Diaspora Attitudes Towards South Africa

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Wilfrid Laurier University Scholars Commons @ Laurier

Southern African Migration Programme Reports and Papers

2012

No. 63: Dystopia and Disengagement: Diaspora Attitudes Towards South Africa

Jonathan Crush Balsillie School of International Affairs/WLU, [email protected]

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Recommended Citation Crush, J. (2012). Dystopia and Disengagement: Diaspora Attitudes Towards South Africa (rep., pp. i-25). Waterloo, ON: Southern African Migration Programme. SAMP Migration Policy Series No. 63.

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Dystopia anD Disengagement: Diaspora attituDes towarDs south africa

migration policy series no. 63 Dystopia anD Disengagement: Diaspora attituDes towarDs south africa

Jonathan crush

series eDitor: prof. Jonathan crush

southern african migration programme (samp) 2012 acknowleDgements The author is CIGI Chair in Global Migration and Development at the Balsillie School of International Affairs and Honorary Professor at the University of Cape Town. He wishes to thank the following for their assistance with the survey on which this report is based: Abel Chikanda, Mary Caesar, Wade Pendleton, Cassan- dra Eberhardt and Ashley Hill. The research was funded by the IDRC.

Printed by Megadigital, Cape Town contents page executive summary 1 introDuction 4 moving to canaDa 8 the kaplan view 13 conclusion 19 enDnotes 21 migration policy series 23

list of tables table 1: annual income of canaDian population anD 10 south african immigrants in canaDa table 2: assets in south africa by year of immigration to canaDa 11 table 3: cultural practices of south african canaDians 12 table 4: comparisons of canaDa anD south africa 13

list of figures figure 1: cartoon commentary on the huntley case 6 figure 2: immigration to canaDa from south africa, 1980–2009 8 MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4563

eExecutiveXECUTIVE sSummaryUMMARY

n 2008, Southealth workers African are Brandon one of Huntleythe categories was given of skilled refugee profession- status in ICanada byals the most Canadian affected Immigrationby globalization. and Over Refugee the Boardpast decade, (IRB). The unprecedentedthere decision, has emerged based a on substantial Huntley’s body claim of thatresearch as a thatwhite tracks South HAfrican he patternswas the ofvictim international of racial persecutionmigration of in health South personnel, Africa, caused aassesses firestorm. causes Interest and consequences, in the case was and particularly debates policy intense responses in South at globalAfrica itselfand national where the scales. decision Within was thisderided literature, in the themedia case and of Souththe South Africa African is governmentattracting growing lodged interest.a formal Forprotest almost with 15 the years Canadian South Africagovernment. has been Over 140the targethigh-profile of a ‘global South raiding’ African of academics skilled professionals also filed a by petition several protesting devel- theoped decision countries. with How the to Canadian deal with Highthe consequences Commission of in the Pretoria. resultant Within out- weeks,flow of thehealth Canadian professionals Minister is aof core Citizenship policy issue and forImmigration the national had gov- lodged anernment. appeal against the IRB decision with the Federal Court of Appeal. Some haveThis claimed paper thataims the to todecision examine of policythe Canadian debates andGovernment issues concerning to seek to overturnthe migration the decisionof skilled of health the IRB professionals was motivated from the by acountry desire and to appease to Southfurnish Africa. new insights This is on highly the recruitmentunlikely. Rather patterns, the of Canadian skilled health government per- wassonnel. concerned The objectives about the of precedent-settingthe paper are twofold: nature of the case and that it couldQ set +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H the stage for a flood of applications from similarly unskilled white South Africansment of seeking skilled professionalsa route into Canada. from South Africa in the health In latesector. 2010, The Justice paper James draws Russell upon of a thedetailed Federal analysis Court ofof recruitmentAppeal issued an extendedadvertising judgment appearing upholding in the theSouth Canadian African Medical government’s Journal appeal for and sendingthe period the Huntley 2000-2004 case and back a seriesto the of IRB interviews for reconsideration. conducted with The Supremeprivate Court recruitingof Canada enterprises. declined to hear an appeal of this judgment in mid-2012,Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< so the case will be got back to the IRB. Huntley’s lawyers are confidentkey of stakeholders a second success in the atSouth the African IRB, indicating health sector, that the the attentionpaper given tooffers his case a series will ofmake recommendations him a marked manfor addressing if he is returned the problem to South of Africa. However,skilled health Justice migration. Russell These provided recommendations a systematic and are painstakinggrounded demolitionin both of virtually South Africanevery element experience of the and original an interrogation IRB decision of inter-and it seems highlynational unlikely debates that and Huntley ‘good will policy’ ever practice be able tofor prove regulating that he recruit- quali- fies for refugeement. protection status in Canada. The case may still drag on for severalThe morepaper years, is organized however, into as five Huntley sections. would Section be entitled Two positions to institute a seconddebates round about ofthe appeals migration in the of courtsskilled if health his claim professionals is rejected within this time. a widerIn constructingliterature that a discussesnarrative theto convince international IRB judgemobility William of talent. Davis that heSection qualified Three for reviews protection research under on the the UN global Refugee circulation Convention, of health Huntley pro- andfessionals, his lawyers focusing attempted in particular to show upon that debates he had relatingbeen the to victim the experience of a series ofof countries racially-motivated in the developing personal world. assaults Section and that Four the moves state the had focus failed from in itsinternational duty to protect. to South None African of these issues supposed and provides attacks new were empirical ever reported mate- torial the drawn police from which the survey proved of rather recruitment awkward patterns for his and case. key However,interviews this wasundertaken explained with away health with sector the circular recruiters argument operating that in sinceSouth the Africa. police did nothingSection whenFive addresses whites were the questionsattacked, ofthere changing was no policy point interventions in reporting thein assaults.South Africa Huntley’s towards recounting the outflow of his of experiencesskilled health make professionals interesting and reading the butrecruitment they were of not, foreign in fact, health central professionals to the Davis to work decision. in South Africa. The

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EXECUTIVE SUMMARY Here we focus on what Davis called the “lifeline” of the Huntley decision: that is, the case made by Huntley’s lawyer, Russell Kaplan and his ealth workers are one of the categories of skilled profession- sister Lara Kaplan, that all whites in South Africa are being systematically als most affected by globalization. Over the past decade, targeted because of the colour of their skin. Justice Russell rejected this there has emerged a substantial body of research that tracks argument, and the selective evidence presented by the Kaplans, in its patterns of international migration of health personnel, entirety. He designated their portrayal of the situation in South Africa the H “Kaplan view.” The core elements of the Kaplan view included assertions assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is that all Black South Africans hated white South Africans; that the country attracting growing interest. For almost 15 years South Africa has been was experiencing “reverse apartheid; that black South Africans have “no the target of a ‘global raiding’ of skilled professionals by several devel- regard” for the lives of white South Africans; that most violent crimes are oped countries. How to deal with the consequences of the resultant out- committed by black against white South Africans; that the police will do flow of health professionals is a core policy issue for the national gov- nothing about the crimes committed against white South Africans; that ernment. white South Africans are undergoing a form of racial genocide; and that This paper aims to to examine policy debates and issues concerning there is systematic discrimination against whites in the workplace. Justice the migration of skilled health professionals from the country and to Russell concluded that the Kaplan view was rooted in the personal experi- furnish new insights on the recruitment patterns of skilled health per- ence of violent crime by the Kaplan family itself in South Africa. sonnel. The objectives of the paper are twofold: This paper argues that to attribute the Kaplan view purely to the nega- Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H tive personal experiences of the Kaplan family in South Africa is to take ment of skilled professionals from South Africa in the health too narrow an interpretation. The central elements of the Kaplan view are sector. The paper draws upon a detailed analysis of recruitment not unique to the Kaplan family but are produced and reproduced by the advertising appearing in the South African Medical Journal for white South African diaspora in Canada more generally. The evidence for the period 2000-2004 and a series of interviews conducted with this assertion comes from a survey of 1,485 South African immigrants in private recruiting enterprises. Canada conducted by SAMP in 2010, some 80% of whom had left South Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< Africa after 1990. key stakeholders in the South African health sector, the paper Between 1991 and 2006, just over 19,000 South Africans moved to offers a series of recommendations for addressing the problem of Canada, a migration that shows few signs of letting up. Most South African skilled health migration. These recommendations are grounded immigrants to Canada are white, highly skilled and educated with many in both South African experience and an interrogation of inter- professionals in their ranks. They enter Canada as permanent residents in national debates and ‘good policy’ practice for regulating recruit- the economic class. South Africans in Canada are high income earners. ment. For example, 26% of the survey respondents earn more than $200,000 a The paper is organized into five sections. Section Two positions year and 43% earn more than $100,000 (compared with only 6% of the debates about the migration of skilled health professionals within a overall Canadian population.) wider literature that discusses the international mobility of talent. The survey respondents reported visiting South Africa relatively often Section Three reviews research on the global circulation of health pro- (only 18% had never been back since arriving in Canada) although only fessionals, focusing in particular upon debates relating to the experience 20% return at least once a year. The rest make episodic visits and the vast of countries in the developing world. Section Four moves the focus from majority of all visits are connected with family issues and events. Most international to South African issues and provides new empirical mate- have family in South Africa to visit. Half of the respondents (54%) have rial drawn from the survey of recruitment patterns and key interviews taken out Canadian citizenship and another 30% are permanent residents. undertaken with health sector recruiters operating in South Africa. South Africans in Canada are neither large nor frequent remitters. Forty- Section Five addresses the questions of changing policy interventions in two percent had never remitted funds to South Africa and only 13% do so South Africa towards the outflow of skilled health professionals and the on a monthly basis. Patterns of asset holding in South Africa show system- recruitment of foreign health professionals to work in South Africa. The atic disinvestment over time. Allied to this pattern of disinvestment are low levels of interest in return migration to South Africa.

