. The next section reviews

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EXECUTIVE SUMMARY the findings of previous studies that suggest that migrant children and students face significant difficulties and prejudice in South Africa. The ealth workers are one of the categories of skilled profession- ensuing sections of the report present and discuss our research findings als most affected by globalization. Over the past decade, on the current experiences of Zimbabwean migrants with the South there has emerged a substantial body of research that tracks African educational system. Finally, the report makes recommendations Hpatterns of international migration of health personnel, on how the situation can be improved. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been The Right to the Classroom the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- ecause there is so much legislative and practical confusion in flow of health professionals is a core policy issue for the national gov- South Africa about which children have a right to be in the 6 ernment. classroom, it is important to return to first principles. South This paper aims to to examine policy debates and issues concerning Africa has ratified both the UN Convention on the Rights of the BChild and the African Charter on the Rights and Welfare of the Child.7 the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- Under Section 28 of the UN Convention, states recognize the right of sonnel. The objectives of the paper are twofold: the child to education, and with a view to achieving this right progres- • To provide an audit of the organization and patterns of recruit- sively and on the basis of equal opportunity, they are to: ment of skilled professionals from South Africa in the health • make primary education compulsory and available free to all; sector. The paper draws upon a detailed analysis of recruitment • encourage the development of different forms of secondary edu- advertising appearing in the South African Medical Journal for cation, including general and vocational education, making them the period 2000-2004 and a series of interviews conducted with available and accessible to every child, and taking appropriate private recruiting enterprises. measures such as the introduction of free education and offering • Based upon the above analysis and additional interviews with financial assistance in case of need; key stakeholders in the South African health sector, the paper • make higher education accessible to all on the basis of capacity by offers a series of recommendations for addressing the problem of every appropriate means; and skilled health migration. These recommendations are grounded • take measures to encourage regular attendance at schools and the in both South African experience and an interrogation of inter- reduction of drop-out rates (Article 28). national debates and ‘good policy’ practice for regulating recruit- Lest it be assumed that these rights only apply to citizens, the ment. Convention is very clear that the right to education applies to all chil- The paper is organized into five sections. Section Two positions dren in a country, regardless of their or their parents’ or guardians’ debates about the migration of skilled health professionals within a nationality or legal status. Thus Article 2(1) of the Convention commits wider literature that discusses the international mobility of talent. governments to respect and ensure the rights in the Convention to each Section Three reviews research on the global circulation of health pro- child within their jurisdiction “without discrimination of any kind, irre- fessionals, focusing in particular upon debates relating to the experience spective of the child’s or his or her parent’s or legal guardian’s race, col- of countries in the developing world. Section Four moves the focus from our, sex, language, religion, political or other opinion, national, ethnic or international to South African issues and provides new empirical mate- social origin, property, disability, birth or other status.” Article 21(1) also rial drawn from the survey of recruitment patterns and key interviews commits governments to making special provision to ensure that children undertaken with health sector recruiters operating in South Africa. who are refugees or seeking refugee status receive appropriate protection Section Five addresses the questions of changing policy interventions in and humanitarian assistance in the enjoyment of applicable Convention South Africa towards the outflow of skilled health professionals and the rights, including the right to education. recruitment of foreign health professionals to work in South Africa. The The African Charter on the Rights of the Child (ratified by South Africa in 2000) extends the right to education in several ways.8 Article

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EXECUTIVE11 of StheUMMARY Charter notes that every child has the right to an education through:: • the promotionealth workers and are development one of the categoriesof the child’s of skilledpersonality, profession- talents and alsmental most and affected physical by globalization.abilities to their Over fullest the potential;past decade, • fosteringthere respecthas emerged for human a substantial rights and body fundamental of research freedoms; that tracks • the preservationpatterns of international and strengthening migration of positive of health African personnel, morals, Htraditional values and cultures; assesses causes and consequences, and debates policy responses at global and• national the preparation scales. Within of the this child literature, for responsible the case life of inSouth a free Africa society, is attractingin thegrowing spirit interest.of understanding For almost tolerance, 15 years dialogue,South Africa mutual has respect been the targetand of friendship a ‘global raiding’among allof peoplesskilled professionalsethnic, tribal by and several religious devel- oped countries.groups. How to deal with the consequences of the resultant out- flowStates of health are to professionals achieve the isfull a corerealization policy ofissue the forright the to national education gov- throughernment. free and compulsory basic education; encouraging the develop- mentThis of secondarypaper aims education to to examine in its policydifferent debates forms and and issues progressively concerning mak- ingthe itmigration free and accessibleof skilled healthto all; makingprofessionals higher from education the country accessible and toto all onfurnish the basis new ofinsights capacity on andthe ability;recruitment taking patterns measures of toskilled encourage health regular per- attendancesonnel. The at objectives schools and of thethe paperreduction are twofold:of drop-out rates; and taking special• measures To provide in anrespect audit of of female, the organization gifted and anddisadvantaged patterns of children,recruit- to ensurement equal of accessskilled to professionals education for from all Southsections Africa of the in community. the health As in thesector. UN Convention,The paper draws these upon rights a aredetailed for all analysis children of in recruitment a country. Article 3advertising on “Non-Discrimination” appearing in the notes South that African “every Medical child shall Journal be enti for- tled to thethe enjoyment period 2000-2004 of the rights and aand series freedoms of interviews recognized conducted and guaran with- teed in (the)private Charter recruiting irrespective enterprises. of the child’s or his/her parents’ or legal guardians’• Based race, upon ethnic the group, above colour,analysis sex, and language, additional religion, interviews political with or other opinion,key stakeholders national and in thesocial South origin, African fortune, health birth sector, or other the status.” paper Domestically,offers a series the Bill of recommendations of Rights in the South for addressing African Constitution the problem of is consistentskilled with health both migration. the UN Convention These recommendations and the African are Charter grounded (withoutin the both constraint South African of progressive experience realisation). and an 9interrogation Section 29(1)(a), of inter- for example,establishesnational debates the and right ‘good to basicpolicy’ education practice for(for regulating all children recruit- and adults) “asment. an immediate right unqualified by any limitation related to progressiveThe paper realisation.” is organized10 Government into five sections. has an Section obligation Two to positions take active stepsdebates to ensureabout the that migration every child of skilledhas access health to educational professionals facilities within anda enjoyswider literaturethe right tothat education. discusses Itthe also international means that mobilitygovernment of talent. (and its agenciesSection Threesuch as reviews schools) research should onnot the impede global access circulation to education. of health The pro- Billfessionals, of Rights focusing binds allin particularthree tiers uponof government debates relating (national, to the provincial experience and municipal)of countries to in give the effectdeveloping to this world. right. GovernmentSection Four canmoves be heldthe focus account from- ableinternational through the to Southcourts Africanif it fails issues to meet and its provides education new obligations empirical tomate- all childrenrial drawn in fromthe country. the survey11 of recruitment patterns and key interviews undertakenDomestic with educational health sector legislation recruiters is generally operating consistent in South with Africa. the ConstitutionalSection Five addresses guarantee the that questions the right of tochanging education policy is for interventions all children. in TheSouth National Africa towardsEducation the Policy outflow Act of of skilled 1996, healthfor example, professionals aims for and “the the advancementrecruitment of and foreign protection health of professionals the fundamental to work rights in South of every Africa. person The guaranteed in terms of Chapter 2 of the Constitution, and in terms of

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EXECUTIVE SUMMARY international conventions ratified by Parliament, and in particular the right of every person to be protected against unfair discrimination within ealth workers are one of the categories of skilled profession- or by an education department or education institution on any ground als most affected by globalization. Over the past decade, whatsoever” (Section 4(1)(i)).12 Section 5(1) of the South African there has emerged a substantial body of research that tracks Schools Act (SASA) 84 of 1996 declares that, “a public school must patterns of international migration of health personnel, admit learners and serve their educational requirements without unfairly H discriminating in any way.”13 Paragraph 19 of the Admission Policy for assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Ordinary Public Schools (Notice 2432 of 1998) states that the South attracting growing interest. For almost 15 years South Africa has been African Schools Act applies equally to learners who are not citizens of the target of a ‘global raiding’ of skilled professionals by several devel- South Africa or whose parents hold temporary or permanent residence oped countries. How to deal with the consequences of the resultant out- permits.14 Additional rights of access to education for refugees in South flow of health professionals is a core policy issue for the national gov- Africa are provided for in the Refugees Act of 1998. Article 27(g) of the ernment. Act states that “refugees as well as refugee children are entitled to the This paper aims to to examine policy debates and issues concerning same basic health services and basic primary education which the inhab- the migration of skilled health professionals from the country and to itants of the republic receive from time to time.”15 furnish new insights on the recruitment patterns of skilled health per- On the other hand, Section 2(1)(c) of the Immigration Act notes sonnel. The objectives of the paper are twofold: that one of the functions of the Department of Home Affairs is to “detect • To provide an audit of the organization and patterns of recruit- and deport illegal foreigners” and in achieving this objective it should ment of skilled professionals from South Africa in the health “inspect institutions of learning to ensure that illega1 foreigners are not sector. The paper draws upon a detailed analysis of recruitment enrolled therein” (Section (2)(b)).16 Section 39(1) of the Act notes that advertising appearing in the South African Medical Journal for “no learning institution shall knowingly provide training or instruction the period 2000-2004 and a series of interviews conducted with to (a) an illegal foreigner; (b) a foreigner whose status does not authorise private recruiting enterprises. him or her to receive such training.” Furthermore, Section 39(2) states • Based upon the above analysis and additional interviews with that “if an illegal foreigner is found on any premises where instruction or key stakeholders in the South African health sector, the paper training is provided, it shall be presumed that such foreigner was receiv- offers a series of recommendations for addressing the problem of ing instruction or training from or allowed to receive instruction or train- skilled health migration. These recommendations are grounded ing by, the person who has control over such premises unless prima facie in both South African experience and an interrogation of inter- evidence to the contrary is adduced.” In other words, the Act makes national debates and ‘good policy’ practice for regulating recruit- schools responsible for ensuring that they do not admit pupils whose legal ment. status in South Africa is unknown or ambiguous. Furthermore, if they The paper is organized into five sections. Section Two positions do admit such students they can be charged with aiding and abetting an debates about the migration of skilled health professionals within a ‘illegal foreigner’ under Section 42(1). wider literature that discusses the international mobility of talent. There is thus a fundamental contradiction between the Convention, Section Three reviews research on the global circulation of health pro- Charter and Constitutional right to education for all children in the fessionals, focusing in particular upon debates relating to the experience country and the Immigration Act’s unconstitutional prohibition on train- of countries in the developing world. Section Four moves the focus from ing or instruction to certain categories of child.17 At present, school international to South African issues and provides new empirical mate- principals and boards operate with conflicting mandates. Further confus- rial drawn from the survey of recruitment patterns and key interviews ing the issue, the Admission Policy for Ordinary Public Schools notes undertaken with health sector recruiters operating in South Africa. that a parent must (a) complete an application form for admission, (b) Section Five addresses the questions of changing policy interventions in present the child’s official birth certificate to the principal or be admit- South Africa towards the outflow of skilled health professionals and the ted conditionally until a copy of the birth certificate is obtained from recruitment of foreign health professionals to work in South Africa. The the Department of Home Affairswithin three months of conditional admission; and (c) show proof that the child has been immunised against