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EXECUTIVETheSUMMARY survey also collected information about the attitudes and perceptions of this group towards their country of origin. The dystopian views advanced byealth the Kaplanworkers view are onein the of Huntleythe categories case fit of comfortably skilled profession- within a broader narrativeals most about affected South by Africa globalization. by white Over South the Africans past decade, in Canada. A considerablethere number has emerged of survey a substantial respondents body portrayed of research South that Africa tracks as an extremelypatterns violent of society international in which migration whites liveof health in a constantpersonnel, state of Hfear and anxiety. Many argued that whites were targeted not because they assesses causes and consequences, and debates policy responses at global ownand nationala disproportionate scales. Within share thisof the literature, wealth in the a highlycase of unequal South Africa society, is but simplyattracting because growing of their interest. colour. For The almost idea 15that years the whiteSouth population Africa has isbeen under siegethe target because of aof ‘global their skin raiding’ colour of extendsskilled professionals well beyond bypersonal several knowledge devel- ofoped incidents countries. of crime How and to deal violence. with theThe consequences theme of racial of targetingthe resultant was drivout-- enflow home of health by the professionals frequent use is ofa coreterms policy such issueas “apartheid for the national in reverse” gov- and “reverseernment. discrimination.” Attacks on white farmers feature prominently in the Thisnarratives paper andaims are to toused examine as a platform policy debatesfor broader and commentaryissues concerning on the supposedthe migration brutality of skilled of Africa health and professionals all Africans. fromPersonal the countryand hearsay and tostories offurnish violent new crime insights were on laced the withrecruitment vituperative patterns accounts of skilled of the health callous per- and indifferentsonnel. The response objectives of the of thepolice paper and are the twofold: government. AnotherQ +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H recurrent complaint was how affirmative action discriminated against whites.ment of There skilled is professionals no sympathy from for or South understanding Africa in theof thehealth reasons for thesesector. policies The nor paper of how draws they upon personally a detailed might analysis have benefitedof recruitment educationally advertisingand economically appearing from in the the racist South policies African of theMedical apartheid Journal govern for - ment. Instead,the period they 2000-2004 represent themselves, and a series and of interviewswhites in general, conducted as victims. with In manyprivate cases, therecruiting sense of enterprises. outrage spills over into overtly racist diatribes aboutQ Africa 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< and Africans. To rationalisekey stakeholders their departure, in the South disengagement African health and sector, decision the neverpaper to return tooffers South a series Africa, of recommendations this post-apartheid for diaspora addressing draws the onproblem the same of narrativeskilled reservoir health of images migration. as the These lawyers recommendations in the Huntley case. are grounded It is therefore inadequatein both South to conclude African that experience the Huntley and an case interrogation was simply of a inter- rather egregiousnational but exceptional debates and miscarriage ‘good policy’ of justice. practice Huntley for regulating is, in many recruit- ways, emblematicment. of a more general and troubling discourse about South Africa thatThe circulates paper isamongst organized white into South five sections. Africans Sectionin Canada. 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 material 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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EXECUTIVE SUMMARY introDuction ealth workers are one of the categories of skilled profession- n mid-2004, South African Brandon Huntley entered Canada on a als most affected by globalization. Over the past decade, Itemporary residence permit in order to work as an amusement park there has emerged a substantial body of research that tracks attendant, having worked in Cape Town as a bartender, cleaner, parking Hpatterns of international migration of health personnel, lot attendant and lawn sprinkler salesman.1 He returned to South Africa assesses causes and consequences, and debates policy responses at global at the end of 2004 when his permit expired. In June 2005, he came to and national scales. Within this literature, the case of South Africa is Canada for a second time and worked for another 18 months with the attracting growing interest. For almost 15 years South Africa has been same company. After the expiry of this work permit at the end of 2007, he the target of a ‘global raiding’ of skilled professionals by several devel- remained in Canada illegally. He married (and later divorced) a Canadian oped countries. How to deal with the consequences of the resultant out- and unsuccessfully tried to enlist in the Canadian armed forces. Finally, in flow of health professionals is a core policy issue for the national gov- June 2008, more than a year after his work permit had expired, Huntley ernment. lodged an application for political asylum in Canada with the Immigration This paper aims to to examine policy debates and issues concerning and Refugee Board (IRB). In August 2008, he appeared before IRB judge, the migration of skilled health professionals from the country and to retired lawyer William Davis, along with his South African-born Toronto furnish new insights on the recruitment patterns of skilled health per- lawyer Russell Kaplan. Kaplan’s sister, Lara, appeared as a corroborating sonnel. The objectives of the paper are twofold: witness for Huntley. Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H Huntley, a former resident of the Cape Town suburb of Mowbray, ment of skilled professionals from South Africa in the health claimed to have been physically attacked a number of times since 1991. sector. The paper draws upon a detailed analysis of recruitment He claimed all these attacks were racially motivated, because his attack- advertising appearing in the South African Medical Journal for ers used derogatory racist epithets including “settler”, “Boer” and “white the period 2000-2004 and a series of interviews conducted with fuck.” Huntley had not reported any of the incidents to the police, arguing private recruiting enterprises. that the police were incompetent and racist and would do nothing when Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< a white person was attacked. The state’s supposed “failure to protect” key stakeholders in the South African health sector, the paper meant that he had a legitimate claim to refugee status in Canada. William offers a series of recommendations for addressing the problem of Davis concluded that “the evidence of the claimant and the witness and skilled health migration. These recommendations are grounded the documentary evidence shows a picture of indifference and inability in both South African experience and an interrogation of inter- or unwillingness of the government and the security forces to protect national debates and ‘good policy’ practice for regulating recruit- White South Africans from persecution by African South Africans.”2 ment. Huntley was “a victim because of his race (white South African) rather The paper is organized into five sections. Section Two positions than a victim of criminality” and his fear of persecution was real. Davis debates about the migration of skilled health professionals within a concluded, in a statement that was widely derided, that Huntley “would wider literature that discusses the international mobility of talent. stand out like a ‘sore thumb’ due to his colour in any part of the country.”3 Section Three reviews research on the global circulation of health pro- Davis’s extraordinary decision to grant Huntley refugee status in Canada fessionals, focusing in particular upon debates relating to the experience unleashed a firestorm of media attention, political protest and commentary of countries in the developing world. Section Four moves the focus from in the blogosphere.4 international to South African issues and provides new empirical mate- The Huntley decision was widely condemned and ridiculed in both rial drawn from the survey of recruitment patterns and key interviews Canada and South Africa (see Figure 1). In September 2009, 142 South undertaken with health sector recruiters operating in South Africa. African academics, including several university vice-chancellors and Section Five addresses the questions of changing policy interventions in deputy vice-chancellors, petitioned the Canadian High Commissioner in South Africa towards the outflow of skilled health professionals and the South Africa.5 The petition criticised the “outrageously distorted represen- recruitment of foreign health professionals to work in South Africa. The tation” of contemporary South Africa and suggested “the sad truth is that this case demonstrates not the perilous condition of white South Africans,

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EXECUTIVEbut theSUMMARY kinds of things some people are still willing to believe about Africa and Africans, based on assumptions that continue to circulate in the white worlds they ealthshare.” workers The Southare one African of the governmentcategories of initiallyskilled profession-accused the Canadian governmentals most affected of racism by globalization. until it was informed Over the that past thedecade, IRB is an independentthere body has and emerged that the aFederal substantial Government body of researchis not accountable that tracks for IRB decisionspatterns about ofrefugee international protection. migration The South of health Africans personnel, then lodged Han official complaint about the IRB decision through diplomatic channels. assesses causes and consequences, and debates policy responses at global andWithin national weeks scales. of Within the decision, this literature, Canadian the Immigration case of South Minister Africa Jasonis Kenneyattracting applied growing to theinterest. Federal For Court almost of 15 Appeal years Southfor a reviewAfrica ofhas the been decision.the target South of Africana ‘global Foreign raiding’ Affairsof skilled Minister professionals Nkosazana by several Dlamini-Zuma devel- claimedoped countries. that the How Canadian to deal government’s with the consequences decision to ofappeal the resultantthe IRB deciout-- sionflow “bearsof health testimony professionals to the is stronga core policy bilateral issue political for the relations national betweengov- ourernment. two countries.” 6 Conservative commentators sympathetic to Huntley sawThis this paperrather aimsas evidence to to examine of Canada policy bowing debates to politicaland issues correctness concerning and appeasementthe migration of of the skilled South health African professionals government. from However, the country It seems and tohighly unlikelyfurnish newthat insightsthe Canadian on the government’srecruitment patterns action had of skilled anything health to do per- with Southsonnel. African The objectives pressure asof the Harperpaper are government twofold: has consistently shown littleQ interest +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H in courting South Africa on any issue at all. What seems more likelyment is ofthat skilled the governmentprofessionals viewed from South the IRB Africa decision in the as health a danger- ous precedentsector. thatThe neededpaper draws to be upon contested. a detailed If allowed analysis to of stand, recruitment it would potentiallyadvertising have opened appearing the door in the to Southan unwanted African flood Medical of refugee Journal claims for from whitethe Southperiod Africans 2000-2004 like and Huntley. a series of interviews conducted with On 24private November recruiting 2010, enterprises. Justice James Russell of the Federal Court of AppealQ 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H

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EXECUTIVE SUMMARY Figure 1: Cartoon Commentary on the Huntley Case ealth workers are one of the categories of skilled professionals most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks Hpatterns of international migration of health personnel, 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 target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant outflow of health professionals is a core policy issue for the national government. This paper aims to to examine policy debates and issues concerning 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: Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H ment 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. Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< 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 material 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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EXECUTIVEForS UMMARYsome, the Huntley case confirms the “dysfunctional nature” of the refugee protection system in Canada.12 Four years after first lodging what most legal commentatorsealth workers wouldare one probably of the categories see as a “manifestly of skilled profession- unfounded” refugee claimals and most nine affected years afterby globalization. he first came Over to Canada the past on decade, a temporary work permit,there Huntley has emerged remains ain substantial the country. body There of research seems little that prospecttracks of a speedy patternsdeportation, of international the kind of migrationprotracted of outcome health personnel, which partially Hexplains, though hardly justifies, the single-minded determination of assesses causes and consequences, and debates policy responses at global theand Canadiannational scales. government Within to this impose literature, draconian the case restrictions of South on Africa would-be is refugeeattracting claimants growing entering interest. Canada. For almost13 Ironically, 15 years theSouth South Africa African has beenrefugee protectionthe target ofsystem a ‘global (modelled raiding’ to of some skilled degree professionals on the Canadian by several and devel- similar examples)oped countries. has the How opposite to deal problem: with the that consequences is, a widespread of the failure resultant to protect out- theflow rights of health of asylum professionals seekers iswho a core are policydeported issue to forother the countries national gov-in their tensernment. of thousands every year with a minimum of due process.14 AnotherThis paper important aims to toaspect examine of the policy case concernsdebates and the issuesnature concerning of the argu- mentthe migration advanced of inskilled support health of Huntley’sprofessionals claim from to the be country a “white and refugee.” to Whilefurnish the new hearing insights took on placethe recruitment in camera, therepatterns is sufficient of skilled documentation health per- insonnel. the public The objectivesdomain (especially of the paper in the are form twofold: of the IRB judge’s justification for Qhis decision +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H to grant refugee status and the court documents from the subsequentment Federal of skilled Court professionals appeal) to permitfrom South a fairly Africa detailed in thereconstruction health of the legalsector. strategy The paper adopted draws by uponHuntley’s a detailed lawyer analysis Russell of Kaplan recruitment and the argumentsadvertising advanced appearing in support in theof the South claim. African Here, Medical we must Journal distinguish for betweenthe the period actual 2000-2004details and andmerits a series of Huntley’s of interviews claim conductedfor refugee withstatus (which private are detailed recruiting in Justice enterprises. Russell’s judgment and are therefore not discussedQ 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< any further here) and the general narrative about South Africa constructedkey stakeholders by Russell and in the Lara South Kaplan, African which health Justice sector, Russell the atpaper different timesoffers labelled a series “the of Kaplanrecommendations view”, “the for Kaplan addressing family the view” problem and theof “Kaplanskilled family healthpoint of migration. view.” These recommendations are grounded This inreport both first South examines African the experience key elements and of an the interrogation “Kaplan view,” of inter- which Davis ofnational the IRB debates had described and ‘good as policy’ the “lifeline” practice offor the regulating Huntley recruit- case.15 Justice Russellment. saw the Kaplan view as emanating from the personal expe- riencesThe andpaper emotional is organized involvement into five sections.of Russell Section and Lara Two Kaplan positions including “thedebates fate about of his thebrother migration (in South of skilled Africa) health and the professionals close-knit, withinmutually-sup a - portivewider literature nature of that the discussesKaplan family.” the international16 Less charitably, mobility he ofnoted talent. that Lara Kaplan’sSection Threetestimony reviews was research“little more on thethan global a personal circulation view propagated of health pro- from withinfessionals, a prosperous focusing inand particular successful upon white debates South relating African to family the experience that, since theof countries end of apartheid, in the developing finds the ‘good world. life’ Section they lived Four before moves 1994 the notfocus as fromgood asinternational it was.”17 However, to South the African Kaplan issues view andcannot provides be adequately new empirical understood mate- if itrial is vieweddrawn frompurely the through survey the of recruitmentlens of the Kaplan patterns family’s and key own interviews experiences. Rather,undertaken it is with necessary health to sector situate recruiters the Kaplan operating view withinin South the Africa. context of theSection broader Five post-apartheid addresses the emigrationquestions of movement changing ofpolicy white interventions South Africans in toSouth Canada. Africa The towards key argument the outflow here of isskilled that thehealth Kaplan professionals representation and the of Southrecruitment Africa of as foreign dystopia health is completely professionals consistent to work with in aSouth broader Africa. narrative The about the country that circulates within the post-apartheid South African

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EXECUTIVE SUMMARY diaspora in Canada and beyond. The evidence for this assertion is to be found in a recent survey of the attitudes of ex-South Africans in Canada ealth workers are one of the categories of skilled profession- conducted by SAMP. als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks moving to canaDa patterns of international migration of health personnel, H ne of the major continuities in South Africa-Canada relations before assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Oand after the end of apartheid is the flow of human resources from attracting growing interest. For almost 15 years South Africa has been one to the other. Before 1990, Canada was one (albeit comparatively the target of a ‘global raiding’ of skilled professionals by several devel- minor) international refuge for opponents of the apartheid regime and oped countries. How to deal with the consequences of the resultant out- white liberals who were deeply pessimistic about the country’s future. The flow of health professionals is a core policy issue for the national gov- end of apartheid accelerated the flow of South Africans to Canada, and ernment. fundamentally changed the profile of the immigrants (Figure 2). Between This paper aims to to examine policy debates and issues concerning 1991 and 2006, just over 19,000 South Africans moved to Canada, bring- the migration of skilled health professionals from the country and to ing the total number to 40,000. Since then, between 1,200 and 1,400 furnish new insights on the recruitment patterns of skilled health per- South Africans have immigrated to Canada each year, raising the overall sonnel. The objectives of the paper are twofold: total nearer to 50,000. This steady movement shows few signs of letting Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H up. Russell and Lara Kaplan were born and raised in South Africa and ment of skilled professionals from South Africa in the health immigrated legally to Canada as adults, though at different times. Brandon sector. The paper draws upon a detailed analysis of recruitment Huntley did not. He was one of a small number of South Africans (less advertising appearing in the South African Medical Journal for than 2,000 in 2010) who migrate temporarily to Canada for work under the period 2000-2004 and a series of interviews conducted with the country’s rapidly-growing Temporary Foreign Worker Program.18 private recruiting enterprises. Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< Figure 2: Immigration to Canada from South Africa, 1980-2009 key stakeholders in the South African health sector, the paper 3 500 offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded 3 000 in both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruit- 2 500 ment.

The paper is organized into five sections. Section Two positions 2 000 debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. 1 500 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 1 000 international to South African issues and provides new empirical material drawn from the survey of recruitment patterns and key interviews 500 undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in 0 South Africa towards the outflow of skilled health professionals and the 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 recruitment of foreign health professionals to work in South Africa. The

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EXECUTIVEMostSUMMARY South African immigrants to Canada are highly skilled and educated with a disproportionate number of professionals in their ranks. They enter ealthCanada workers as permanent are one of residents the categories in the ofeconomic skilled profession- class, filling skills gaps inals the most Canadian affected labour by globalization. market. The Over post-apartheid the past decade, migration of professionalsthere and has other emerged skilled a substantialworkers from body South of research Africa to that the tracks United Kingdom, thepatterns United of States, international Australia, migration New Zealand of health and personnel, Canada is com- Hmonly viewed as a “brain drain” with negative impacts for South Africa.19 assesses causes and consequences, and debates policy responses at global Inand 2009, national South scales. Africa’s Within High this Commissioner literature, the tocase Canada, of South Dr Africa Abraham is Nkomo,attracting complained growing interest. publicly For that almost South 15 African years doctorsSouth Africa migrate has “at been a very highthe target cost” toof Southa ‘global Africa raiding’ causing of skilled “a huge professionals loss” of investment by several in education devel- andoped training. countries.20 Repeated How to deal efforts with by the the consequences South African of governmentthe resultant to out- get Canadaflow of healthto place professionals a moratorium is aon core the policy hiring issue (or poaching, for the national in its words) gov- of Southernment. African skills have met with little success.21 AThis more paper detailed aims to economic to examine and policy social debates profile and of issues the South concerning African diasporathe migration in Canada of skilled emerges health in professionals an online survey from the conducted country inand 2010 to by SAMP.furnish22 new The insights survey onwas the completed recruitment by 1,485 patterns respondents. of skilled Ofhealth these, per- 83% hadsonnel. emigrated The objectives to Canada of afterthe paper 1990. are The twofold: survey provided an opportunity for Q respondents +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H to elaborate in writing on issues such as why they left South Africa,ment ofwhy skilled they professionalscame to Canada, from what South links Africa they in maintained the health with South Africasector. and The whether paper drawsthey would upon evera detailed return analysis to South of Africa.recruitment A total of 638 respondentsadvertising appearing chose to in share the theirSouth views African on Medical these issues, Journal some for at considerablethe period length. 2000-2004 and a series of interviews conducted with The privatemajority recruiting (59%) of enterprises. the respondents immigrated to Canada under the Qeconomic 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< class of entry. Another 11% entered under the family spon- sorship class,key stakeholders 4% to study in and the 4% South in the African provincial health nominee sector, theclass. paper None had beenoffers admitted a series as ofasylum recommendations seekers or refugees. for addressing Only 6% the of problem those com of - pleting theskilled survey health were migration. temporary These workers recommendations (Huntley’s means are grounded of entry). The respondentsin both South are a highlyAfrican educated experience group: and 56% an interrogation had obtained ofa tertiaryinter- educationnational qualification debates in and South ‘good Africa policy’ and practice another for 21% regulating a technical recruit- or vocationalment. diploma or certificate. Some 28% also had a professional qualification.The paperForty-three is organized percent into had five continued sections. their Section education Two positions outside South Africa.debates Southabout Africansthe migration in Canada of skilled are healthhigh income professionals earners within compared a to thewider overall literature Canadian that discusses population the (Tableinternational 1). For mobility example, of 26%talent. of South AfricanSection respondentsThree reviews who research immigrated on the toglobal Canada circulation after 1990 of health earn pro- more thanfessionals, $200,000 focusing a year in (compared particular uponwith onlydebates 1% relatingof the overall to the population.) experience Orof countriesagain, 43% in earnthe developingmore than $100,000world. Section compared Four withmoves 6% the of focusthe overall from population.international At to the South other African end of issues the spectrum,and provides only new 14% empirical earn less mate- than $25,000rial drawn a year,from compared the survey with of recruitment 44% of the patternslocal population. 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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EXECUTIVE SUMMARY Table 1: Annual Income of Canadian Population and South African Immigrants in Canada Canadian population South Africans in Canada ealth workers are one of the categories of skilled profession- Less than $25,000 44.1 14.4 als most affected by globalization. Over the past decade, $26,000 – $50,000 29.2 19.6 there has emerged a substantial body of research that tracks $51,000 – $75,000 15.2 12.4 Hpatterns of international migration of health personnel, $76,000 – $100,000 5.7 10.8 assesses causes and consequences, and debates policy responses at global $101,000 – $200,000 4.7 16.6 and national scales. Within this literature, the case of South Africa is More than $200,000 1.0 26.2 attracting growing interest. For almost 15 years South Africa has been Source: Statistics Canada, SAMP Survey the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- A great deal of international attention is currently focused on the flow of health professionals is a core policy issue for the national gov- role and potential of African diasporas as agents of development in their ernment. countries of origin.23 This phenomenon – known as diaspora engagement – This paper aims to to examine policy debates and issues concerning rests upon close personal, professional and economic linkages with “home” the migration of skilled health professionals from the country and to and takes a variety of forms including remittances, investment, knowledge furnish new insights on the recruitment patterns of skilled health per- and technology transfer, educational exchanges, philanthropy, charitable sonnel. The objectives of the paper are twofold: donations and return migration. An obvious question, then, is whether Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H South Africans in Canada are an engaged diaspora with attitudes and ment of skilled professionals from South Africa in the health activities commensurate with that status. Certainly, the survey respond- sector. The paper draws upon a detailed analysis of recruitment ents reported visiting South Africa relatively often (only 18% had never advertising appearing in the South African Medical Journal for been back since arriving in Canada) although only 20% return at least the period 2000-2004 and a series of interviews conducted with once a year. The rest make episodic visits and the vast majority of all visits private recruiting enterprises. are connected with family issues and events. Most have family in South Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< Africa to visit (79% have brothers and sisters, 76% have parents and 52% key stakeholders in the South African health sector, the paper have grandparents there). offers a series of recommendations for addressing the problem of On most measures, however, there is a clear pattern of disengagement skilled health migration. These recommendations are grounded from South Africa.24 Half of the respondents (54%) have taken out Cana- in both South African experience and an interrogation of inter- dian citizenship and another 30% are permanent residents (all of whom national debates and ‘good policy’ practice for regulating recruit- are recent immigrants eligible for citizenship after a period of continuous ment. residence in Canada). South Africans in Canada are neither large nor The paper is organized into five sections. Section Two positions frequent remitters. Forty-two percent had never remitted funds to South debates about the migration of skilled health professionals within a Africa and only 13% do so on a monthly basis. Half have never remit- wider literature that discusses the international mobility of talent. ted goods since arriving in Canada. Funds and goods are remitted almost Section Three reviews research on the global circulation of health pro- exclusively to family members for their immediate use. There is no collec- fessionals, focusing in particular upon debates relating to the experience tive remitting and no broader pattern of remitting, for example to support of countries in the developing world. Section Four moves the focus from community projects. international to South African issues and provides new empirical mate- In the year prior to the survey, less than 3% of the respondents had rial drawn from the survey of recruitment patterns and key interviews bought a house or property in South Africa, exported or imported goods undertaken with health sector recruiters operating in South Africa. from either country, or invested in a business in South Africa. Looking Section Five addresses the questions of changing policy interventions in ahead, 86% thought it unlikely that they would invest in the country. South Africa towards the outflow of skilled health professionals and the Only 25% said it was likely that they would make a charitable donation recruitment of foreign health professionals to work in South Africa. The that would benefit South Africa and 14% that they would send money for a development project in South Africa. Less than 1% belonged to a dias-