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EXECUTIVEvariousSUMMARY communicable diseases. It is clear that these conditions apply to South African children for two reasons: first, it would be nonsensical to require childrenealth born workers outside are onethe countryof the categories to produce of askilled South profession- African birth certificate;als most and affected second, bythe globalization. regulations contain Over the a separate past decade, clause for admissionthere of non-citizens. has emerged However, a substantial as this body report of research shows, non-Souththat tracks African parentspatterns are requiredof international to produce migration birth certificates of health aspersonnel, well. HThe Admission Policy for Ordinary Public Schools also contains three assesses causes and consequences, and debates policy responses at global clausesand national on the scales. admission Within of non-citizens this literature, which the notecase ofthat South “this Africa policy is appliesattracting equally growing to learners interest. who For are almost not citizens15 years of South the Republic Africa has of Southbeen Africathe target and ofwhose a ‘global parents raiding’ are in of possession skilled professionals of a permit by for several temporary devel- or permanentoped countries. residence How issuedto deal by with the theDepartment consequences of Home of the Affairs.” resultant Does out- thisflow mean of health that professionalsnon-citizens haveis a core to produce policy issue birth for certificates the national from gov- their countriesernment. of birth as well? The Regulations do not say. However, they are Thisvery clearpaper about aims toone to category examine of policy child: debates “Persons and classified issues concerning as illegal aliensthe migration must, when of skilled they apply health for professionals admission for from their the children country or and for tothem- selves,furnish show new evidenceinsights on that the they recruitment have applied patterns to the of Departmentskilled health of per-Home Affairssonnel. to The legalise objectives their stayof the in paperthe country are twofold: in terms of the Aliens Control Act,• 1991 To (No.provide 96 ofan 1991).” audit of The the implicationorganization seems and patternsto be that of therecruit- chil- dren of “illegalment of aliens” skilled cannot professionals be admitted from Southto schools Africa unless in the they health show evidencesector. that they The havepaper taken draws steps upon to a regularise detailed analysis their status. of recruitment However, this shouldadvertising be a moot appearing point for in two the reasons: South African first, the Medical Aliens ControlJournal for Act is nothe longer period in 2000-2004force and, second,and a series according of interviews to the Bill conducted of Rights, with all childrenprivate are entitled recruiting to an enterprises. education and to bar them from schools on the •basis Based of the upon legal the status above of their analysis parents and wouldadditional be illegal interviews and unconsti with - tutional.key As stakeholdersPolzer notes, in“while the South school African principals health are supposedsector, the to paper uphold all children’soffers rights a series to ofeducation recommendations and ensure for that addressing all children the inproblem a com- of munity areskilled in school, health theymigration. are being These asked recommendations to enforce the birth are groundedcertificate or studyin permit both requirementSouth African and experience exclude children and an interrogationon that basis.” of18 inter- Givennational recurrent debates reports and that ‘good foreign policy’ children practice areoftendenied for regulating admis recruit-- sion to Southment. African schools, human rights groups focused on ensuring thatThe their paper rights is areorganized protected into in five the sections. omnibus SectionChildren’s Two Bill positions first tabled indebates 2002. aboutConcerns the migrationabout the oflack skilled of protection health professionals for migrant childrenwithin a ignitedwider literature during public that discussesand parliamentary the international debates onmobility the Children’s of talent. Bill (leadingSection Threeup to the reviews eventual research passage on theof the global Children’s circulation Act Noof health 35 of 2005 pro- andfessionals, the Children’s focusing Amendment in particular Actupon 41 debates of 2007, relating which tocame the fullyexperience into forceof countries on 1 April in the 2010). developing19 In 2004, world. the SectionChildren’s Four Bill moves Working the Groupfocus from (an allianceinternational of 24 majorto South non-governmental African issues and organizations provides new including empirical Lawyers mate- forrial Human drawn fromRights, the the survey Southern of recruitment African Catholic patterns Bishops’ and key Conferenceinterviews andundertaken the South with African health National sector recruiters Council foroperating Child Welfare) in South submitted Africa. thatSection the FiveBill under addresses consideration the questions was ofa “palechanging shadow” policy of interventionsthe 2002 origi -in nalSouth and Africa cut children’s towards rightsthe outflow to the ofbone: skilled “critical health issues professionals which have and been the sacrificedrecruitment in thisof foreign process health include professionals the rights ofto child work refugees in South and Africa. undocu The- mented foreign children.”20 Educational rights and the right of children

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EXECUTIVE SUMMARY to appropriate services were also “gone.” In short, concluded the Group, the Bill had “lost its soul.” ealth workers are one of the categories of skilled profession- Human rights lawyers were very sceptical of government’s motives in als most affected by globalization. Over the past decade, removing the references to foreign children that were present in earlier there has emerged a substantial body of research that tracks drafts of the legislation. The Refugee Rights Project at the University patterns of international migration of health personnel, of Cape Town, for example, argued that the Immigration Act and the H Refugees Act did not adequately protect the rights of children, and that assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is the Children’s Act should explicitly address the silences in existing legis- attracting growing interest. For almost 15 years South Africa has been lation on the treatment of foreign children.21 In a subsequent submission the target of a ‘global raiding’ of skilled professionals by several devel- to the Parliamentary Portfolio Committee on Social Development, the oped countries. How to deal with the consequences of the resultant out- Refugee Rights project added that “the gap that exists in terms of these flow of health professionals is a core policy issue for the national gov- pieces of legislation (the Refugees and Immigration Acts) is a combined, ernment. holistic one. The Acts are vague as they do not come together to clearly This paper aims to to examine policy debates and issues concerning describe and put into place specific protection measures with respect the migration of skilled health professionals from the country and to to refugee and unaccompanied foreign children, before and after their furnish new insights on the recruitment patterns of skilled health per- detection and status determination.”22 sonnel. The objectives of the paper are twofold: Defending the decision to drop any reference to “foreign children” • To provide an audit of the organization and patterns of recruit- in the Act, the Minister of Social Development noted that there was no ment of skilled professionals from South Africa in the health need to specifically identify migrant children because the Act applied sector. The paper draws upon a detailed analysis of recruitment equally to all children in the country.23 In discussions between Lawyers advertising appearing in the South African Medical Journal for for Human Rights and the Department of Social Development, the the period 2000-2004 and a series of interviews conducted with Department noted that the removal of any explicit mention of foreign private recruiting enterprises. children from the Bill should be regarded as a positive development • Based upon the above analysis and additional interviews with since it reaffirmed the Department’s commitment to the inclusion of all key stakeholders in the South African health sector, the paper children irrespective of status, nationality, or whether they are accom- offers a series of recommendations for addressing the problem of panied or not, and to provide services to all children under 18 within skilled health migration. These recommendations are grounded the borders of the country.24 According to LHR, however, “as much as in both South African experience and an interrogation of inter- the current bill is based on the premise that a “child is a child” regard- national debates and ‘good policy’ practice for regulating recruit- less of status or nationality, and an implicit regard for the principle of ment. non-discrimination, this principle is not explicitly stated in the Bill. The The paper is organized into five sections. Section Two positions absence of an explicit clause that affirms the non-discriminatory applica- debates about the migration of skilled health professionals within a tion of the provisions in the Bill to all children leaves the door open for wider literature that discusses the international mobility of talent. restrictive and exclusionary interpretations.”25 But if “a child is a child”, Section Three reviews research on the global circulation of health pro- as the Department maintains, then there should be no barriers to migrant fessionals, focusing in particular upon debates relating to the experience children accessing the educational system in South Africa. As this report of countries in the developing world. Section Four moves the focus from shows with regard to Zimbabwean children, this is very far from being the international to South African issues and provides new empirical mate- case. rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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BEaXECUTIVErriers toS UMMARYAdmission

esearchersealth workers and areNGOs one haveof the alreadypointed categories of skilled to some profession- of the problemsals most thataffected migrant by globalization. children and Over their the parents past decade, face in 26 accessingthere has government emerged a substantial schools in body South of researchAfrica. thatThese tracks includepatterns demands of international by school migration administrators of health and personnel, principals RHfor study permits and birth certificates, language admission tests, claims assesses causes and consequences, and debates policy responses at global thatand nationalschools are scales. ‘full’, Within being relegatedthis literature, to the the bottom case of enrolmentSouth Africa lists, is financialattracting hardship, growing geographicalinterest. For almostinaccessibility 15 years and South unwarranted Africa has fee been 27 demands.the target ofThe a ‘global 2007 Southraiding’ African of skilled Community professionals Survey by severalfound that devel- of theoped 53,524 countries. children How aged to deal 7-15 with who the were consequences born outside of the the country, resultant 6,438 out- 28 (orflow 12%) of health were professionalsnot in school. is aThe core equivalent policy issue figure for thefor thenational 8.5 mil gov-- lionernment. South African-born children was only 4.5%. Another recent survey showedThis thatpaper school aims attendanceto to examine rates policy vary debatesconsiderably and issues with theconcerning migra- 29 tionthe migrationstatus of the of skilledparents health and child. professionals Amongst from the the school-going country and age to childrenfurnish of permanentnew insights residents, on the recruitment the non-attendance patterns rateof skilled is 12%. health Amongst per- refugeessonnel. Theit is objectives21% and amongst of the paper asylum are seekers twofold: 23%. Finally, 43% of the children• To of provideirregular an migrants audit of are the not organization in school. Suchand patterns a wide variationof recruit- can onlyment be explained of skilled by professionals the existence from of “gatekeeping”South Africa atin the levelhealth of individualsector. schools.The The paper intensity draws uponof gatekeeping a detailed by analysis schools of seems recruitment to vary from placeadvertising to place, appearing possibly even in the from South school African to school. Medical For Journalexample, for 13% of migrantthe period children 2000-2004 in Pretoria and a doseries not of attend interviews school, conducted compared with to 24% inprivate Gauteng, recruiting 28% in enterprises. Durban, 31% in Port Elizabeth and 33% in 30 Cape• Town. Based upon the above analysis and additional interviews with Givenkey the stakeholders extra guarantees in the of South the Refugees African Act,health child sector, refugees the paper should haveoffers no a seriesdifficulty of recommendations at all in gaining access for addressing to schools. the But problem parents of who haveskilled come health to South migration. Africa to These seek recommendationsasylum are frustrated are bygrounded South Africa’soverburdenedin both South and African ineffectual experience refugee and system. an interrogation As Landau ofpoints inter- out, the nationalrefugee determinationdebates and ‘good process policy’ can practicetake months for regulating if not years, recruit- leav- ing asylumment. seekers in “a state of limbo during which they may stay in the country,The paperbut can is organizedaccess few into social five services sections. and Section receive Two almost positions no official ordebates private about assistance the migration in the form of skilled of direct health aid or professionals help in finding within employ a - 31 ment.”wider literature However, that the discusses proportion the ofinternational asylum seekers mobility who areof talent. granted ref- ugeeSection status Three is very reviews small. research In 2009, on for the example, global circulationthere were of220,028 health new pro- applicationsfessionals, focusing for refugee in particular status in Southupon debates Africa. relatingIn that sameto the year, experience 45,538 applicationsof countries werein the rejected developing and onlyworld. 4,531 Section were Four accepted. moves Of the these focus 75% from wereinternational from three to countriesSouth African (the DRC, issues Ethiopiaand provides and Somalia)new empirical (Table mate- 1). In Januaryrial drawn 2011, from the the UNHCR survey ofestimated recruitment that patternsrefugee statusand key had interviews been grant- 32 edundertaken to only around with health 53,000 sector applicants recruiters in the operating whole post-apartheid in South Africa. period. TheSection number Five ofaddresses registered the asylum questions seekers of changing in the country policy atinterventions that time in wasSouth around Africa 420,000.With towards the outflowregard to of Zimbabwean skilled health refugee professionals claimants, and the the Departmentrecruitment of Homeforeign Affairs, health andprofessionals the government to work more in South generally, Africa. take The the position that Zimbabwe is not a refugee-generating country.33 While

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EXECUTIVE SUMMARY nearly 150,000 Zimbabweans applied for refugee status in 2009 (which would certainly qualify as a ‘mass exodus’ under the Refugees Act), only ealth workers are one of the categories of skilled profession- 200 were granted refugee status while 15,370 were refused. als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks Table 1: Refugee Applications and Decisions, 2009 Hpatterns of international migration of health personnel, Applications Accepted Refused assesses causes and consequences, and debates policy responses at global Algeria 133 0 50 and national scales. Within this literature, the case of South Africa is Angola 335 7 132 attracting growing interest. For almost 15 years South Africa has been Bangladesh 4923 31 3310 the target of a ‘global raiding’ of skilled professionals by several devel- Burundi 1208 133 367 oped countries. How to deal with the consequences of the resultant out- Cameroon 667 9 429 flow of health professionals is a core policy issue for the national gov- China 3327 0 1634 ernment. Congo 3223 613 1391 This paper aims to to examine policy debates and issues concerning DRC 6226 779 1706 the migration of skilled health professionals from the country and to Eritrea 219 202 71 furnish new insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: Ethiopia 10715 1307 3130 • To provide an audit of the organization and patterns of recruit- Ghana 942 0 648 ment of skilled professionals from South Africa in the health India 3632 0 1045 sector. The paper draws upon a detailed analysis of recruitment Kenya 624 0 276 advertising appearing in the South African Medical Journal for Lesotho 258 0 54 the period 2000-2004 and a series of interviews conducted with Malawi 15697 0 7749 private recruiting enterprises. Mozambique 2559 0 882 • Based upon the above analysis and additional interviews with Niger 1445 0 1071 key stakeholders in the South African health sector, the paper Nigeria 3023 0 2046 offers a series of recommendations for addressing the problem of Pakistan 3196 0 1770 skilled health migration. These recommendations are grounded Rwanda 275 17 68 in both South African experience and an interrogation of inter- Senegal 204 0 74 national debates and ‘good policy’ practice for regulating recruit- Somalia 3580 1213 638 ment. Uganda 1425 20 759 The paper is organized into five sections. Section Two positions Tanzania 1739 0 602 debates about the migration of skilled health professionals within a Zambia 1000 0 266 wider literature that discusses the international mobility of talent. Zimbabwe 149453 200 15370 Section Three reviews research on the global circulation of health pro- Totals 220028 4531 45538 fessionals, focusing in particular upon debates relating to the experience Source: UNHCR of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- A refugee permit should guarantee automatic access to a school. In rial drawn from the survey of recruitment patterns and key interviews practice, the permits look very different from South African identity undertaken with health sector recruiters operating in South Africa. documents and school administrators are often unfamiliar with them. Section Five addresses the questions of changing policy interventions in Most South Africans also believe that the majority of refugee claims in South Africa towards the outflow of skilled health professionals and the South Africa are bogus.34 In such circumstances, refugee permits are “not recruitment of foreign health professionals to work in South Africa. The enabling documents and despite the fact that various rights are attached to such a documents, refugees struggle to access these rights. The South

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EXECUTIVEAfricanSUMMARY government has done very little to educate South Africans about refugee documents and as a result refugees are severely prejudiced.”35 Xenophobicealth attitudes workers are are veryone strongof the categoriesin South African of skilled communities profession- and public institutionsals most affected and many by globalization. South Africans Over have the a pastparticularly decade, negative view ofthere foreign has Africans,emerged especiallya substantial Zimbabweans. body of research36 Are that these tracks views and stereotypespatterns internalised of international and reproduced migration by ofSouth health African personnel, children in Hthe classroom and playground? Earlier investigations of discrimination in assesses causes and consequences, and debates policy responses at global theand schools national tended scales. to Within focus on this the literature, persistence the of case racism of South but had Africa little is to sayattracting about thegrowing associated interest. problem For almost of xenophobia. 15 years 37South More Africa recently, has therebeen havethe target been ofa fewa ‘global case studies raiding’ of of the skilled experiences professionals of foreign by several children devel- in Southoped countries. African schools. How to One deal study with ofthe five consequences schools in Johannesburg’s of the resultant inner- out- city,flow forof healthexample, professionals found that ismigrant a core policychildren issue were for regularly the national subject gov- to verbalernment. abuse and name-calling from fellow pupils (including derogatory epithetsThis suchpaper as aims amakwerekwere to to examine, ingogongo policy debates, kwang and issues‘crocodile concerning driv- ers’).the migration38 In another of skilled study healthof the inner-cityprofessionals by Witsfrom University the country and and Khanya to College,furnish new refugee insights children on the talked recruitment about “taunts patterns by teachersof skilled in health the class per-- roomsonnel. and The by objectiveslearners in ofthe the playground paper are …twofold: Some learners make insinu- ations• about To provide refugees an not audit washing. of the Othersorganization pester and them patterns by asking of recruit- what they arement doing of in skilled South professionalsAfrica and when from they South are Africa going inback the to health their countriessector. of origin, The suchpaper as draws ‘you Congo,upon a detailedwhat have analysis you come of recruitment here to do?’ Some teachersadvertising ignore appearing them in inclassrooms the South or African when they Medical notice Journal them itfor is only to tease.”the period39 Another 2000-2004 micro-study and a series in Athlone, of interviews Cape conductedTown, reported with similar findingsprivate recruitingamong a group enterprises. of younger refugee children.40 More recently,• Based a study upon of 150 the highabove school analysis students and additional aged 16 to interviews 21 in three with Cape Town schoolskey stakeholders found that inseveral the South common African myths health about sector, migrants the were paper “frequentlyoffers reiterated” a series of in recommendations interviews and focus for addressinggroups.41 the problem of skilled health migration. These recommendations are grounded Study Methodologyin both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruitment.he fieldwork for this study of the contemporary Zimbabwean The paperexperience is organized with theinto South five sections. African educationalSection Two system positions was debates aboutconducted the migration in Cape ofTown skilled and health Johannesburg professionals in August within and a wider literatureSeptember that 2010.discusses Although the international Zimbabwean mobility migrants of talent.are scat- Ttered around the country, the majority live in these two cities. Within Section Three reviews research on the global circulation of health pro- eachfessionals, city, three focusing different in particular types of uponneighbourhood debates relating were selected. to the experience In Cape Town,of countries the three in the areas developing were Observatory world. Section (a middle-income Four moves thesuburb), focus Du from Nooninternational (an informal to South settlement) African andissues Masimphumelele and provides new (a township).empirical mate- In Johannesburg,rial drawn from the the survey survey was of carriedrecruitment out in patterns Johannesburg and key Central interviews (the innerundertaken city), Alexandrawith health (a sector township) recruiters and Orange operating Farm in South(an informal Africa. settlement).Section Five addresses the questions of changing policy interventions in SouthThe Africa project towards adopted the a “snowball”outflow of skilledsampling health strategy professionals to identify and the respondents.recruitment ofThis foreign involved health the professionals use of respondents to work to in identify South Africa.other The respondents through their own networks. The process began by identify-

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EXECUTIVE SUMMARY ing migrants as initial sampling points. Considerable effort was made to ensure that the initial sampling points were of varied backgrounds in ealth workers are one of the categories of skilled profession- terms of age, occupation, gender and legal status. Given the “mixed” als most affected by globalization. Over the past decade, nature of Zimbabwean migration to South Africa, the aim was to identify there has emerged a substantial body of research that tracks and interview as heterogeneous a sample as possible.The survey used patterns of international migration of health personnel, two major data collection methods: in-depth interviews and focus group H discussions. One hundred in-depth interviews were carried out in the assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is two cities: 50 in Cape Town and 50 in Johannesburg. These interviews attracting growing interest. For almost 15 years South Africa has been collected detailed information on access to health and educational the target of a ‘global raiding’ of skilled professionals by several devel- services, the challenges migrants face and other issues related to these oped countries. How to deal with the consequences of the resultant out- services. In order to complement data gathered through interviews, flow of health professionals is a core policy issue for the national gov- a total of 10 focus group discussions were conducted, 5 in each city. ernment. In Cape Town, the focus group discussions were held in the following This paper aims to to examine policy debates and issues concerning areas: 1 in Observatory and 2 each in Du Noon and Masimphumelele. the migration of skilled health professionals from the country and to In Johannesburg, 1 focus group discussion was undertaken in Alexandra furnish new insights on the recruitment patterns of skilled health per- while 2 each were conducted in Johannesburg Central and Orange Farm. sonnel. The objectives of the paper are twofold: Each focus group discussion had approximately 10 participants. Besides • To provide an audit of the organization and patterns of recruit- collecting additional information and opinions, the focus group discus- ment of skilled professionals from South Africa in the health sions gave respondents the opportunity to talk not only about their own sector. The paper draws upon a detailed analysis of recruitment experiences, but those of other migrants as well. All of the field research- advertising appearing in the South African Medical Journal for ers were Zimbabwean and spoke the major Zimbabwean languages the period 2000-2004 and a series of interviews conducted with (Shona and Ndebele). The findings of the research on the barriers to private recruiting enterprises. accessing public health facilities in South Africa are discussed in a sepa- • Based upon the above analysis and additional interviews with rate paper.42 key stakeholders in the South African health sector, the paper The majority of the migrants indicated that they were aware of where offers a series of recommendations for addressing the problem of and how to access educational services in South Africa. They knew of skilled health migration. These recommendations are grounded the public-private divide but indicated a preference for government in both South African experience and an interrogation of inter- schools because they were cheap and affordable. Few migrants knew that national debates and ‘good policy’ practice for regulating recruit- they had any rights to education under the South African Constitution. ment. The majority believe that because they are foreigners, they have privileg- The paper is organized into five sections. Section Two positions es rather than rights and these can be taken away by the South African debates about the migration of skilled health professionals within a government at will. The idea that they would have rights to education in wider literature that discusses the international mobility of talent. a foreign country seemed inconceivable to most migrants, except those Section Three reviews research on the global circulation of health pro- with some tertiary education. fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from Accessing the Right to Education international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews he National Department of Education stipulates that in undertaken with health sector recruiters operating in South Africa. order to register a child at a government school, parents are Section Five addresses the questions of changing policy interventions in required to provide a birth certificate and an immunization South Africa towards the outflow of skilled health professionals and the card. Lawyers for Human Rights and CoRMSAhave found Tthat schools generally turn children away if their parents cannot produce recruitment of foreign health professionals to work in South Africa. The these documents.43 This was confirmed by the Zimbabwean migrants

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EXECUTIVEinterviewedSUMMARY for this study. All of the migrants indicated that is very difficult to enrol their children in South African schools without these documents. ealthPassports workers or asylum are one and of refugeethe categories papers ofare skilled not generally profession- accepted as alsalternatives. most affected One by woman globalization. described Over how the she past failed decade, to secure a place in Gradethere Onehas emergedfor her child a substantial because shebody did of notresearch have thethat child’s tracks HZimbabweanpatterns birth certificate: of international migration of health personnel, assessesI triedcauses several and consequences, schools, but the and issue debates was thepolicy same…they responses at global and nationalneeded scales.a birth Within certificate. this Sinceliterature, I had the not case managed of South to getAfrica is attractingone growingfor my daughter interest. when For almost I was still15 years in Zimbabwe, South Africa I could has been the targetnot doof aanything. ‘global raiding’ I cannot of affordskilled to professionals go back to Zimbabwe by several to devel- oped countries.try and secure How one….soto deal with my childthe consequences is at home. I ofwill the try resultant again outflow ofat health the end professionals of the year isand a core maybe policy I will issue succeed…I for the national just hope government.I do because my child is growing bigger for grade one.44 This paper aims to to examine policy debates and issues concerning theMost migration school of authorities skilled health do not professionals even give parentsfrom the a countrychance toand enrol to theirfurnish children new insights while they on the try recruitmentto secure the patterns required of documentation. skilled health per- Thesonnel. choice The is objectives documentation of the upfrontpaper are or twofold:no registration at all. Most Zimbabwean• To provide nationals an auditleft their of the country organization under crisis and patternsconditions of thatrecruit- did not givement them of skilled time toprofessionals bring all their from documents South Africa or enough in the timehealth to acquire sector.them. ItThe is therefore paper draws unreasonable upon a detailed to expect analysis them of to recruitment produce what theyadvertising do not have appearing or have in little the chanceSouth African of acquiring. Medical Demanding Journal for proof of theresidence period or2000-2004 a South African and a series next ofof interviewskin as a condition conducted for withreg- istrationprivate is equally recruiting pointless enterprises. as few Zimbabwean nationals possess such documents• Based or haveupon localsthe above who analysisare willing and to additional act as their interviews kin. with Withoutkey stakeholdersmoney to return in the home South to ZimbabweAfrican health to secure sector, a birth the paper certificate foroffers their a serieschildren, of recommendations many migrants end for up addressing keeping themthe problem at home, of deprivingskilled them health of a much-needed migration. These education recommendations in their early years.are grounded In fact, as notedin above, both Southit is not African at all clear experience from the and legislation an interrogation and regulations, of inter- that non-Southnational African debates parents and ‘good are policy’required practice to produce for regulating home country recruit- birth certificatesment. at all. More generally, it is completely unreasonable to expectThe an paper asylum is organized seeker or intorefugee five to sections. return toSection the country Two positions they fled fromdebates to obtainabout thea birth migration certificate of skilled before health their children professionals can be within enrolled a inwider a South literature African that school. discusses Obtaining the international a birth certificate mobility for of a talent. child born inSection South ThreeAfrica reviews can also research very difficult. on the Apart global from circulation the general of health inef- pro- ficiencyfessionals, of thefocusing Home in Affairs particular bureaucracy, upon debates parents relating need toto theobtain experience birth recordsof countries from inthe the institution developing where world. the Sectionchild was Four born. moves Migrants the focus reported from thatinternational some local to hospitals South African refuse toissues provide and providesthem with new the empirical records on mate- therial groundsdrawn from that the they survey were of‘illegal recruitment migrants’ patterns when they and gavekey interviews birth and areundertaken therefore with not entitledhealth sector to documents. recruiters Thisoperating kind ofin obstructionism South Africa. is anotherSection clearFive addressesexample ofthe the questions medical ofxenophobia changing policythat permeates interventions public in 45 healthSouth Africainstitutions. towards the outflow of skilled health professionals and the recruitmentMany migrants of foreign are forcedhealth to professionals turn to private to work educational in South institutions Africa. The that do not make a fuss about documentation. Even in private schools