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EXECUTIVEpora SassociationUMMARY in Canada and less than one in ten belonged to a South African alumni association, a South African ethnic or cultural association, a professionalealth association workers arein Canadaone of the or ancategories NGO or of faith skilled organization profession- in Canada withals links most to affected South Africa. by globalization. Over the past decade, Patterns thereof asset has holding emerged in Southa substantial Africa showbody aof systematic research that trend tracks of disinvestment patternsover time. of Onlyinternational a minority migration of those of who health immigrated personnel, between H1990 and 2010 still hold assets in South Africa (in total, 28% have a bank assesses causes and consequences, and debates policy responses at global account,and national 16% scales.have investments, Within this 11%literature, have savings,the case 10% of South own aAfrica house, is 6% ownattracting land and growing only 1%interest. own aFor business almost in 15 South years Africa)South Africa(Table has2). beenIf these assetsthe target are cross-tabulatedof a ‘global raiding’ with ofthe skilled year ofprofessionals entry to Canada, by several in every devel- case almostoped countries. 40% or more How ofto thedeal asset with holders the consequences had immigrated of the in resultant the previous out- fiveflow years.of health By contrast,professionals less is than a core 10% policy of those issue stillfor the holding national these gov- assets arrivedernment. in Canada between 1990 and 1994. AlliedThis paper to this aims pattern to to examine of disinvestment policy debates are low and levelsissues ofconcerning interest in returnthe migration migration of skilledto South health Africa. professionals Only 14% from said thethey country had given and ato great dealfurnish of thoughtnew insights to returning on the recruitmentto live in South patterns Africa. of Evenskilled fewer health (6%) per- said itsonnel. was likely The theyobjectives would of return the paper to live are and twofold: work in South African within twoQ years. +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H Slightly more (11%) said it was likely within the next five years. These findingsment of areskilled a sobering professionals contrast from with South an Africa earlier in SAMP the health survey of health professionalssector. The paperin South draws Africa upon itself, a detailed which foundanalysis that of 47%recruitment had given a great dealadvertising of thought appearing to leaving in the the South country. African25 Medical Journal for the period 2000-2004 and a series of interviews conducted with Table 2: Assets in Southprivate Africa recruiting by Year ofenterprises. Immigration to Canada AssetsQ 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H

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EXECUTIVE SUMMARY myself” and 82% agreed/strongly agreed with the statement “I feel strong ties with people from South Africa.” This sense of a South African identity ealth workers are one of the categories of skilled profession- is expressed in and reinforced by various cultural practices including eating als most affected by globalization. Over the past decade, foods from South Africa (92%), listening to South African music (83%), there has emerged a substantial body of research that tracks wanting their children to know about South African culture (82%), read- patterns of international migration of health personnel, ing newspapers from South Africa (77%) and so on (Table 3). On every H measure, more than 50% of respondents responded in the affirmative. 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 Table 3: Cultural Practices of South African Canadians the target of a ‘global raiding’ of skilled professionals by several devel- Activity % Yes oped countries. How to deal with the consequences of the resultant out- Eat traditional foods from South Africa 92 flow of health professionals is a core policy issue for the national government. Listen to music from South Africa 83 This paper aims to to examine policy debates and issues concerning Want your children to know about the culture of South Africa 82 the migration of skilled health professionals from the country and to Read an online or print newspaper from South Africa in the past year 77 furnish new insights on the recruitment patterns of skilled health per- Consulted a website relating to South Africa in the past year 76 sonnel. The objectives of the paper are twofold: Joined a social networking group that is associated with South Africa in the past year 61 Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H Find that most of your best friends are from South Africa 60 ment of skilled professionals from South Africa in the health Want your children to learn a South African language 56 sector. The paper draws upon a detailed analysis of recruitment Closely followed political events in South Africa in the past year 53 advertising appearing in the South African Medical Journal for Source: SAMP Survey the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. Identification as South African and engagement in practices and activi- Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< ties consistent with that self-identity does not, however, translate into key stakeholders in the South African health sector, the paper a positive set of ideas and images about the country. Asked to compare offers a series of recommendations for addressing the problem of Canada and South Africa on a variety of social, economic and political skilled health migration. These recommendations are grounded indices, respondents consistently gave Canada higher scores (Table 4). On in both South African experience and an interrogation of inter- three key indicators that resonate with the Huntley case (personal and national debates and ‘good policy’ practice for regulating recruit- family safety; racial, ethnic and cultural tolerance; and prospects for job ment. advancement), over three-quarters of the respondents rated Canada more The paper is organized into five sections. Section Two positions strongly. Other indicators on which a large majority rated Canada higher debates about the migration of skilled health professionals within a included upkeep of public amenities, income and medical services and wider literature that discusses the international mobility of talent. treatment. On only one indicator, social life, was South Africa rated higher. Section Three reviews research on the global circulation of health pro- Russell Kaplan has said that Brandon Huntley’s claim for refugee status fessionals, focusing in particular upon debates relating to the experience in Canada was a test case for “informing the world what a sickly place of countries in the developing world. Section Four moves the focus from South Africa is for many white South Africans.” In Kaplan’s view, the case international to South African issues and provides new empirical mate- “contributed towards placing the plight of many white South Africans in 26 rial drawn from the survey of recruitment patterns and key interviews South Africa on the world stage.” In other words, Kaplan’s objective was undertaken with health sector recruiters operating in South Africa. not simply to obtain refugee status for his client but to open the door for Section Five addresses the questions of changing policy interventions in further claims by white South Africans by presenting the situation in South South Africa towards the outflow of skilled health professionals and the Africa in a certain light. The next section examines how the “Kaplan view” recruitment of foreign health professionals to work in South Africa. The constructs South Africa and whether this view has any resonance amongst the South African diaspora in Canada.

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ETableXECUTIVE 4: ComparisonsSUMMARY of Canada and South Africa Better in Better in No difference South Africa No opinion % ealth workersCanada are one % of the categories of% skilled profession- % als most affected by globalization. Over the past decade, Personal and family safety 98 0 1 1 there has emerged a substantial body of research that tracks Upkeep of public amenities 92 2 2 4 patterns of international migration of health personnel, Racial, ethnicH and cultural tolerance 84 3 9 4 assesses causes and consequences, and debates policy responses at global Prospects forand job national advancement scales. Within77 this literature,8 the case 10of South Africa5 is Level of incomeattracting growing interest.69 For almost 1215 years South11 Africa has been7 Medical servicesthe target and treatment of a ‘global raiding’69 of skilled22 professionals 7by several devel-2 Level of taxationoped countries. How to deal31 with the consequences28 26of the resultant15 out- Social life flow of health professionals33 is a core policy47 issue for 17the national gov-3 Source: SAMPernment. Survey This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to the kaplanfurnish vnewiew insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: n Qhis judgment, +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H Justice Russell spoke of the “excesses” of Lara’s testimony Ito thement IRB andof skilled observed professionals that she was from not South the most Africa objective in the health witness to call to bolstersector. Huntley’s The paper claim draws for upon refugee a detailed protection. analysis27 In ofhis recruitment view, Russell Kaplan wasadvertising also not appearing the most inobjective the South counsel African that Medical Huntley Journal could forhave chosen tothe represent period 2000-2004 him.28 Justice and Russell’s a series ofconclusion interviews was conducted based primarily with on the Kaplans’private recruitinghighly emotional enterprises. account at the IRB hearing in which they bothQ wept 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< while Lara recounted the details of the torture of their brother, Robert, keyby three stakeholders black assailants in the South in his AfricanSouth African health sector,home in the 1997. paper The Kaplan familyoffers aclearly series hadof recommendations a “heavy emotional for investmentaddressing thein theproblem outcome of of this case”skilled and health “wanted migration. to assert These their recommendationsview of ‘reverse apartheid’ are grounded before the world.”in both Justice South Russell African was carefulexperience not to and criticise an interrogation them for this, of reservinter-- ing his negativenational remarks debates forand William ‘good policy’ Davis, practicewho had for taken regulating a very differentrecruit- view of thement. testimony. As Davis had noted: “(Lara Kaplan) brought to the hearingThe paperfrom heris organized own personal into fiveexperience, sections. a Section vivid and Two detailed positions account ofdebates what aboutis taking the place migration in South of skilled Africa health today professionalsvis-à-vis the Africanwithin a South Africanswider literature and the that white discusses South Africansthe international and the indifferencemobility of talent.of the mainly AfricanSection policeThree forcereviews to researchprotect them.on the White global South circulation Africans, of health she alleges, pro- arefessionals, no longer focusing welcome in particularin South Africa.”upon debates29 relating to the experience of countriesJustice Russell in the concluded developing that world. Davis Section was “captivated” Four moves by the the focus Kaplans’ from interpretationinternational to of South what African what was issues happening and provides in South new Africaempirical to whites.mate- Herial summariseddrawn from the surveykey elements of recruitment of the Kaplan patterns view and of key South interviews Africa as follows:undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africareasons towards and regard the outflow all whites of skilledas equally health responsible professionals for apartheid, and the recruitmentbelieving of foreign that they health “should professionals be eradicated to work and in stompedSouth Africa. on like The an ant” (in Lara Kaplan’s words);