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EXECUTIVE SUMMARY and other educational institutions, however, there are still challenges. Undocumented migrants and those with asylum papers are usually asked ealth workers are one of the categories of skilled profession- to provide a next of kin with South African citizenship to act as guaran- als most affected by globalization. Over the past decade, tors in the event the migrant defaults on fees. Migrants who are unable there has emerged a substantial body of research that tracks to find South African nationals to act as their next of kin face challenges Hpatterns of international migration of health personnel, in securing places in some private institutions. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Financial Barriers attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- he Department of Education encourages all students to oped countries. How to deal with the consequences of the resultant out- be enrolled in the same area in which they are domiciled. flow of health professionals is a core policy issue for the national gov- However, migrant children rarely benefit from this policy. This ernment. is because they are usually the last to be offered places as local Tstudents are given priority. They may therefore end up getting a place This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to at a school further away from where they live. In Cape Town, for exam- furnish new insights on the recruitment patterns of skilled health per- ple, one migrant parent living in Observatory said that his two children sonnel. The objectives of the paper are twofold: were going to school in Wynberg, some 10 kilometres away, because they • To provide an audit of the organization and patterns of recruit- could not get into a school in Observatory or the nearby residential areas ment of skilled professionals from South Africa in the health of Mowbray or Salt River. The students therefore have to commute to sector. The paper draws upon a detailed analysis of recruitment school: advertising appearing in the South African Medical Journal for In addition to the fees, the cost of transport is high. I have the period 2000-2004 and a series of interviews conducted with to pay approximately R30 a day for my kids and its really private recruiting enterprises. straining my finances, but there is nothing that I can do. My • Based upon the above analysis and additional interviews with salary cannot cope…so I have to walk into town to work so key stakeholders in the South African health sector, the paper that I can save a little. Things would have been different if offers a series of recommendations for addressing the problem of I had secured them places close to home where they would skilled health migration. These recommendations are grounded walk to school.46 in both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruit- Section 5 (1) (a) of the South African Schools Act of 1996 states ment. that “no learner may be refused admission to a public school on the The paper is organized into five sections. Section Two positions grounds that his or her parent is unable to pay or has not paid the school debates about the migration of skilled health professionals within a fees determined by the governing body.” Schools are required to exempt wider literature that discusses the international mobility of talent. learners from households with incomes that fall below a prescribed means 47 Section Three reviews research on the global circulation of health pro- test. Certain categories of children (or their caregivers) are automati- fessionals, focusing in particular upon debates relating to the experience cally eligible for full exemptions. The loss of revenue and lack of compen- of countries in the developing world. Section Four moves the focus from sation has made schools extremely reluctant to implement the exemption 48 international to South African issues and provides new empirical mate- policy, and even to accept learners who may be unable to pay fees. A rial drawn from the survey of recruitment patterns and key interviews High Court judgment in 2007 clarified that the exemption policy must undertaken with health sector recruiters operating in South Africa. be implemented by schools and enforced by provincial education depart- Section Five addresses the questions of changing policy interventions in ments. In 2007, a new national funding policy was implemented in which 49 South Africa towards the outflow of skilled health professionals and the the poorest 40% of schools were granted no-fee status. recruitment of foreign health professionals to work in South Africa. The The cost of public education to parents or guardians in South Africais therefore not astronomical. In addition, fee exemptions should now be

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EXECUTIVEgrantedSUMMARY more readily. In other words, school fees are not generally an insurmountable barrier to access. However, the parents of migrant children “have ealthgreat difficulty”workers are in one accessing of the feecategories exemption of skilled forms: profession- We haveals most seen affectedcases of byunaccompanied globalization. foreignOver the children past decade, who were thereunder has severe emerged pressure a substantial to pay school body fees of researchdespite having that tracks Hno meanspatterns of financial of international or other migrationsupport. We of havehealth seen personnel, cases assesseswhere causes the and schools consequences, have handed and overdebates cases policy such responsesas these to at global and nationaldebt collectors scales. Within who have this proceeded literature, to the aggressively case of South pursue Africa is attractingunaccompanied growing interest. foreign For children almost with15 years the unfortunateSouth Africa result has been the targetof causing of a ‘global the child raiding’ to leave of skilled school. professionals50 by several devel- oped countries. How to deal with the consequences of the resultant out- flowUnable of health to get professionals fee relief and is afor core other policy reasons issue (such for the as nationalthe documenta gov- - tionernment. issue and preferential access for local children), many migrants find it veryThis difficult paper aimsto get to their to examine children policy into these debates schools. and issues concerning theMigrant migration parents of skilled or guardians health professionals respond in various from the ways country when andtheir to childrenfurnish new are shutinsights out onof athe government recruitment schools. patterns One of optionskilled ishealth to “school per- shop”sonnel. which, The objectivesif successful, of theoften paper means are added twofold: commuting costs because the •school To isprovide further an away audit from of thewhere organization they live. andAnother patterns option of recruit-is to enrol thement children of skilled in private professionals schools wherefrom South no questions Africa inare the asked health about documentation.sector. The paper A significant draws upon number a detailed of migrant analysis children of recruitment from better-offadvertising families are appearing in private in schools the South but Africanthe fees Medicalare high Journaland often for far morethe than period the average2000-2004 migrant and afamily series can of interviewsafford. Poorer conducted migrants with have absolutelyprivate recruitingno chance enterprises. of accessing the elitist private system. Many Zimbabwean• Based migrants upon the in above South analysis Africa areand employed additional in interviews low-paying with jobs in the hospitalitykey stakeholders and construction in the South sectors African where health they sector,work as the waiters, paper cleaners,offers bartenders, a series securityof recommendations guards and general for addressing hands. With the problemthese kinds of of jobs, mostskilled find health it very migration. difficult toThese consistently recommendations pay for their are children’s grounded educationalin both costs. South As one African respondent experience recounted: and an interrogation of inter- I enrollednational mydebates child and at a ‘good private policy’ school practice after failing for regulating to secure recruit- a ment.place at government schools in my area. She is in Grade The3 paperand I payis organized R1 200 a into month. five Thissections. is very Section expensive Two forpositions me, debatesbut about I have the no migration choice. The of skilled school health is very professionals strict and if Iwithin do not a wider payliterature in time, that my discusses child is excludedthe international from classes mobility by being of talent. made Sectionto Threesit in thereviews staff-room research so thaton the she global does notcirculation get to learn. of health I professionals,am barely focusing managing in particular as I earn upon very debates little fromrelating my tojob the as aexperience of countrieswaiter….but in the developingI have no choice. world. ISection just have Four to persevere.moves the51 focus from international to South African issues and provides new empirical mate- Others respond by keeping their children at home, hoping that their rial drawn from the survey of recruitment patterns and key interviews work situation will eventually improve and they will be able to pay for undertaken with health sector recruiters operating in South Africa. their children’s education. Section Five addresses the questions of changing policy interventions in If their financial situation does not improve, some migrants eventually South Africa towards the outflow of skilled health professionals and the resort to sending their children back to Zimbabwe so that they can be recruitment of foreign health professionals to work in South Africa. The educated there:

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EXECUTIVE SUMMARY My sister brought her two children to this country at the beginning of 2009. She could not find them a place in a gov- ealth workers are one of the categories of skilled profession- ernment school so she ended up enrolling them at a private als most affected by globalization. Over the past decade, school. It was expensive…I think she was paying R800 per there has emerged a substantial body of research that tracks month for each child, one in grade 3 and the other in grade patterns of international migration of health personnel, 5. She could only afford to pay for the first two terms and H withdrew them until the end of the year. She had to send assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is them back to Zimbabwe at the end of the year. But they attracting growing interest. For almost 15 years South Africa has been have had to repeat their grades this year and now they are a the target of a ‘global raiding’ of skilled professionals by several devel- grade behind their age group.52 oped countries. How to deal with the consequences of the resultant out- At private high schools, the fees can be as high as R35 000 per year. flow of health professionals is a core policy issue for the national gov- Some parents look for cheaper institutions. But if these are further away ernment. from their place of residence, migrants also face the added cost of trans- This paper aims to to examine policy debates and issues concerning porting their children to and from the schools. the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: Discrimination and Xenophobia • To provide an audit of the organization and patterns of recruit- he focus group discussions in both Cape Town and Johannesburg ment of skilled professionals from South Africa in the health revealed that discrimination and hostility towards Zimbabwean sector. The paper draws upon a detailed analysis of recruitment Tchildren in school is pervasive: advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with It is difficult for our children in some of these schools. They private recruiting enterprises. are discriminated against by some teachers. My friend’s • Based upon the above analysis and additional interviews with child, who is in grade 9, was asked to move from a computer key stakeholders in the South African health sector, the paper and make way for a South African student. When he tried offers a series of recommendations for addressing the problem of to refuse, the teacher threatened him that this was not a skilled health migration. These recommendations are grounded Mugabe school and he had to move. But we pay the same in both South African experience and an interrogation of inter- fees….it is not his problem that there are few computers national debates and ‘good policy’ practice for regulating recruit- at the school…to be fair I think they just need to alternate ment. the students or make them share, but not to deprive others. 53 The paper is organized into five sections. Section Two positions How will they learn? debates about the migration of skilled health professionals within a In addition, migrant students are subjected to xenophobic taunts wider literature that discusses the international mobility of talent. fromstudents as well as teachers who do not like foreign students in their Section Three reviews research on the global circulation of health pro- classes. One Zimbabwean parent interviewed in Observatory recounted fessionals, focusing in particular upon debates relating to the experience how her Grade 7 child was continuously ridiculed by some of her class- of countries in the developing world. Section Four moves the focus from mates. They commented that her skin colour was too dark, her pronunci- international to South African issues and provides new empirical mate- ation of English too African, and that she ate too much because there is rial drawn from the survey of recruitment patterns and key interviews no food in Zimbabwe. Sometimes the comments were more threatening: undertaken with health sector recruiters operating in South Africa. Our children are abused everyday by other students who call Section Five addresses the questions of changing policy interventions in them ‘makwerekwere’ and pass on negative comments about South Africa towards the outflow of skilled health professionals and the them and where they come from. We usually ask our chil- recruitment of foreign health professionals to work in South Africa. The dren to ignore these comments, but sometimes it just gets too much and really frightening. At one point my child was

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EXECUTIVE StoldUMMARY by her classmate that she would be stabbed by a knife if she did not return to her country. I had to spend time per- suadingealth her workers to go to are school one ofbecause the categories she wanted of skilledto quit profession- out of fear.als54 most affected by globalization. Over the past decade, This kindthere of treatment has emerged makes a substantial the children body of migrantsof research feel that alienated, tracks Hinferior andpatterns unwanted. of internationalSome students, migration subjected of to health xenophobic personnel, insults andassesses comments, causes and become consequences, withdrawn and and debates do not policyparticipate responses in class at orglobal take partand nationalin extra-mural scales. activities. Within this literature, the case of South Africa is attractingMost parents growing or interest.guardians For would almost take 15 verbal years bullyingSouth Africa and threats has been of violencethe target to of the a ‘globalschool raiding’authorities. of skilled However, professionals the focus bygroup several discussions devel- revealedoped countries. that this How is no to easy deal thing with forthe Zimbabweans consequences in of South the resultant Africa. out- Parentsflow of healthare usually professionals left frustrated is a core as most policy school issue authorities for the national do nottake gov- theernment. threats seriously, even after the nation-wide xenophobic violence of MayThis 2008. paper Some aims participantsto to examine even policy suggested debates that and school issues authoritiesconcerning dothe not migration act because of skilled the students’ health professionals xenophobic fromattitudes the countrymirror their and ownto feelingsfurnish newtowards insights foreigners. on the Migrant recruitment parents patterns usually of do skilled not pluck health up per- the couragesonnel. Theto report objectives the cases of the or confrontpaper are the twofold: school authorities for fear that• their To child provide will anbe auditfurther of victimizedthe organization or their and place patterns at school of recruit- jeopard- ized. As mentone parent of skilled in Orange professionals Farm, fromJohannesburg, South Africa commented: in the health sector. The paper draws upon a detailed analysis of recruitment Itadvertising is wasting timeappearing if you ingo theto report South the African incidents Medical to the Journal for schoolthe period authorities. 2000-2004 Some and teachers a series do of not interviews even take conducted it seri- with ously…theyprivate recruiting just tell enterprises. you that some students are naughty. •Or Based that uponthey willthe dealabove with analysis the issue. and additionalBut nothing interviews happens with really….insteadkey stakeholders your in childthe South is abused African further. health If you sector, persist the in paper goingoffers to a theseries school, of recommendations then your child isfor in addressing trouble…teachers the problem of 55 ignoreskilled or health even taunt migration. her. These recommendations are grounded Parentsin bothare certainly South African convinced, experience on the andbasis an of interrogationexperience, that of inter- noth- ing will nationalbe done todebates make andthings ‘good easier policy’ for their practice children for regulating and that therecruit- perpetratorsment. will not be disciplined in any way. One parent observed that all theyThe canpaper do is is organized hope and into pray five that sections. their children Section are Two strong positions enough to withstanddebates about the ill-treatmentthe migration and of skilledpersist healthwith their professionals education withinuntil they a graduate.wider literature In the thatwords discusses of another, the internationalthey have no alternativemobility of buttalent. to leave theirSection children Three ‘in reviews the hands research of God.’ on the global circulation of health professionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from Language Problems international to South African issues and provides new empirical mate- rial drawnn South from Africa, the surveyschools of are recruitment required to patterns teach students and key using interviews their undertakenmother languagewith health from sector Grade recruiters 1 to Grade operating 3. Thereafter, in South they Africa. can be Sectiontaught Five in addresseseither English the questions or Afrikaans of changing until matriculation policy interventions at the end in Southof GradeAfrica 12.towards The mainthe outflow problem of forskilled the childrenhealth professionals of Zimbabwean and the Imigrantsrecruitment in primary of foreign schools health is theirprofessionals inability to to workspeak in or South understand Africa. local The languages such as Zulu, Sotho, Xhosa, Pedi and Tswana. Most migrants

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EXECUTIVE SUMMARY indicated that their children usually have a difficult time coping in the first few years of primary school as they have to learn a new language. ealth workers are one of the categories of skilled profession- One migrant parent, who came to South Africa three years ago and als most affected by globalization. Over the past decade, enrolled her daughter in second grade, recounted the problems that her there has emerged a substantial body of research that tracks child faced: Hpatterns of international migration of health personnel, My daughter did not understand Zulu when she came… assesses causes and consequences, and debates policy responses at global so she had difficulty communicating with the teachers and and national scales. Within this literature, the case of South Africa is other students. For the first two terms, she was just going to attracting growing interest. For almost 15 years South Africa has been school, but I do not think she learnt much. I would ask her the target of a ‘global raiding’ of skilled professionals by several devel- when she came back what she had learnt, but she could not oped countries. How to deal with the consequences of the resultant out- tell me a lot. Now she is in grade 3 and she is doing a bit flow of health professionals is a core policy issue for the national gov- better, but still she struggles.56 ernment. This paper aims to to examine policy debates and issues concerning Most migrant children enrolled in primary schools face the problem the migration of skilled health professionals from the country and to ofhaving to learn in a language they do not understand. Learning the furnish new insights on the recruitment patterns of skilled health per- new language takes time and the children usually lag behind in their sonnel. The objectives of the paper are twofold: school work. From Grade 4 onwards, schools are supposed to use either • To provide an audit of the organization and patterns of recruit- English or Afrikaans. However, the Zimbabwean migrants said that some ment of skilled professionals from South Africa in the health schools continue teaching in their vernacular language well into the sector. The paper draws upon a detailed analysis of recruitment secondary level. While this may be beneficial to local students, as they advertising appearing in the South African Medical Journal for continue to be taught in a language that they understand well, it disad- the period 2000-2004 and a series of interviews conducted with vantages migrant students who join these schools in later years and are private recruiting enterprises. unable to adapt to the language. • Based upon the above analysis and additional interviews with key stakeholders in the South African health sector, the paper Obstacles in the Tertiary Sector offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded rticle 3(g) of the SADC Protocol on Education and Training in both South African experience and an interrogation of inter- commits governments “to work towards the relaxation and national debates and ‘good policy’ practice for regulating recruit- eventual elimination of immigration formalities in order to ment. facilitate freer movement of students and staff within the ARegion for the specific purposes of study, teaching, research and any The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a other pursuits relating to education and training.” There is little evidence wider literature that discusses the international mobility of talent. that South African institutions of higher learning, or the Department Section Three reviews research on the global circulation of health proof Home Affairs, are doing much to achieve this commitment.With the fessionals, focusing in particular upon debates relating to the experience exception of cost, migrants from other SADC countries find it no easier of countries in the developing world. Section Four moves the focus from to access tertiary education in South Africa than those from further international to South African issues and provides new empirical mate- afield. rial drawn from the survey of recruitment patterns and key interviews Colleges and universities require certain documentation before undertaken with health sector recruiters operating in South Africa. a migrant student can be registered. A study permit issued by the Section Five addresses the questions of changing policy interventions in Department of Home Affairs is the basic requirement for “international South Africa towards the outflow of skilled health professionals and the students.” According to the Immigration Act, study permits can only recruitment of foreign health professionals to work in South Africa. The be applied for in the student’s home country. In practice, this unreasonable requirement is often waived for migrants already in the country

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EXECUTIVEwho wishSUMMARY to start studying in South Africa. Applications can be made at Department of Home Affairs’ offices within the country. Migrant students with asylumealth workers papers are alsoone requiredof the categories to apply offor skilled study permitsprofession- in order to be registeredals most affected in local by colleges globalization. and universities. Over the Manypast decade, in this category have passports,there has emergedbut entered a substantial the country body on ofvisitors’ research permits that ortracks clan- destinely. However,patterns theof international Department ofmigration Home Affairs of health refuses personnel, to accept Htheir applications for study permits on the basis that they are in the assesses causes and consequences, and debates policy responses at global countryand national illegally. scales. They Within are told this that literature, they should the casereturn of toSouth Zimbabwe Africa andis makeattracting an application growing interest. at the South For almost African 15 Embassyyears South there. Africa One has respond been- entthe intarget Cape of Town a ‘global described raiding’ the of difficulty: skilled professionals by several devel- oped countries.Last year IHow applied to deal for andwith was the offered consequences places at of two the univer resultant- out- flow ofsities health here professionals to study commerce is a core andpolicy accounting. issue for theMy nationalproblem government.now is how to acquire a study permit. I have been to the ThisHome paper Affairs aims toDepartment to examine three policy times debates and have,and issues on all concerning the migrationoccasions, of beenskilled told health that professionalsthey cannot acceptfrom the my country applica -and to furnishtion new since insights my passport on the recruitment does not have patterns an entry of skilledstamp…they health personnel.want The me objectives to go back of theto Zimbabwe paper are twofold:to apply from there. But I •cannot To provide afford an to auditgo back…I of the wantorganization to save theand littlepatterns money of recruit-I havement for of tuition. skilled Soprofessionals now I am stuck.from South57 Africa in the health sector. The paper draws upon a detailed analysis of recruitment Manyadvertising Zimbabweans appearing are in ina similar the South situation, African wanting Medical to furtherJournal for their educationthe period in South2000-2004 Africa and but a unableseries of to interviews do so because conducted they do with not have studyprivate permits. recruiting Even migrantsenterprises. who have entered the country legally and• have Based all the upon documentation, the above analysis find it and difficult additional to get interviewsthe permits. with This is becausekey they stakeholders are unable in to the meet South some African of the healthrequirements sector, forthe study paper permits.offers These a conditionsseries of recommendations include a requirement for addressing to show thethey problem have suf of- ficient moneyskilled to health pay for migration. tuition, accommodation These recommendations and sustenance are grounded and the acquisitionin both of prepaid South healthAfrican insurance. experience and an interrogation of inter- Mostnational prospective debates migrant and students‘good policy’ in the practice survey forsaid regulating that the condirecruit-- tions arement. too stringent and that they are unlikely to satisfy them. Because mostThe of thempaper areis organized involved intoin part-time five sections. work itSection is impossible Two positions to raise enoughdebates moneyabout theto paymigration tuition ofand skilled health health insurance professionals for the whole within year a in onewider lump literature sum. Rather that discusses they prefer the tointernational pay fees in instalmentsmobility of talent.throughout theSection year Three– an arrangement reviews research which on most the institutionsglobal circulation in the countryof health The pro- Homefessionals, Affairs focusing Department, in particular however, upon insists debates on relatingprospective to the students experience pro- vidingof countries proof ofin enoughthe developing income world.and a health Section insurance Four moves valid the for focus a year from beforeinternational it will issue to South a study African permit. issues and provides new empirical mate- rialThe drawn Refugees from the Act survey is clear of thatrecruitment a refugee patterns permit exemptsand key ainterviews student fromundertaken having withto obtain health a studysector permit. recruiters However, operating the inorganisation South Africa. Unity forSection Tertiary Five Refugee addresses Students the questions (UTRS) of reports changing that policy universities interventions “take the in mostSouth central Africa and towards unexpected the outflow role asof culpritsskilled healthin excluding professionals refugee andstu- the 58 dents.”recruitment UTRS of foreign continues: health professionals to work in South Africa. The From the responses and attitudes of university staff, when a

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EXECUTIVE SUMMARY refugee applies for admission to an institution, the first reac- tion is very often that of rejection, not based on academic ealth workers are one of the categories of skilled profession- weakness or irregularities but rather on the refugee’s iden- als most affected by globalization. Over the past decade, tity, his or her status as a person in exile. What often occurs there has emerged a substantial body of research that tracks is that the refugee applicant is told that he or she is not patterns of international migration of health personnel, allowed to study, or more succinctly, ‘You can’t study here, H because you are not allowed to.’ assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is The position of those with asylum seeker permits is less clear. Some attracting growing interest. For almost 15 years South Africa has been institutions accept them in lieu of a study permit. Other do not on the the target of a ‘global raiding’ of skilled professionals by several devel- grounds that that they are temporary and can therefore be revoked oped countries. How to deal with the consequences of the resultant out- anytime. A female respondent who lives in Masimphumelele Township flow of health professionals is a core policy issue for the national gov- in Cape Town, explained how she could have been in a nurse training ernment. school had the school accepted her asylum permit: This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to I applied and got a place at a local nurse training institution. furnish new insights on the recruitment patterns of skilled health per- I paid my deposit through the bank, but when I went to reg- sonnel. The objectives of the paper are twofold: ister they told me that they could not register me with the • To provide an audit of the organization and patterns of recruit- asylum paper. I tried everything, but they refused and so I ment of skilled professionals from South Africa in the health ended up asking for my money back, which took me almost sector. The paper draws upon a detailed analysis of recruitment 9 months to be refunded. Even then, I only got a part of the advertising appearing in the South African Medical Journal for deposit as they said that the other part was not refundable. I the period 2000-2004 and a series of interviews conducted with could have been half way through my course right now.59 private recruiting enterprises. The prospect of furthering their education in South Africa is limited • Based upon the above analysis and additional interviews with as long as institutions are ignorant of their legal responsibilities or make key stakeholders in the South African health sector, the paper excessive demands for particular kinds of documentation or ignore the offers a series of recommendations for addressing the problem of SADC Protocol. Schools and colleges also seem extremely reluctant to skilled health migration. These recommendations are grounded accept students who have asylum permits. Those that do will only pro- in both South African experience and an interrogation of inter- vide temporary registration – valid for the duration of the asylum permit, national debates and ‘good policy’ practice for regulating recruit- which is usually three months. If the migrant fails to renew the asylum ment. permit, registration at the educational institution automatically lapses. The paper is organized into five sections. Section Two positions At the tertiary level, migrants also face prohibitive costs espe- debates about the migration of skilled health professionals within a cially at universities. Under the terms of the SADC Protocol, students wider literature that discusses the international mobility of talent. from Zimbabwe are charged the same fees as their local counterparts. Section Three reviews research on the global circulation of health pro- However, Zimbabwean students enrolled at tertiary institutions generally fessionals, focusing in particular upon debates relating to the experience have to fund their own studies. South African students have access to of countries in the developing world. Section Four moves the focus from bursaries but Zimbabwean students do not, as citizenship is a pre- international to South African issues and provides new empirical mate- condition for bursary support: rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. It’s difficult to get a scholarship if you are a foreigner. At our Section Five addresses the questions of changing policy interventions in university we get a lot of information on bursaries and how South Africa towards the outflow of skilled health professionals and the to apply for them. But most of them are meant for South recruitment of foreign health professionals to work in South Africa. The African students….there is very little for foreigners. The competition for refugee bursaries is too intense as there are only a few that are offered…last year I was in the top 5 % in