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EXECUTIVE SUMMARY which is in 200 percent of all the minds of white South Africans” ealth workers are one of the categories of skilled profession- (in Kaplan’s words); als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks towards them; patterns of international migration of health personnel, H Africans and South African society is “brutal”; 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 Africans against white South Africans; the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- white South Africans; flow of health professionals is a core policy issue for the national government. cahoots” with black criminals; This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to deserve what is happening to them for historical reasons and it is furnish new insights on the recruitment patterns of skilled health per- “payback time for the blacks”; sonnel. The objectives of the paper are twofold: Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H South Africans is “some kind of genocide”; and ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment adopted and promoted policies aimed at replacing white South advertising appearing in the South African Medical Journal for Africans with black South Africans in positions of power and influ- the period 2000-2004 and a series of interviews conducted with ence.30 private recruiting enterprises. Lara Kaplan’s statements to the Huntley hearing included the following on Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< “reverse apartheid” in the police force: key stakeholders in the South African health sector, the paper (The police) never do anything. What police? There is no offers a series of recommendations for addressing the problem of law and order there, there is no proper police force. It’s free skilled health migration. These recommendations are grounded reign in South Africa, kill who you want and get away with in both South African experience and an interrogation of inter- murder…. They are so poorly paid they get backhands, it’s full national debates and ‘good policy’ practice for regulating recruit- of fraudulence and corruption and there is no proper police ment. force like there was prior to 1994. They could not handle it The paper is organized into five sections. Section Two positions even if they wanted to and to be honest I don’t think they debates about the migration of skilled health professionals within a want to. They don’t care, if you are white South African and wider literature that discusses the international mobility of talent. you report a case it’s like, you know, sorry, I’m busy. I’m on my Section Three reviews research on the global circulation of health pro- teabreak. That’s the perception… They – everybody includ- fessionals, focusing in particular upon debates relating to the experience ing the police force – seems to believe that if you are a white of countries in the developing world. Section Four moves the focus from South African and you are attacked it’s because you deserve international to South African issues and provides new empirical mate- it. It’s coming to you, it’s due to you, it’s long overdue.31 rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Russell Kaplan deposited a selection of lurid South African newspaper arti- Section Five addresses the questions of changing policy interventions in cles detailing an array of violent crimes, attacks against white farmers in South Africa towards the outflow of skilled health professionals and the rural areas and affirmative action that had supposedly “stripped the coun- recruitment of foreign health professionals to work in South Africa. The try of 75 percent of its skilled population and is responsible for the depriva- tion of the constitutional and social rights of the white population.” Justice

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EXECUTIVERussellSUMMARY examined these and concluded that Davis had relied on material that was “strong on opinion but not on facts” and that, far from supporting the case, actuallyealth contradictedworkers are one the ofallegations the categories of criminality of skilled based profession- on racial discriminationals mostagainst affected white Southby globalization. Africans.32 Over Russell the criticised past decade, Davis for ignoring thethere IRB’s has own emerged National a substantial Discrimination body ofPackage’s research List that of tracks Docu- ments on Southpatterns Africa of internationalthat provided migration an alternative of health perspective personnel, on crime Hand violence in South Africa and for not reviewing “more authoritative, assesses causes and consequences, and debates policy responses at global objectiveand national and scales.less emotionally Within this partial literature, sources.” the case of South Africa is attractingJustice growing Russell appearsinterest. to For have almost thought 15 years that South the KaplanAfrica has view been was a directthe target reflection of a ‘global of the raiding’ Kaplan of skilled family’s professionals personal experiences by several devel- in South Africa.oped countries. The question How tohere, deal though, with the is consequenceswhether the Kaplan’s of the resultant construction out- offlow South of health Africa professionals as a racial dystopia is a core is policy not part issue of fora broader the national discourse gov- that circulatesernment. within the white South African diaspora abroad. Certainly, Kaplan’sThis paperrepresentation aims to to of examine South Africa policy as debates a dystopia and issuesis echoed concerning and rein- forcedthe migration by groups of suchskilled as health“We are professionals White Refugees” from the that country assiduously and tofollow andfurnish comment new insights on the on Huntley the recruitment case, organised patterns an of online skilled petition health againstper- thesonnel. Canadian The objectives government’s of the decision paper areto appealtwofold: the IRB decision, continu- ouslyQ add +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H to the reservoir of negative imagery about post-apartheid South Africa, andment hearken of skilled back professionals to the “good from old South days.” Africa33 But into thewhat health extent is the Kaplansector. view The echoed paper more draws broadly upon a within detailed the analysis South ofAfrican recruitment diaspora in Canada?advertising The argument appearing here in isthe that South the Africandystopian Medical views Journaladvanced for by Russell andthe periodLara Kaplan 2000-2004 sit comfortably and a series within of interviews a broader conducted narrative withabout South Africaprivate by recruiting white South enterprises. Africans in Canada. The evidence is to be foundQ in 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< the responses of respondents to the SAMP diaspora survey. A considerablekey stakeholders number in ofthe survey South respondents African health portrayed sector, South the paper Africa as an extremelyoffers a seriesviolent of societyrecommendations in which whites for addressing live in a constantthe problem state of of fear andskilled anxiety: health migration. These recommendations are grounded I in was both personally South African attacked experience and assaulted and an eight interrogation times in oneof inter- year.national My eldestdebates daughter and ‘good was policy’ robbed practice and held for regulating at gunpoint recruit- threement. times in one year. My house was robbed twice in one Theyear, paper whilst is organized I was in theinto house five sections. (Respondent Section No. Two 26). positions debates about the migration of skilled health professionals within a wider Crimeliterature was that a bigdiscusses factor the in myinternational decision to mobility move away of talent. from SectionSouth Three Africa. reviews Myself research and four on theother global family circulation members ofhad health been professionals,carjacked focusing over in the particular years. My upon immediate debates relatingfamily and to the relatives experience of countrieshad been in the victims developing of robbery world. and Section or burglary Four moves of some the sort.focus from internationalIt was justto South a matter African of time issues before and provides someone new was empirical murdered material drawn(Respondent from the No.survey 107). of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. SectionI realisedFive addresses that sleeping the questions with a ofgun changing under my policy pillow interventions was not in South normalAfrica towardspractice. the The outflow statistics of skilledat the timehealth were professionals that one out and the recruitmentof three of womenforeign healthwould beprofessionals raped, and to if workyou were in South raped, Africa. you The would contract HIV/AIDS. That equals a death sentence for me (Respondent No. 345). 151 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Dystopia anD Disengagement: Diaspora attituDes towarDs south africa

EXECUTIVE SUMMARY I worked in a Security Armed Response Control Room, and we would receive the distress calls from homes that we moni- ealth workers are one of the categories of skilled profession- tor. The things I heard as we would dispatch armed guards to als most affected by globalization. Over the past decade, try and help, was unimaginable. There is no media out there, there has emerged a substantial body of research that tracks Canada included, that show the true occurrences that take patterns of international migration of health personnel, place in South Africa. I promised myself I would not have H children in South Africa and took my entire family (mom, assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is dad, brother, sister-in-law, wife) to Canada. I have never attracting growing interest. For almost 15 years South Africa has been returned, nor will I ever (Respondent No. 319). the target of a ‘global raiding’ of skilled professionals by several devel- Many of the respondents argued that whites were targeted not because oped countries. How to deal with the consequences of the resultant out- they own a disproportionate share of the wealth in a highly unequal soci- flow of health professionals is a core policy issue for the national gov- ety, but simply because of their colour: “No one feels safe in South Africa ernment. anymore, especially the whites as they are targeted and attacked on a This paper aims to to examine policy debates and issues concerning daily basis” (Respondent No. 473). South Africa, in the view of another, is the migration of skilled health professionals from the country and to riven by “crime, corruption, unfair discrimination, killing of white farmers furnish new insights on the recruitment patterns of skilled health per- and crime targeted towards whites” (Respondent No. 114). Canada was sonnel. The objectives of the paper are twofold: a country which offered “a safe life and opportunities for White people” Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H (Respondent No. 77). ment of skilled professionals from South Africa in the health The theme of racial targeting was driven home by the frequent use of sector. The paper draws upon a detailed analysis of recruitment terms such as “apartheid in reverse.” The idea that the white population advertising appearing in the South African Medical Journal for is under siege because of their skin colour extends well beyond personal the period 2000-2004 and a series of interviews conducted with knowledge of incidents of crime and violence. Here there are clear echoes private recruiting enterprises. of Lara Kaplan’s claim that the violent attack on her brother is evidence of Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< a genocide against whites of which the world is unaware: key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of After Nelson Mandela was elected president the situation skilled health migration. These recommendations are grounded instead of being resolved was flipped around in South Africa, in both South African experience and an interrogation of inter- and everyone who was white was now being racially discrimi- national debates and ‘good policy’ practice for regulating recruit- nated against. This involved jobs, education, and all other ment. aspects of life (Respondent No. 419). The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a The only links I maintain with Africa are with my family wider literature that discusses the international mobility of talent. members. I would return only if the political regime were to Section Three reviews research on the global circulation of health pro- change to one that is ‘white-friendly’ and doesn’t actively fessionals, focusing in particular upon debates relating to the experience want to get rid of me. I view the current political climate in of countries in the developing world. Section Four moves the focus from SA as genocide in the making, and believe the levels of so- international to South African issues and provides new empirical mate- called ‘crime’ are encouraged as a way to rid the country of rial drawn from the survey of recruitment patterns and key interviews white people (Respondent No. 217). undertaken with health sector recruiters operating in South Africa. I think a lot of people are totally unaware of what is really Section Five addresses the questions of changing policy interventions in happening in SA. I have to say that SA is one of the most South Africa towards the outflow of skilled health professionals and the beautiful countries in the world, however corruption, crime, recruitment of foreign health professionals to work in South Africa. The affirmative action and reverse apartheid makes it very dif- ficult to live there. There is very little or no future for white