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EXECUTIVE SmyUMMARY class, but I failed to get a bursary…that’s how tough it is. Now I owe the university close to R30 000 and I do not thinkealth that nextworkers year are they one will of allowthe categories me to register. of skilled60 profession- Migrantsals who most are affected accepted by at globalization. local colleges Over and universitiesthe past decade, frequent- ly fail to takethere up theirhas emerged offers as athey substantial are unable body to ofraise research the required that tracks fees. HThose that findpatterns the moneyof international to register migration often terminate of health their personnel, studies before theyassesses finish causes their and programmes consequences, due to and mounting debates debt.policy Some responses interrupt at global their studiesand national and find scales. work Within in the hopethis literature, that they thecan caseraise of enough South moneyAfrica tois comeattracting back growingto school interest. again.61 For almost 15 years South Africa has been theAnother target of hurdle a ‘global that raiding’ Zimbabwean of skilled migrants professionals face in byaccessing several educadevel-- tionoped in countries. South Africa How is to the deal issue with of thethe consequencesaccreditation ofof theirthe resultant foreign out- qualifications.flow of health Southprofessionals African is law a core requires policy that issue students for the must national have gov- their qualificationsernment. evaluated by the South African Qualifications Evaluation AuthorityThis paper (SAQA). aims toIn toorder examine to get policy a certificate debates of and evaluation, issues concerning documents havethe migration to be sent of to skilled Pretoria, health the professionalsonly centre that from handles the country such evaluations and to infurnish the country. new insights This is on a costlythe recruitment process for patterns migrants: of skilled health personnel. The objectives of the paper are twofold: •I earn To provide very little an auditmoney, of butthe Iorganization hope to go toand school patterns so that of recruit- inment future of my skilled life wouldprofessionals improve. from My South major Africaproblem in isthe that health ofsector. the SAQA The paper certificate draws which upon Ia dodetailed not have. analysis It is ofexpensive recruitment foradvertising me…I can appearing not afford in the the R500 South that African I may Medicalneed to haveJournal for thethe whole period process 2000-2004 done. andI have a series applied of interviewsto two government conducted with institutions,private recruiting but they enterprises. keep turning me down, asking me to •have Based my upon qualifications the above done analysis first. and Without additional that certificateinterviews I with 62 knowkey stakeholdersI will not get in the the place. South African health sector, the paper The offersrespondents a series also of recommendationsindicated that the for evaluation addressing takes the an problem inordi- of nately longskilled time, health sometimes migration. as long These as four recommendations months. While arethey grounded wait for the processin both to be South completed, African they experience lose opportunities and an interrogation to apply for ofand inter- be acceptednational into educational debates and institutions. ‘good policy’ practice for regulating recruitment. The paper is organized into five sections. Section Two positions Conclusions and Recommendations debates about the migration of skilled health professionals within a wider literaturehis report that has discusses identified the someinternational of the obstacles mobility which of talent. Section ThreeZimbabweans reviews researchface in accessing on the global public circulation educational of institutionshealth professionals,in focusing South Africa. in particular There uponis clearly debates considerable relating to“gatekeeping” the experience at of countriesschools in the which developing precludes world. some Section children Four from moves getting the an focus educa from- Ttion.international Zimbabwean to South parents African are forced issues to and adopt provides other newstrategies empirical to get mate- their childrenrial drawn into from school. the survey These ofinclude recruitment turning patterns to the private and key system, interviews putting theirundertaken children with in non-neighbourhoodhealth sector recruiters schools operating or sending in South them Africa. back to Zimbabwe,Section Five all addresses of which themean questions significant of changing additional policy financial interventions hardship. in TheSouth result, Africa in towardsan alarming the outflowproportion of skilledof cases, health is that professionals children do and not the gorecruitment to school atof all.foreign Given health that professionalsmost Zimbabweans to work are in in South South Africa. Africa The to make a living (and contribute significantly to the South Africa economy),

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EXECUTIVE SUMMARY it would be an appropriate neighbourly gesture for South Africa to agree to educate Zimbabwean children in the country until such time as condi- ealth workers are one of the categories of skilled profession- tions in that country permit their parents or guardians to return home. als most affected by globalization. Over the past decade, However, appeals to the “goodwill” of South Africans are unlikely to be there has emerged a substantial body of research that tracks successful given the pervasiveness of anti-foreign (and anti-Zimbabwean) patterns of international migration of health personnel, sentiment in the country. H As a result, the criteria for all decisions about who should be edu- assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is cated in South Africa should be referred to the international conventions attracting growing interest. For almost 15 years South Africa has been which the South African government has ratified and its own Bill of the target of a ‘global raiding’ of skilled professionals by several devel- Rights. These instruments all agree that education cannot be denied to oped countries. How to deal with the consequences of the resultant out- any child in South Africa on the basis of their or their parents or guard- flow of health professionals is a core policy issue for the national gov- ians’ nationality. All children in South Africa should have the same right ernment. of access to education as South African children. In discussions around This paper aims to to examine policy debates and issues concerning the Children’s Act, the Department of Social Development argued that the migration of skilled health professionals from the country and to there was no need to build in special protection for migrant children furnish new insights on the recruitment patterns of skilled health per- because the Act applies to all children, regardless of origin or national- sonnel. The objectives of the paper are twofold: ity. The research for this paper calls this argument into question and also • To provide an audit of the organization and patterns of recruit- demonstrates that government and schools are, in practice, regularly in ment of skilled professionals from South Africa in the health violation of the UN Convention on the Rights of the Child, the African sector. The paper draws upon a detailed analysis of recruitment Charter on the Rights of the Child and the Bill of Rights. advertising appearing in the South African Medical Journal for The national policy and legislative framework around school admis- the period 2000-2004 and a series of interviews conducted with sion not only appears to violate the Convention, Charter and Bill of private recruiting enterprises. Rights at points but is also contradictory. The Immigration Act, in par- • Based upon the above analysis and additional interviews with ticular, unfairly places the burden of immigration enforcement on schools key stakeholders in the South African health sector, the paper and also makes schools unsafe spaces for children. It is not unreasonable offers a series of recommendations for addressing the problem of for government schools to ask for identity documentation (but not neces- skilled health migration. These recommendations are grounded sarily birth certificates) and proof of immunization. But to use non-com- in both South African experience and an interrogation of inter- plianceor a lack of documentation to single out non-South African stu- national debates and ‘good policy’ practice for regulating recruit- dents, relegating them to the bottom of enrolment lists or denying them ment. access altogether is unacceptable. The Department of Education’s legisla- The paper is organized into five sections. Section Two positions tion from the 1990s and the Immigration Act need to be re-examined debates about the migration of skilled health professionals within a for their constitutionality. It is troubling that the regulations for school wider literature that discusses the international mobility of talent. admission on the Department of Education website make reference to a Section Three reviews research on the global circulation of health pro- piece of legislation, the Aliens Control Act, that was repealed as long ago fessionals, focusing in particular upon debates relating to the experience as 2002. of countries in the developing world. Section Four moves the focus from Educational administrators, principals and governing bodies also need international to South African issues and provides new empirical mate- clear and unambiguous direction from government that the best inter- rial drawn from the survey of recruitment patterns and key interviews ests of the child should be the operative principle in all decisions about undertaken with health sector recruiters operating in South Africa. admission and that they should not discriminate against foreign children. Section Five addresses the questions of changing policy interventions in At present, there is far too much inconsistency and discretion and, as a South Africa towards the outflow of skilled health professionals and the result, discrimination. Others are quick to use unconstitutional regula- recruitment of foreign health professionals to work in South Africa. The tions and directives to deny Zimbabwean and other children access to their schools.As this report shows, the problems do not diminish for

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EXECUTIVEstudentsSUMMARY seeking to access training in the tertiary education sector in South Africa. This reportealth confirms workers that are Zimbabweanone of the categories children ofare skilled often singledprofession- out in the classroomals most by bothaffected teachers by globalization. and fellow students Over the for past being decade, foreign. This verbal therebullying has is emerged fundamentally a substantial antithetical body ofto researchthe positive that edu tracks- cational experiencepatterns promisedof international all children migration in the of country. health Thepersonnel, fact that Hthere are students in South African schools who are bent on taunting assesses causes and consequences, and debates policy responses at global andand verballynational abusing scales. Withinforeign studentsthis literature, is an indictment, the case of Southnot of theAfrica chil is- drenattracting themselves, growing but interest. of their For parents almost and 15 South years SouthAfrican Africa society has in beengener- al.the Teachers target of need a ‘global to educate raiding’ South of skilled African professionals pupils that by migrant several students devel- areoped just countries. like them How and todeserve deal with to be the treated consequences with respect. of the As resultant for teach out-- ersflow who of healthtake part professionals in xenophobia is a coreagainst policy students issue forthat the they national teach, gov-it is worthernment. asking whether such teachers even have a place in South African schools.This Manypaper aimsmigrant to tochildren examine come policy from debates a tortured and issuespast and concerning what they needthe migration is to be welcomed of skilled ratherhealth than professionals abused; to from be understoodthe country rather and to than harassed;furnish new and insights to be made on the part recruitment of the school patterns rather of than skilled to behealth continu per-- ouslysonnel. reminded The objectives that they of do the not paper belong. are twofold: The• ToSouth provide African an auditgovernment of the organizationis obliged by andits own patterns legislation, of recruit- as well as thement values of skilled enshrined professionals in the Bill from of Rights,South Africato counter in the xenophobia. health The Preamblesector. toThe the paper 2002 draws Immigration upon a Actdetailed notes analysis that the of legislationrecruitment aims to putadvertising in place appearing a system ofin immigration the South African control Medicalin which, Journal amongst for other things,the period “xenophobia 2000-2004 is prevented and a series and of countered interviews both conducted within with Governmentprivate and recruiting civil society.” enterprises. Section 2(1)(e) of the Act states that the •Department Based upon of Home the above Affairs analysis will prevent and additional and deter interviews xenophobia with within thekey Department, stakeholders any in the sphere South of governmentAfrican health or organsector, of the State paper and at communityoffers alevel. series In of order recommendations to achieve this, for government addressing thewill problem“educate of communitiesskilled and health organs migration. of civil society These onrecommendations the rights of foreigners, are grounded illegal foreignersin andboth refugees, South African and conduct experience other andactivities an interrogation to prevent xenophoof inter-- bia” (Sectionnational 2(2)(e). debates Further, and ‘good Section policy’ 3(1)(f) practice commits for regulatingthe Department recruit- of Homement. Affairs to “organise and participate in community fora or other community-basedThe paper is organized organisation into tofive deter sections. xenophobia” Section and Two educate positions the citi- zenrydebates in aboutmigration the migrationissues. of skilled health professionals within a widerTackling literature xenophobia that discusses in the theschools international would be mobilitya substantial of talent. step towardsSection producingThree reviews the educated,research on tolerant the global and acceptingcirculation South of health African pro- citizenryfessionals, envisaged focusing byin theparticular Act and upon the debatesBill of Rights.A relating greatto the deal experience can be learnedof countries from inthe the example developing of schools world. like Section Claireville Four movesPrimary the in focusDurban. from Theinternational school opened to South its doors African to foreignissues and students provides in 1997, new empiricalwhen three mate- pupilsrial drawn from from the DRC the survey began ofattending. recruitment Now patterns one-third and of key the interviews 768 pupils areundertaken from other with African health countries, sector recruiters with the operating South African in South pupils Africa. coming mainlySection from Five a addresses nearby informal the questions settlement.The of changing two policy groups interventions are extremely in friendlySouth Africa and mix towards well. Principalthe outflow Sam of Bhairopersadskilled health recalls professionals that “we and were the therecruitment first school of foreignin Durban health to open professionals our doors to to work students in South from Africa.other coun The- tries - other schools around here were scared. We felt that these are

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EXECUTIVE SUMMARY children like all others and they also needed good education, and we could not deny them the right to education.”63 Schools need to become ealth workers are one of the categories of skilled profession- refuges from xenophobia rather than sites for its perpetuation. als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks Endnotes patterns of international migration of health personnel, H 1 J. Jansen, “Zim Can Teach Us a Thing or Two: That Country’s Schools Work, assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Its Teachers Really Teach” Sunday Times 2 December 2010. attracting growing interest. For almost 15 years South Africa has been 2 J. Crush et al, The Perfect Storm: The Realities of Xenophobia in Contemporary the target of a ‘global raiding’ of skilled professionals by several devel- South Africa, SAMP Migration Policy Series No 50, Cape Town, 2008. oped countries. How to deal with the consequences of the resultant out- 3 L. Chisholm, “The State of South Africa’s Schools” In J. Lutchman and R. flow of health professionals is a core policy issue for the national gov- Southall, eds., State of the Nation: South Africa 2004-2005 (Pretoria: HSRC ernment. Press, 2005); F. Hunt, “Policy in Practice: Teacher-Student Conflict in South This paper aims to to examine policy debates and issues concerning African Schools” In M. Dunne and F. Leach, eds., Education, Conflict and the migration of skilled health professionals from the country and to Reconciliation (Peter Lang Publishers, 2007); M. Lumadi, “Teachers’ Exodus furnish new insights on the recruitment patterns of skilled health per- in South African Schools: A Smoke With Burning Fire” Issues in Education sonnel. The objectives of the paper are twofold: Research 1 (2008); K. Milner and H. Khoza, “A Comparison of Teacher Stress • To provide an audit of the organization and patterns of recruit- and School Climate across Schools with Different Matric Success Rates” South ment of skilled professionals from South Africa in the health African Journal of Education 28 (2008). sector. The paper draws upon a detailed analysis of recruitment 4 C. Fritsch, E. Johnson and A. Juska, “The Plight of Zimbabwean advertising appearing in the South African Medical Journal for Unaccompanied Refugee Minors in South Africa: A Call for Comprehensive the period 2000-2004 and a series of interviews conducted with Legislative Action” Denver Journal of International Law and Policy 38 (2010): private recruiting enterprises. 623. • Based upon the above analysis and additional interviews with 5 J. Crush and D. Tevera, eds., Zimbabwe’s Exodus: Crisis, Migration, Survival key stakeholders in the South African health sector, the paper (Cape Town and Ottawa: SAMP and IDRC, 2010). offers a series of recommendations for addressing the problem of 6 P. Christie, “The Complexity of Human Rights in Global Times: The Case of skilled health migration. These recommendations are grounded the Right to Education in South Africa” International Journal of Educational in both South African experience and an interrogation of inter- Development 30 (2010): 3-11. national debates and ‘good policy’ practice for regulating recruit- 7 See http://www.un.org/documents/ga/res/44/a44r025.htm ment. 8 See http://www.africa-union.org/Official_documents/Treaties_%20 The paper is organized into five sections. Section Two positions Conventions_%20Protocols/A.%20C.%20ON%20THE%20RIGHT%20 debates about the migration of skilled health professionals within a AND%20WELF%20OF%20CHILD.pdf wider literature that discusses the international mobility of talent. 9 See http://www.info.gov.za/documents/constitution/1996/96cons2.htm Section Three reviews research on the global circulation of health pro- 10 L. Lake and S. Pendlebury, “Children’s Right to Basic Education” In S. fessionals, focusing in particular upon debates relating to the experience Pendlebury, L. Lake and C. Smith, eds., South African Child Gauge 2008/2009 of countries in the developing world. Section Four moves the focus from (Cape Town: UCT Children’s Institute, 2009), p. 19. international to South African issues and provides new empirical mate- 11 Ibid. rial drawn from the survey of recruitment patterns and key interviews 12 http://www.info.gov.za/acts/1996/a27-96.pdf undertaken with health sector recruiters operating in South Africa. 13 http://www.info.gov.za/acts/1996/a84-96.pdf Section Five addresses the questions of changing policy interventions in 14 http://www.polity.org.za/polity/govdocs/notices/1998/not98-2432.html South Africa towards the outflow of skilled health professionals and the 15 http://www.home-affairs.gov.za/PDF/Acts/Refugees%20Act130.pdf recruitment of foreign health professionals to work in South Africa. The 16 http://www.info.gov.za/view/DownloadFileAction?id=68047 17 T. Polzer, “Education Access for Non-Citizens in Border Areas” Discussion

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EXECUTIVEBrief for NationalSUMMARY Department of Education, Forced Migration Studies Program, Wits University, Johannesburg, 2007. 18 Ibid. ealth workers are one of the categories of skilled profession- 19 http://www.info.gov.za/view/DownloadFileAction?id=67892als most affected by globalization. Over the past decade, 20 Children’s Bill Workingthere has Group, emerged Joint a Submissionsubstantial bodyon the of Children’s research that Bill tracksto the Portfolio Committeepatterns on Social of international Development, migration Cape Town, of health July personnel,2004 athttp:// www.ci.org.za/depts/ci/plr/pdf/subs/jul04/cbill_working_group.pdfH assesses causes and consequences, and debates policy responses at global 21 N. Machingambiand national and scales. S. Ralekwa, Within this“Children’s literature, Bill: the Foreign case of South Africa is Children”Submissionattracting growing to Nationalinterest. ForCouncil almost of 15Provinces, years South South Africa African has been Parliament,the target 2005. of a ‘global raiding’ of skilled professionals by several devel- 22 Refugeeoped Rights countries. Project, How UCT, to dealSubmission with the to consequences the Portfolio Committeeof the resultant on out- Socialflow Development of health professionals on the Children’s is a core Amendment policy issue Bill for [B19B-2006], the national Capegov- Town,ernment. 2007 athttp://www.ci.org.za/depts/ci/plr/pdf/subs/aug07/UCT%20 Law%20Clinic%20Submission%20on%20B19B-2006.pdfThis paper aims to to examine policy debates and issues concerning 23 I. Palmary,the migration For Better of Implementationskilled health professionals of Migrant Children’sfrom the country Rights inand to Southfurnish Africa. new Report insights for UNICEF, on the recruitment Forced Migration patterns Studies of skilled Programme, health per- Johannesburg,sonnel. The 2009, objectives p. 11. of the paper are twofold: 24 Submission• by To Lawyers provide for an Human audit of Rights the organization to Public Hearings and patterns on the of Children’srecruit- Amendment mentBill, Gauteng, of skilled 25 professionals October 2006 from at Southhttp://www.ci.org.za/depts/ci/ Africa in the health plr/pdf/publichearings/gauteng/Submissions/LHRSubmissionOctober2006.pdfsector. The paper draws upon a detailed analysis of recruitment 25 Ibid. advertising appearing in the South African Medical Journal for 26 D. Timngum,the “Assisting period 2000-2004Urban Refugee and Childrena series of in interviews South Africa: conducted with Humanitarianprivate Challenges recruiting to State enterprises. and Non-state Actors” M.A. Thesis, University• of BasedWitwatersrand, upon the aboveJohannesburg analysis 2001;and additional .L. Stone interviewsand S. with Winterstein, key“A Right stakeholders or a Privilege? in the SouthAccess African to Basic health Education sector, for the paper Refugee and offersAsylum-Seeker a series of Children recommendations in South Africa”for addressing Report thefor Nationalproblem of Consortium forskilled Refugee health Affairs, migration. Johannesburg, These recommendations 2003; F. Belvedere, are National grounded Refugee Baselinein bothSurvey South: Final African Report, experienceCommunity and Agency an interrogation for Social Enquiry of inter- (CASE), Pretoria,national 2003; debates S. Motha, and ‘good “The policy’Education practice Rights for of regulating Refugees, recruit- Asylum Seekersment. and Migrants in South Africa” Education Rights Project, Wits EducationThe Policy paper Unit, is organized Johannesburg, into five 2005. sections. Section Two positions 27 Consortiumdebates for about Refugees the migration and Migrants of skilled in South health Africa professionals (CoRMSA), within a “Protectingwider literatureRefugees, thatAsylum discusses Seekers the and international Immigrants mobility in South of Africa” talent. Johannesburg,Section Three 2009. reviews research on the global circulation of health pro- 28 B. Fleisch,fessionals, J. Shindler focusing and in H. particular Perry, “Children upon debates Out of relating School: to Evidence the experience from the Communityof countries Survey” in the developingIn S. Pendlebury, world. L. Section Lake and Four C. moves Smith, the eds., focus South from Africaninternational Child Gauge to 2008/2009 South African (Cape issues Town: and UCT provides Children’s new empiricalInstitute, 2009),mate- p. 43.rial drawn from the survey of recruitment patterns and key interviews 29 CoRMSA,undertaken “Protecting with healthRefugees, sector Asylum recruiters Seekers operating and Immigrants in South inAfrica. South Africa”,Section pp. 96-7. Five addresses the questions of changing policy interventions in 30 CoRMSA,South “Protecting Africa towards Refugees, the outflow Asylum of Seekers skilled healthand Immigrants professionals in South and the Africa”recruitment of foreign health professionals to work in South Africa. The 31 L. Landau, “Protection and Dignity in Johannesburg: Shortcomings of South

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EXECUTIVE SUMMARY Africa’s Urban Refugee Policy” Journal of Refugee Studies 19(3)(2006): 308- 27; T. Schreier, “A Critical Examination of South Africa’s Application of the ealth workers are one of the categories of skilled profession- Expanded OAU Refugee Definition: Is Adequate Protection Being Offered als most affected by globalization. Over the past decade, Within the Meaning of the 1969 OAU Refugee Convention” LL.M. Thesis, there has emerged a substantial body of research that tracks University of Cape Town, 2008; D. Vigneswaran, “A Foot in the Door: Access patterns of international migration of health personnel, to Asylum in South Africa” Refuge 25(2) (2008): 41-52; R. Amit, “Protection H and Pragmatism: Addressing Administrative Failures in South Africa’s Refugee assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Status Determination Decisions” Forced Migration Studies Programme, Wits attracting growing interest. For almost 15 years South Africa has been University, 2010. the target of a ‘global raiding’ of skilled professionals by several devel- 32 http://www.unhcr.org/cgi-bin/texis/vtx/page?page=49e485aa6 oped countries. How to deal with the consequences of the resultant out- 33 T. Polzer, “Silence and Fragmentation: South African Responses to flow of health professionals is a core policy issue for the national gov- Zimbabwean Migration” In Crush and Tevera, Zimbabwe’s Exodus, pp. 383. ernment. 34 Crush et al, The Perfect Storm, p. This paper aims to to examine policy debates and issues concerning 35 F. Khan, “Local Integration: Lessons Learned and the Way Forward” Refugee the migration of skilled health professionals from the country and to Rights Project, University of Cape Town, Cape Town, 2007. furnish new insights on the recruitment patterns of skilled health per- 36 Crush et al, The Perfect Storm, p. sonnel. The objectives of the paper are twofold: 37 S. Vally and Y. Dalamba, “Racism, ‘Racial Integration’ and Desegregation • To provide an audit of the organization and patterns of recruit- in South African Public Secondary Schools” South African Human Rights ment of skilled professionals from South Africa in the health Commission, Braamfontein, 1999; B. Mda and M. Mothata, Critical Issues sector. The paper draws upon a detailed analysis of recruitment in South African Education After 1994 (Kenwyn: Juta, 2000); J. Jansen, advertising appearing in the South African Medical Journal for “Dealing with Difference in South Africa: A Critical Review of Literature and the period 2000-2004 and a series of interviews conducted with Experiences on Racism, Prejudice and Xenophobia in South African Schools” private recruiting enterprises. Soul Buddyz Series No 2, Soul City, Johannesburg, 2001. • Based upon the above analysis and additional interviews with 38 R. Osman, “The Phenomenon of Xenophobia as Experienced by Immigrant key stakeholders in the South African health sector, the paper Learners in Inner City Schools of Johannesburg” M.Ed. Thesis, UNISA, 2009. offers a series of recommendations for addressing the problem of 39 S. Motha and B. Ramadiro, “Education Rights of Migrants in the Inner City of skilled health migration. These recommendations are grounded Johannesburg, South Africa” Wits Education Policy Unit and Khanya College, in both South African experience and an interrogation of inter- Johannesburg, 2005, p. 19. national debates and ‘good policy’ practice for regulating recruit- 40 T. Livesey, “A Study on the Extent of Xenophobia Towards Refugee Children” ment. M.Diaconiology Thesis, UNISA, 2006. The paper is organized into five sections. Section Two positions 41 A. Hill, “Youth Attitudes to Foreigners in South Africa: The Impact of the debates about the migration of skilled health professionals within a Post-Apartheid Education System” MSc Thesis, Oxford University, 2010. wider literature that discusses the international mobility of talent. 42 J. Crush and G. Tawodzera, “Medical Xenophobia and the Access of Section Three reviews research on the global circulation of health pro- Zimbabwean Migrants to Health Services in South Africa” SAMP Migration fessionals, focusing in particular upon debates relating to the experience Policy Series No 54, Cape Town, 2011. of countries in the developing world. Section Four moves the focus from 43 Lawyers for Human Rights (LHR) and CoRMSA, Joint Submission to the international to South African issues and provides new empirical mate- Portfolio Committee on Basic Education on the Difficulties faced by Refugees, rial drawn from the survey of recruitment patterns and key interviews Asylum Seekers and Other Foreign Migrant Children in Accessing Education, undertaken with health sector recruiters operating in South Africa. Cape Town, February 2010. Section Five addresses the questions of changing policy interventions in 44 Interview No 30, Du Noon, Cape Town, 25th August 2010 South Africa towards the outflow of skilled health professionals and the 45 Crush and Tawodzera, “Access of Zimbabwean Migrants to Health Services in recruitment of foreign health professionals to work in South Africa. The South Africa.” 46 Interview No 11, Observatory, Cape Town, 23rd August 2010