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EXECUTIVE SSouthUMMARY Africans. The crime is not petty crime, it’s barbaric, senseless (Respondent No. 353). Attacks on whiteealth farmersworkers featureare one prominently of the categories in the ofnarrative skilled profession-and are used as a platformals for most broader affected commentary by globalization. on Africa Over and the Africans: past decade, there has emerged a substantial body of research that tracks The infamouspatterns ofBoer international killings started, migration and ofwhat health that personnel, means is Hbasically if you are a white farmer you will be slaughtered assesses causes and consequences, and debates policy responses at global and nationalfor your scales. land becauseWithin thisthe blackliterature, majority the casefeels ofthat South it’s theirsAfrica is attractingto begin growing with, interest. even with For theiralmost lack 15 ofyears education South Africaand history has been the targetsense of (Respondent a ‘global raiding’ No. 419).of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- I emigrated because the Government took my farm and gave flow of health professionals is a core policy issue for the national gov- it to the Black people who now are not effectively and eco- ernment. nomically managing it. I emigrated because we had several This paper aims to to examine policy debates and issues concerning farm attacks and murdering of farmers in our region without the migration of skilled health professionals from the country and to any help of anyone. The media does not inform Canada about furnish new insights on the recruitment patterns of skilled health per- the “quiet WAR” going on in Africa right at this moment sonnel. The objectives of the paper are twofold: (Respondent No. 222). Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H Everyment day of skilledwe read professionals about white from people South who Africa get killed in the in theirhealth homessector. and The are paper living draws in fearupon for a detailed their lives. analysis Jobs of are recruitment being takenadvertising away fromappearing the white in the population. South African Thank Medical God forJournal the for whitethe period brain power 2000-2004 for many and years a series whom of interviews the black peopleconducted hate with inprivate SA. If itrecruiting was not for enterprises. them, SA would have been the same as QEast, 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< West and North Africa (Respondent No. 166). key stakeholders in the South African health sector, the paper Personaloffers and hearsaya series storiesof recommendations of violent crime for were addressing laced with the problemvituperative of accountsskilled of the health callous migration. and indifferent These response recommendations of the police are and grounded the government:in “Get both rid South of the African criminal experience government,” and an wrote interrogation one, “and ofget inter- rid of the butchersnational and debates the police and force‘good that policy’ is absolutely practice for useless regulating as they recruit- work mainly onment. bribes” (Respondent No. 499). AnotherThe paper persistent is organized theme into five with sections. clear echoes Section of Two the positions Kaplan view concernsdebates about what the the migration respondents of skilled refer tohealth as “reverse professionals discrimination” within a (i.e. affirmativewider literature action that and discusses Black Economic the international Empowerment mobility or BEE of talent. in the South AfricanSection lexicon).Three reviews None researchof the over on 600the respondentsglobal circulation showed of anyhealth sympathy pro- withfessionals, or appreciation focusing in for particular the rationale upon behinddebates theserelating corrective to the experience policies or ofof thecountries fact that in the they developing personally world. might Section have benefitted Four moves educationally the focus from and economicallyinternational fromto South the racist African policies issues of andthe apartheidprovides new government. empirical Instead, mate- theyrial drawn generally from represented the survey themselves,of recruitment and patterns whites in and general, key interviews as victims: undertakenThe governmentwith health couldn’tsector recruiters care less operating about the in futureSouth Africa. of my Sectionchildren. Five addresses The government the questions couldn’t of changing care less policy about interventionssafety and in South security.Africa towards As long the as outflow they achieve of skilled their health political professionals ambitions and the recruitmentwhich ofbasically foreign consistshealth professionalsof putting black to work women in South then Africa.black The men (and make your way up through the different lighter

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EXECUTIVE SUMMARY colour schemes and sexes until you get to white men) into any job whether they have the ability to do it or not (Respondent ealth workers are one of the categories of skilled profession- No. 67). als most affected by globalization. Over the past decade, there has emerged a substantial body of research that tracks As a family physician in South Africa I was forced by the patterns of international migration of health personnel, ANC government to take on a black previously disadvan- H taged partner as part of affirmative action. Now you have assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is to ask yourself if such a partner is a family physician and attracting growing interest. For almost 15 years South Africa has been qualified is he or she still disadvantaged? After the so-called the target of a ‘global raiding’ of skilled professionals by several devel- watering down (drop in standards to accommodate him/her) oped countries. How to deal with the consequences of the resultant out- mickey mouse qualification he or she left university with, I flow of health professionals is a core policy issue for the national gov- was expected to drop my standards to help this candidate. ernment. This would have resulted in me doing the work as a physi- This paper aims to to examine policy debates and issues concerning cian and guarding my own patients against my underqualified the migration of skilled health professionals from the country and to black partner. I refused to drop standards and saw emigration furnish new insights on the recruitment patterns of skilled health per- as the only option. My family members were murdered and sonnel. The objectives of the paper are twofold: the spineless South African Police Service failed them. It was Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H and still is just a matter of time before the ongoing policy of ment of skilled professionals from South Africa in the health genocide against my white South African countrymen and sector. The paper draws upon a detailed analysis of recruitment women will be completed (Respondent No. 66). advertising appearing in the South African Medical Journal for The white population of South Africa, argued one, has no future “because the period 2000-2004 and a series of interviews conducted with they are now at the bottom of the list for employment opportunities” private recruiting enterprises. (Respondent No. 578). Many recounted personal experiences of victimiza- Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< tion, for example, “When my husband lost his job in SA we realised the key stakeholders in the South African health sector, the paper future looked scary since we could not survive on my salary and he was offers a series of recommendations for addressing the problem of unlikely to find employment because of BEE” (Respondent No. 610). The skilled health migration. These recommendations are grounded idea that Black Economic Empowerment (BEE) turns whites into victims in both South African experience and an interrogation of inter- is especially common: national debates and ‘good policy’ practice for regulating recruitment. A co-worker was promoted to a Management position despite The paper is organized into five sections. Section Two positions not being able to operate a computer (I therefore had to do debates about the migration of skilled health professionals within a all her typing and e-mails) – yet she earned almost double my wider literature that discusses the international mobility of talent. salary (Reason given: B.E.E)!! (Respondent No. 26). Section Three reviews research on the global circulation of health pro- I was laid off at Telkom on management level, because I’m fessionals, focusing in particular upon debates relating to the experience white. They had to ‘correct’ the numbers by having less of countries in the developing world. Section Four moves the focus from white managers. Crime levels reached a high of family being international to South African issues and provides new empirical mate- murdered and raped just because they are white people. I will rial drawn from the survey of recruitment patterns and key interviews never return. I am too afraid I will get a letter again spelling undertaken with health sector recruiters operating in South Africa. out that I lose my job because I’m white. We can send billions Section Five addresses the questions of changing policy interventions in of dollars to Africa and the Black people will waste it with South Africa towards the outflow of skilled health professionals and the corruption like they have been doing for ages – don’t you read recruitment of foreign health professionals to work in South Africa. The the news over there? (Respondent No. 57).

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EXECUTIVEThis S finalUMMARY verbatim quotation draws attention to a recurrent motif that Canada and the West does not know or care about what is happening to whites in Southealth Africa: workers are one of the categories of skilled profession- As a als white most person affected I was by globalization. always very liberal Over the when past living decade, in SA andthere had has the emerged highest a hopes substantial that everyone,body of research especially that the tracks Hblacks,patterns would ofhave international a better life migration after Mandela’s of health release personnel, and assessesthe causes end and of apartheid. consequences, However and debates the ANC policy hopelessly responses failed at global and nationalits own scales.people Within in my opinion,this literature, and the the rise case of ofcharacters South Africa like is attractingMalema, growing who interest. will surely For bealmost the next15 years president, South willAfrica lead has SA been the targetto the of samea ‘global fate raiding’as Zimbabwe. of skilled But professionals oh to be politically by several correct devel- oped countries.in Canada How is more to deal important with the than consequences anything else, of the so resultant let the outflow ofpeople health be professionals murdered inis a the core hundreds policy issue of thousands for the national without government.any Canadian press coverage, and continue to live in poverty Thisand paper zero aimshope to for to the examine future andpolicy rather debates sing andthe issuespraises concerning of the the migrationgreat hero of Mandelaskilled health to make professionals us feel good from about the ourselves country andhere to furnishin new North insights America. on the Never recruitment acknowledge patterns the realitiesof skilled for health fear of personnel.uttering The objectives what could of thebe interpretedpaper are twofold: as racist. Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H In manyment cases, of the skilled sense professionals of outrage fromabout South Canadian Africa attitudes in the healthspills over into overtlysector. racist The diatribes paper draws about upon Africa a detailedand Africans. analysis The of unreconstruct recruitment - ed apartheid-eraadvertising racist appearing content in of the these South narratives African is Medical not analysed Journal further for here becausethe period there 2000-2004is no evidence and froma series the of Huntley interviews case conducted that Huntley, with or the Kaplans,private are recruiting motivated enterprises. by racism. If anything, the Kaplan view seems to findQ 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< the supposed “genocidal war” against whites quite understand- able givenkey the stakeholders history of inthe the country South and African the “natural”health sector, human the desire paper for revenge.offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded conclusion in both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruit- he meritsment. of Brandon Huntley’s claim for refugee status in Canada will TTheshortly paper be isre-assessed organized by into the five Immigration sections. andSection Refugee Two Boardpositions following thedebates finding about of thethe Federalmigration Court of skilled that the health original professionals judgment waswithin unreason a - ablewider and literature strewn thatwith discusseserrors and the procedural international irregularities. mobility Mediaof talent. attention willSection no doubtThree escalatereviews research as the hearing on the drawsglobal closercirculation and a of new health judgment pro- isfessionals, announced. focusing As this in particularpaper has upon argued, debates the dystopianrelating to picture the experience of South Africaof countries painted in bythe lawyer developing Russell world. Kaplan Section and witnessFour moves Lara theKaplan focus at from the originalinternational IRB hearing to South is notAfrican peculiar issues to andthese provides two individuals new empirical but circulates mate- morerial drawn broadly from within the survey the South of recruitment African diaspora patterns in and Canada, key interviews in virtually everyundertaken detail. with health sector recruiters operating in South Africa. SectionTo what Five extent addresses is this the narrative questions of ofSouth changing Africa policy as dystopia interventions the stuff in of everydaySouth Africa interaction towards and the conversation outflow of skilled between health South professionals African Canadians? and the Torecruitment what extent of foreignand through health what professionals channels tois thiswork narrative in South fed, Africa. sustained The and amplified by new information, stories and anecdotes from South Afri-

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EXECUTIVE SUMMARY ca? Is this narrative particular to South Africans in Canada or does it have looser spatial boundaries and broader connectivities? The first two ques- ealth workers are one of the categories of skilled profession- tions can only be addressed through further research. However, some com- als most affected by globalization. Over the past decade, ments on the third question are in order. In September 2009, the “We Are there has emerged a substantial body of research that tracks White Refugees” website launched an online petition to the UNHCR and patterns of international migration of health personnel, various governments on behalf of Huntley. In all, the group gathered 1,026 H signatures. The petitioners were drawn from a wide variety of countries but assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is the list was dominated by white South Africans in South Africa (53% of attracting growing interest. For almost 15 years South Africa has been the signatories) followed by the United States (11%), Australia and New the target of a ‘global raiding’ of skilled professionals by several devel- Zealand (9%), Europe (7%), the United Kingdom (6%) and Canada (5%). oped countries. How to deal with the consequences of the resultant out- Many of those signing the petition also left comments that directly echo flow of health professionals is a core policy issue for the national gov- aspects of the Kaplan view about the situation and fate of whites in South ernment. Africa. In other words, the Kaplan view is certainly not constrained by This paper aims to to examine policy debates and issues concerning Canada’s national boundaries. The narrative of South Africa as dystopia is the migration of skilled health professionals from the country and to likely to originate and be reinforced by sections of the white population in furnish new insights on the recruitment patterns of skilled health per- South Africa itself and is an example of what Steyn and Foster call “white sonnel. The objectives of the paper are twofold: talk” and “resistant whiteness.”34 Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H There is no question that post-apartheid South Africa has experienced ment of skilled professionals from South Africa in the health unprecedented levels of violent crime. But, as Justice Russell observed, it sector. The paper draws upon a detailed analysis of recruitment is quite another thing to suggest that all crime against whites is racially advertising appearing in the South African Medical Journal for motivated and part of a broader campaign of genocide. None of the the period 2000-2004 and a series of interviews conducted with respondents in the SAMP survey made any reference to the disproportion- private recruiting enterprises. ate impact of violent crime on the country’s black population.35 In the Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< Kaplan view, only whites are victims. A 2010 survey of a representative key stakeholders in the South African health sector, the paper national sample of South Africans painted a very different picture.36 The offers a series of recommendations for addressing the problem of survey found that other racial groups were significantly more vulnerable skilled health migration. These recommendations are grounded to theft and physical attacks than whites: 11% of whites had experienced in both South African experience and an interrogation of inter- a physical attack on them or their family members in the previous year, national debates and ‘good policy’ practice for regulating recruit- compared to 18% of Black Africans and Indians and 17% of Coloureds. Or ment. again, while 29% of whites reported a theft from their home in the previous The paper is organized into five sections. Section Two positions year, the equivalent figure for other racial groups was 45% for Indians and debates about the migration of skilled health professionals within a Coloureds and 37% of Black Africans. Fear of crime was also more intense wider literature that discusses the international mobility of talent. amongst other groups: for example, 11% of whites said they lived in con- Section Three reviews research on the global circulation of health pro- stant fear of crime in their own homes compared with 19% of Coloureds, fessionals, focusing in particular upon debates relating to the experience 20% of Black Africans and 54% of Indians. However, when asked which of countries in the developing world. Section Four moves the focus from was the most important problem facing the country, 22% of whites said international to South African issues and provides new empirical mate- crime and security (a concern of only 5% of Black Africans). In contrast, rial drawn from the survey of recruitment patterns and key interviews 41% of Black Africans said that unemployment was the major problem undertaken with health sector recruiters operating in South Africa. compared with only 11% of whites. Given the Kaplan view that affirmative Section Five addresses the questions of changing policy interventions in action and BEE are denying employment opportunities to whites this, too, South Africa towards the outflow of skilled health professionals and the is an important corrective finding. recruitment of foreign health professionals to work in South Africa. The The final issue concerns the pervasiveness of the Kaplan view of racial genocide within the white South African diaspora in Canada. On the one

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EXECUTIVEhand,S itUMMARY might be objected, asking people their reasons for leaving South Africa will inevitably draw responses that focus on the threat to life and security. Onealth the other, workers there are was one no of compulsion the categories and of no skilled additional profession- probing involved in als collecting most affected the narratives. by globalization. They were Over voluntarily the past decade, offered and there were fewthere contrary has emerged views. aWhile substantial some narrativesbody of research were more that extremetracks than others,patterns they were of allinternational of a type and migration have resonance of health in personnel,the Kaplan view Harticulated at the Huntley hearing. We certainly cannot conclude that the assesses causes and consequences, and debates policy responses at global viewand nationalis held and scales. internalised Within bythis all literature, South Africans the case in Canada.of South For Africa example, is aattracting small proportion growing interest.of the respondents For almost (around15 years 20%)South doAfrica engage has inbeen some ofthe the target activities of a ‘global more raiding’ typical of skilled an engaged professionals diaspora by and several see adevel- role for themselvesoped countries. in the How development to deal with of theSouth consequences Africa. However, of the resultantthe dominant out- diasporaflow of health view ofprofessionals South Africa is afrom core Canadapolicy issue is that for itthe is, national at best, gov-a racial dystopiaernment. and, more accurately, a site of systematic racial destruction of the whiteThis population. paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- enDnotessonnel. The objectives of the paper are twofold: Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H 1 Federal Court of Appeal, File No IMM-4423-09, Minister of Citizenship and ment of skilled professionals from South Africa in the health Immigration v Brandon Carl Huntley, 24 November 2010, Para. 216. sector. The paper draws upon a detailed analysis of recruitment 2 IRB Ruling: Brandon Carl Huntley RPD File/No. Dossier SPR: MA8-04910 at advertising appearing in the South African Medical Journal for www.cbc.ca/news/pdf/huntley-decision.pdf (accessed 26 September 2012). the period 2000-2004 and a series of interviews conducted with 3 Ibid. private recruiting enterprises. 4 A Google search in 2009 found that the case had been the subject of 113,000 Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< press stories and articles; see Federal Court of Appeal, File No IMM-4423-09, key stakeholders in the South African health sector, the paper Minister of Citizenship and Immigration v Brandon Carl Huntley, Affidavit offers a series of recommendations for addressing the problem of from Stephanie Gude, 2 November 2009, Para. 3. skilled health migration. These recommendations are grounded 5 “Brandon Huntley: An Open Letter to Canada, 13 September 2009” at http:// in both South African experience and an interrogation of inter- www.scribd.com/doc/20519947/FF-04-b-142-SA-Academics-Open-Letter-to- national debates and ‘good policy’ practice for regulating recruit- Canada-Re-Brandon-Huntley. ment. 6 “Dlamini-Zuma Welcomes Canada’s Decision On Huntley” Immigration The paper is organized into five sections. Section Two positions Watch Canada 21 October 2009 at http://www.immigrationwatchcanada. debates about the migration of skilled health professionals within a org/2009/10/21/dlamini-zuma-welcomes-canadas-decision-on-huntley/ wider literature that discusses the international mobility of talent. 7 Federal Court of Appeal, File No IMM-4423-09, Minister of Citizenship and Section Three reviews research on the global circulation of health pro- Immigration v Brandon Carl Huntley, 24 November 2010, Para. 254. fessionals, focusing in particular upon debates relating to the experience 8 Federal Court of Appeal, File No IMM-4423-09, Minister of Citizenship and of countries in the developing world. Section Four moves the focus from Immigration v Brandon Carl Huntley, 24 November 2010, Para. 220. international to South African issues and provides new empirical mate- 9 Ibid., Para. 231. On the idiosyncratic nature of IRB decision-making, see S. rial drawn from the survey of recruitment patterns and key interviews Rehaag, “Troubling Patterns in Canadian Refugee Adjudication” Ottawa Law undertaken with health sector recruiters operating in South Africa. Review 39(2) (2007-8): 335-65. Section Five addresses the questions of changing policy interventions in 10 N. Barbeau, “Huntley Takes Another Route to Stay in Canada” The Star 6 July South Africa towards the outflow of skilled health professionals and the 2012. recruitment of foreign health professionals to work in South Africa. The 11 J. Gould, C. Sheppard and J. Wheeldon, “A Refugee from Justice? Disparate Treatment in the Federal Court of Canada” Law & Policy 32(4) (2010): 454-86.