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47EXECUTIVE K. Hall andS UMMARYS. Giese, “Addressing Quality through School Fees and School Funding” In S. Pendlebury, L. Lake and C. Smith, eds., South African Child Gauge 2008/2009ealth (Cape workers Town: areUCT one Children’s of the categories Institute, of 2009), skilled p. profession- 36. 48 Ibid. als most affected by globalization. Over the past decade, 49 Ibid. there has emerged a substantial body of research that tracks 50 LHR and CoRMSA,patterns “Joint of Submissioninternational to migrationthe Portfolio of healthCommittee personnel, on Basic Education”H p. 4. assesses causes and consequences, and debates policy responses at global 51 Interviewand nationalNo 10, Observatory, scales. Within Cape this Town, literature, 23rd Augustthe case 2010 of South Africa is 52 Participantattracting in Focus growing Group interest. Discussion, For almost Alexandra, 15 years Johannesburg, South Africa 1st has been Septemberthe target 2010 of a ‘global raiding’ of skilled professionals by several devel- 53 Participantoped countries. in Focus Group How to Discussion, deal with Alexandra,the consequences Johannesburg, of the resultant 1st out- Septemberflow of 2010 health professionals is a core policy issue for the national gov- 54 Interviewernment. No 85, Alexandra, Johannesburg, 1st September 2010 55 Focus GroupThis Discussion,paper aims toOrange to examine Farm, Johannesburg,policy debates 2ndand Septemberissues concerning 2010 56 Interviewthe migration No 99, Orange of skilled Farm, health Johannesburg, professionals 3rd from September the country 2010 and to 57 Interviewfurnish No new 47, Masimphumelele,insights on the recruitment Cape Town, patterns 29th August of skilled 2010 health per- 58 F. Bidandisonnel. and The A. objectivesWamundiya, of “Evaluatingthe paper are Refugee twofold: Access to Institutions of Higher• Learning To provide in South an audit Africa” of theUnity organization for Tertiray and Refugee patterns Students, of recruit- University of mentWestern of skilled Cape, professionalsnd. from South Africa in the health 59 Interview Nosector. 36, Masimphumelele, The paper draws Cape upon Town, a detailed 27th analysisAugust 2010of recruitment 60 Interview Noadvertising 6, Observatory, appearing Cape inTown, the South23rd August African 2010 Medical Journal for 61 Focus Group theDiscussion, period 2000-2004 Observatory, and Cape a series Town, of interviews 4th September conducted 2010 with 62 Interview Noprivate 50, Masimphumelele, recruiting enterprises. Cape Town, 5th September 2010 63 ”School a• Refuge Based from upon Xenophobia” the above analysis IRIN 24 and November additional 2009. interviews with key stakeholders in the South African health sector, the paper Migration Poliofferscy a Sserieseries of recommendations for addressing the problem of skilled health migration. These recommendations are grounded 1. Covert Operations:in both ClandestineSouth African Migration, experience Temporary and an interrogationWork and Immigration of inter- Policy in Southnational Africa debates (1997) andISBN ‘good 1-874864-51-9 policy’ practice for regulating recruit- 2. Riding the Tiger:ment. Lesotho Miners and Permanent Residence in South Africa (1997) ISBNThe paper 1-874864-52-7 is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a 3. International Migration, Immigrant Entrepreneurs and South Africa’s Small wider literature that discusses the international mobility of talent. Enterprise Economy (1997) ISBN 1-874864-62-4 Section Three reviews research on the global circulation of health pro- 4. Silencedfessionals, by Nation focusing Building: in particular African Immigrantsupon debates and relating Language to the Policy experience in the New Southof countries Africa in (1998) the developing ISBN 1-874864-64-0 world. Section Four moves the focus from 5. Left Outinternational in the Cold? to SouthHousing African and Immigration issues and provides in the New new South empirical Africa mate- (1998)rial ISBN drawn 1-874864-68-3 from the survey of recruitment patterns and key interviews 6. Tradingundertaken Places: Cross-Border with health Traderssector recruiters and the Southoperating African in South Informal Africa. Sector (1998)Section ISBN 1-874864-71-3Five addresses the questions of changing policy interventions in 7. ChallengingSouth AfricaXenophobia: towards Myth the outflowand Realities of skilled about health Cross-Border professionals Migration and the in Southernrecruitment Africa (1998) of foreign ISBN health 1-874864-70-5 professionals to work in South Africa. The

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EXECUTIVE SUMMARY 8. Sons of Mozambique: Mozambican Miners and Post-Apartheid South Africa (1998) ISBN 1-874864-78-0 ealth workers are one of the categories of skilled profession- 9. Women on the Move: Gender and Cross-Border Migration to South Africa als most affected by globalization. Over the past decade, (1998) ISBN 1-874864-82-9. there has emerged a substantial body of research that tracks 10. Namibians on South Africa: Attitudes Towards Cross-Border Migration and Hpatterns of international migration of health personnel, Immigration Policy (1998) ISBN 1-874864-84-5. assesses causes and consequences, and debates policy responses at global 11. Building Skills: Cross-Border Migrants and the South African Construction and national scales. Within this literature, the case of South Africa is Industry (1999) ISBN 1-874864-84-5 attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- 12. Immigration & Education: International Students at South African oped countries. How to deal with the consequences of the resultant out- Universities and Technikons (1999) ISBN 1-874864-89-6 flow of health professionals is a core policy issue for the national gov- 13. The Lives and Times of African Immigrants in Post-Apartheid South Africa ernment. (1999) ISBN 1-874864-91-8 This paper aims to to examine policy debates and issues concerning 14. Still Waiting for the Barbarians: South African Attitudes to Immigrants and the migration of skilled health professionals from the country and to Immigration (1999) ISBN 1-874864-91-8 furnish new insights on the recruitment patterns of skilled health per- 15. Undermining Labour: Migrancy and Sub-contracting in the South African sonnel. The objectives of the paper are twofold: Gold Mining Industry (1999) ISBN 1-874864-91-8 • To provide an audit of the organization and patterns of recruitment of skilled professionals from South Africa in the health 16. Borderline Farming: Foreign Migrants in South African Commercial sector. The paper draws upon a detailed analysis of recruitment Agriculture (2000) ISBN 1-874864-97-7 advertising appearing in the South African Medical Journal for 17. Writing Xenophobia: Immigration and the Press in Post-Apartheid South the period 2000-2004 and a series of interviews conducted with Africa (2000) ISBN 1-919798-01-3 private recruiting enterprises. 18. Losing Our Minds: Skills Migration and the South African Brain Drain (2000) • Based upon the above analysis and additional interviews with ISBN 1-919798-03-x key stakeholders in the South African health sector, the paper 19. Botswana: Migration Perspectives and Prospects (2000) ISBN 1-919798-04-8 offers a series of recommendations for addressing the problem of 20. The Brain Gain: Skilled Migrants and Immigration Policy in Post-Apartheid skilled health migration. These recommendations are grounded South Africa (2000) ISBN 1-919798-14-5 in both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruit- 21. Cross-Border Raiding and Community Conflict in the Lesotho-South African ment. Border Zone (2001) ISBN 1-919798-16-1 The paper is organized into five sections. Section Two positions 22. Immigration, Xenophobia and Human Rights in South Africa (2001) debates about the migration of skilled health professionals within a ISBN 1-919798-30-7 wider literature that discusses the international mobility of talent. 23. Gender and the Brain Drain from South Africa (2001) ISBN 1-919798-35-8 Section Three reviews research on the global circulation of health pro- 24. Spaces of Vulnerability: Migration and HIV/AIDS in South Africa (2002) fessionals, focusing in particular upon debates relating to the experience ISBN 1-919798-38-2 of countries in the developing world. Section Four moves the focus from 25. Zimbabweans Who Move: Perspectives on International Migration in international to South African issues and provides new empirical mate- Zimbabwe (2002) ISBN 1-919798-40-4 rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. 26. The Border Within: The Future of the Lesotho-South African International Section Five addresses the questions of changing policy interventions in Boundary (2002) ISBN 1-919798-41-2 South Africa towards the outflow of skilled health professionals and the 27. Mobile Namibia: Migration Trends and Attitudes (2002) ISBN 1-919798-44-7 recruitment of foreign health professionals to work in South Africa. The 28. Changing Attitudes to Immigration and Refugee Policy in Botswana (2003) ISBN 1-919798-47-1

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29.EXECUTIVE The New BrainSUMMARY Drain from Zimbabwe (2003) ISBN 1-919798-48-X 30. Regionalizing Xenophobia? Citizen Attitudes to Immigration and Refugee Policy in Southernealth Africa workers (2004) are ISBN one of1-919798-53-6 the categories of skilled profession- 31. Migration, Sexualityals most and HIV/AIDSaffected by inglobalization. Rural South Over Africa the (2004) past decade, ISBN 1-919798-63-3there has emerged a substantial body of research that tracks patterns of international migration of health personnel, 32. SwazilandH Moves: Perceptions and Patterns of Modern Migration (2004) assesses causes and consequences, and debates policy responses at global ISBN 1-919798-67-6 and national scales. Within this literature, the case of South Africa is 33. HIV/AIDSattracting and growingChildren’s interest. Migration For inalmost Southern 15 years Africa South (2004) Africa has been ISBNthe 1-919798-70-6 target of a ‘global raiding’ of skilled professionals by several devel- 34. Medicaloped Leave: countries. The Exodus How to of deal Health with Professionals the consequences from Zimbabweof the resultant (2005) out- ISBNflow 1-919798-74-9 of health professionals is a core policy issue for the national gov- 35. Degreesernment. of Uncertainty: Students and the Brain Drain in Southern Africa (2005) ISBNThis 1-919798-84-6paper aims to to examine policy debates and issues concerning 36. Restlessthe Minds: migration South of skilledAfrican health Students professionals and the Brain from Drainthe country (2005) and to ISBNfurnish 1-919798-82-X new insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: 37. Understanding Press Coverage of Cross-Border Migration in Southern Africa • To provide an audit of the organization and patterns of recruit- since 2000 (2005) ISBN 1-919798-91-9 ment of skilled professionals from South Africa in the health 38. Northern Gateway:sector. Cross-BorderThe paper draws Migration upon a Between detailed Namibiaanalysis ofand recruitment Angola (2005) ISBN advertising1-919798-92-7 appearing in the South African Medical Journal for 39. Early Departures:the period The Emigration 2000-2004 Potential and a series of Zimbabwean of interviews Students conducted (2005) with ISBN 1-919798-99-4private recruiting enterprises. 40. Migration• and Based Domestic upon Workers:the above Worlds analysis of andWork, additional Health andinterviews Mobility with in Johannesburgkey (2005) stakeholders ISBN 1-920118-02-0 in the South African health sector, the paper 41. The Quality ofoffers Migration a series Services of recommendations Delivery in South for addressing Africa (2005) the problem of ISBN 1-920118-03-9skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- 42. States of Vulnerability:national debates The Future and ‘good Brain policy’ Drain ofpractice Talent for to Southregulating Africa recruit- (2006) ISBN ment.1-920118-07-1 43. MigrationThe and paper Development is organized in Mozambique:into five sections. Poverty, Section Inequality Two positions and Survival (2006)debates ISBN about1-920118-10-1 the migration of skilled health professionals within a 44. Migration,wider literatureRemittances that and discusses Development the international in Southern mobility Africa of(2006) talent. ISBNSection 1-920118-15-2 Three reviews research on the global circulation of health pro- 45. Medicalfessionals, Recruiting: focusing The inCase particular of South upon African debates Health relating Care to Professionals the experience (2007)of ISBNcountries 1-920118-47-0 in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- 46. Voices From the Margins: Migrant Women’s Experiences in Southern Africa (2007) rial drawn from the survey of recruitment patterns and key interviews ISBN 1-920118-50-0 undertaken with health sector recruiters operating in South Africa. 47. The HaemorrhageSection Five of addresses Health Professionals the questions From of changingSouth Africa: policy Medical interventions Opinions in (2007)South ISBN Africa 978-1-920118-63-1 towards the outflow of skilled health professionals and the 48. The Qualityrecruitment of Immigration of foreign and health Citizenship professionals Services to in work Namibia in South (2008) Africa. The ISBN 978-1-920118-67-9

291 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Right to the Classroom: Educational Barriers for Zimbabweans in South Africa

EXECUTIVE SUMMARY 49. Gender, Migration and Remittances in Southern Africa (2008) ISBN 978-1-920118-70-9 ealth workers are one of the categories of skilled profession- 50. The Perfect Storm: The Realities of Xenophobia in Contemporary South Africa als most affected by globalization. Over the past decade, (2008) ISBN 978-1-920118-71-6 there has emerged a substantial body of research that tracks 51. Migrant Remittances and Household Survival in Zimbabwe (2009) Hpatterns of international migration of health personnel, ISBN 978-1-920118-92-1 2009 assesses causes and consequences, and debates policy responses at global 52. Migration, Remittances and ‘Development’ in Lesotho (2010) and national scales. Within this literature, the case of South Africa is ISBN 978-1-920409-26-5 attracting growing interest. For almost 15 years South Africa has been 53. Migration-Induced HIV and AIDS in Rural Mozambique and Swaziland (2011) the target of a ‘global raiding’ of skilled professionals by several devel- ISBN 978-1-920409-49-4 oped countries. How to deal with the consequences of the resultant out- 54. Medical Xenophobia: Zimbabwean Access to Health Services in South Africa flow of health professionals is a core policy issue for the national gov- (2011) ISBN 978-1-920409-63-0 ernment. 55. The Engagement of the Zimbabwean Medical Diaspora (2011) This paper aims to to examine policy debates and issues concerning ISBN 978-1-920409-64-7 the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: • To provide an audit of the organization and patterns of recruitment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. • Based upon the above analysis and additional interviews with key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded in both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruitment. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health professionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

1 30 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk Co-Published by:

southern AfriCAn MigrAtion ProgrAMMe Idasa and the University of Cape Town Cape Town, South Africa and Southern African Research Centre Kingston, Ontario, Canada

oPen soCiety initiAtive for southern AfriCA Johannesburg, South Africa