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EXECUTIVE SUMMARY 12 S. Gallagher, “Canada’s Dysfunctional Refugee Protection System: Canadian Asylum Policy from a Comparative Perspective” Public Policy Sources No. 78, ealth workers are one of the categories of skilled profession- Fraser Institute, Vancouver, 2003. als most affected by globalization. Over the past decade, 13 A. Kaushal and C. Dauvergne, “The Growing Culture of Exclusion: Trends in there has emerged a substantial body of research that tracks Canadian Refugee Exclusions” International Journal of Refugee Law 23(1) (2011): patterns of international migration of health personnel, 54-92. H 14 R. Amit, “Protection and Pragmatism: Addressing Administrative Failures in assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is South Africa’s Refugee Status Determination Decisions” Research Report for attracting growing interest. For almost 15 years South Africa has been Forced Migration Studies Programme, Wits University, Johannesburg, 2010. the target of a ‘global raiding’ of skilled professionals by several devel- 15 Ibid., Para. 173. oped countries. How to deal with the consequences of the resultant out- 16 Ibid., Para. 229. flow of health professionals is a core policy issue for the national gov- 17 Ibid., Para. 207. ernment. 18 D. Nakache and P. Kinoshita, “The Canadian Temporary Foreign Worker Pro- This paper aims to to examine policy debates and issues concerning gram: Do Short-Term Economic Needs Prevail over Human Rights Concerns?” the migration of skilled health professionals from the country and to Study No. 5, Institute for Research on Public Policy, Montreal, 2011. furnish new insights on the recruitment patterns of skilled health per- 19 R. Joudrey and K. Robson, “Practising Medicine in Two Countries: South Afri- sonnel. The objectives of the paper are twofold: can Physicians in Canada” Sociology of Health & Illness 32(4) (2010): 528-44; Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H J. Crush and W. Pendleton, “Brain Flight: The Exodus of Health Professionals ment of skilled professionals from South Africa in the health from South Africa” International Journal of Migration, Health and Social Care 6(3) sector. The paper draws upon a detailed analysis of recruitment (2011): 3-18. advertising appearing in the South African Medical Journal for 20 “Africa says Canada is stealing MDs” Prince George Citizen 19 August 2009. the period 2000-2004 and a series of interviews conducted with 21 H. Grant, “From the Transvaal to the Prairies: The Migration of South African private recruiting enterprises. Physicians to Canada” Journal of Ethnic and Migration Studies 32(4) (2006): 681-95. Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< 22 J. Crush, W. Pendleton, A. Chikanda, C. Eberhardt, M. Caesar and A. Hill, key stakeholders in the South African health sector, the paper “Diasporas on the Web: New Networks, New Methodologies” In C. Vargas- offers a series of recommendations for addressing the problem of Silva, ed., Handbook of Research Methods in Migration (Cheltenham: Edward skilled health migration. These recommendations are grounded Elgar, 2012). in both South African experience and an interrogation of inter- 23 S. Plaza and D. Ratha, eds., Diaspora for Development in Africa (Washington DC: national debates and ‘good policy’ practice for regulating recruit- World Bank, 2011). ment. 24 J. Crush, A. Chikanda and W. Pendleton, “The Disengagement of the South The paper is organized into five sections. Section Two positions African Medical Diaspora in Canada” Journal of Southern African Studies, 38(4) debates about the migration of skilled health professionals within a (2012): 927-49. wider literature that discusses the international mobility of talent. 25 Crush and Pendleton, “Brain Flight.” Section Three reviews research on the global circulation of health pro- 26 Russell Kaplan, “Huntley Accomplished ‘African White Refugee’ Objectives” at fessionals, focusing in particular upon debates relating to the experience http://why-we-are-white-refugees.blogspot.ca/2010/12/huntley-accomplished- of countries in the developing world. Section Four moves the focus from african-white_5407.html. international to South African issues and provides new empirical mate- 27 Federal Court of Appeal, File No IMM-4423-09, Minister of Citizenship and rial drawn from the survey of recruitment patterns and key interviews Immigration v Brandon Carl Huntley, 24 November 2010, Para 177. undertaken with health sector recruiters operating in South Africa. 28 Ibid., Para. 180. Section Five addresses the questions of changing policy interventions in 29 Ibid., Para. 184. South Africa towards the outflow of skilled health professionals and the 30 Ibid., Para. 204. recruitment of foreign health professionals to work in South Africa. The 31 Ibid., Para. 190. 32 Ibid., Para. 210-229.

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33EXECUTIVE See http://why-we-are-white-refugees.blogspot.ch/SUMMARY and http://www.thepeti- tionsite.com/1/minister-of-citizenship-immigration-canada/ 34 M. Steyn and D. ealthFoster, workers “Repertoires are one for of Talking the categories White: Resistantof skilled Whitenessprofession- in Post-Apartheid Southals most Africa” affected Ethnic by andglobalization. Racial Studies Over 31(1) the (2008):past decade, 25-51. 35 G. Silber and N. thereGeffen, has “Race, emerged Class a substantialand Violent body Crime of researchin South that Africa: tracks Dis- pelling the ‘Huntley’patterns Thesis” of international SA Crime Quarterly migration 30(2009): of health 35-43. personnel, 36 Z. Ismail,H “Is Crime Dividing the Rainbow Nation? Fear of Crime in South assesses causes and consequences, and debates policy responses at global Africa”and Afrobarometer national scales. Briefing Within Paper this No.literature, 96, Cape the Town, case of 2009. South Africa is attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- migrationoped pcountries.olicy s Howeries to deal with the consequences of the resultant outflow of health professionals is a core policy issue for the national gov- 1. Coverternment. Operations: Clandestine Migration, Temporary Work and Immigration Policy inThis South paper Africa aims (1997) to to examineISBN 1-874864-51-9 policy debates and issues concerning 2. Ridingthe the migration Tiger: Lesotho of skilled Miners health and professionals Permanent from Residence the country in South and toAfrica (1997)furnish ISBN new 1-874864-52-7 insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: 3. International Migration, Immigrant Entrepreneurs and South Africa’s Small Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H Enterprise Economy (1997) ISBN 1-874864-62-4 ment of skilled professionals from South Africa in the health 4. Silenced by Nationsector. TheBuilding: paper African draws upon Immigrants a detailed and analysis Language of recruitment Policy in the New South Africaadvertising (1998) appearing ISBN 1-874864-64-0 in the South African Medical Journal for 5. Left Out in the the period Cold? 2000-2004 Housing and and Immigration a series of interviews in the New conducted South Africawith (1998) ISBN private1-874864-68-3 recruiting enterprises. 6. Trading Places:Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< Cross-Border Traders and the South African Informal Sector (1998) ISBN key1-874864-71-3 stakeholders in the South African health sector, the paper 7. Challenging Xenophobia:offers a series Myth of recommendations and Realities about for addressingCross-Border the Migrationproblem of in Southern Africaskilled (1998) health ISBN migration. 1-874864-70-5 These recommendations are grounded in both South African experience and an interrogation of inter- 8. Sons of Mozambique:national debates Mozambican and ‘good Miners policy’ and practice Post-Apartheid for regulating South recruit- Africa (1998) ISBN ment.1-874864-78-0 9. Women Theon the paper Move: is organized Gender into and five Cross-Border sections. Section Migration Two to positions South Africa (1998)debates ISBN about1-874864-82-9. the migration of skilled health professionals within a 10. Namibianswider literature on South that Africa: discusses Attitudes the international Towards Cross-Border mobility of Migration talent. and ImmigrationSection Policy Three (1998) reviews ISBN research 1-874864-84-5. on the global circulation of health pro- 11. Buildingfessionals, Skills: focusing Cross-Border in particular Migrants upon and debates the South relating African to the Construction experience Industryof countries (1999) ISBN in the 1-874864-84-5 developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- 12. Immigration & Education: International Students at South African Universities rial drawn from the survey of recruitment patterns and key interviews and Technikons (1999) ISBN 1-874864-89-6 undertaken with health sector recruiters operating in South Africa. 13. The LivesSection and Five Times addresses of African the questions Immigrants of changing in Post-Apartheid policy interventions South Africa in (1999)South ISBN Africa 1-874864-91-8 towards the outflow of skilled health professionals and the 14. Still Waitingrecruitment for theof foreign Barbarians: health South professionals African to Attitudes work in toSouth Immigrants Africa. The and Immigration (1999) ISBN 1-874864-91-8

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EXECUTIVE SUMMARY 15. Undermining Labour: Migrancy and Sub-contracting in the South African Gold Mining Industry (1999) ISBN 1-874864-91-8 ealth workers are one of the categories of skilled profession- 16. Borderline Farming: Foreign Migrants in South African Commercial Agricul- als most affected by globalization. Over the past decade, ture (2000) ISBN 1-874864-97-7 there has emerged a substantial body of research that tracks 17. Writing Xenophobia: Immigration and the Press in Post-Apartheid South Africa Hpatterns of international migration of health personnel, (2000) ISBN 1-919798-01-3 assesses causes and consequences, and debates policy responses at global 18. Losing Our Minds: Skills Migration and the South African Brain Drain (2000) and national scales. Within this literature, the case of South Africa is ISBN 1-919798-03-x attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- 19. Botswana: Migration Perspectives and Prospects (2000) ISBN 1-919798-04-8 oped countries. How to deal with the consequences of the resultant out- 20. The Brain Gain: Skilled Migrants and Immigration Policy in Post-Apartheid flow of health professionals is a core policy issue for the national gov- South Africa (2000) ISBN 1-919798-14-5 ernment. 21. Cross-Border Raiding and Community Conflict in the Lesotho-South African This paper aims to to examine policy debates and issues concerning Border Zone (2001) ISBN 1-919798-16-1 the migration of skilled health professionals from the country and to 22. Immigration, Xenophobia and Human Rights in South Africa (2001) ISBN furnish new insights on the recruitment patterns of skilled health per- 1-919798-30-7 sonnel. The objectives of the paper are twofold: Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H 23. Gender and the Brain Drain from South Africa (2001) ISBN 1-919798-35-8 ment of skilled professionals from South Africa in the health 24. Spaces of Vulnerability: Migration and HIV/AIDS in South Africa (2002) ISBN sector. The paper draws upon a detailed analysis of recruitment 1-919798-38-2 advertising appearing in the South African Medical Journal for 25. Zimbabweans Who Move: Perspectives on International Migration in Zimba- the period 2000-2004 and a series of interviews conducted with bwe (2002) ISBN 1-919798-40-4 private recruiting enterprises. 26. The Border Within: The Future of the Lesotho-South African International Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< Boundary (2002) ISBN 1-919798-41-2 key stakeholders in the South African health sector, the paper 27. Mobile Namibia: Migration Trends and Attitudes (2002) ISBN 1-919798-44-7 offers a series of recommendations for addressing the problem of skilled health migration. These recommendations are grounded 28. Changing Attitudes to Immigration and Refugee Policy in Botswana (2003) in both South African experience and an interrogation of inter- ISBN 1-919798-47-1 national debates and ‘good policy’ practice for regulating recruit- 29. The New Brain Drain from Zimbabwe (2003) ISBN 1-919798-48-X ment. 30. Regionalizing Xenophobia? Citizen Attitudes to Immigration and Refugee Policy The paper is organized into five sections. Section Two positions in Southern Africa (2004) ISBN 1-919798-53-6 debates about the migration of skilled health professionals within a 31. Migration, Sexuality and HIV/AIDS in Rural South Africa (2004) ISBN wider literature that discusses the international mobility of talent. 1-919798-63-3 Section Three reviews research on the global circulation of health pro- 32. Swaziland Moves: Perceptions and Patterns of Modern Migration (2004) ISBN fessionals, focusing in particular upon debates relating to the experience 1-919798-67-6 of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- 33. HIV/AIDS and Children’s Migration in Southern Africa (2004) ISBN 1-919798- rial drawn from the survey of recruitment patterns and key interviews 70-6 undertaken with health sector recruiters operating in South Africa. 34. Medical Leave: The Exodus of Health Professionals from Zimbabwe (2005) Section Five addresses the questions of changing policy interventions in ISBN 1-919798-74-9 South Africa towards the outflow of skilled health professionals and the 35. Degrees of Uncertainty: Students and the Brain Drain in Southern Africa recruitment of foreign health professionals to work in South Africa. The (2005) ISBN 1-919798-84-6

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36.EXECUTIVE Restless Minds:SUMMARY South African Students and the Brain Drain (2005) ISBN 1-919798-82-X 37. Understanding Pressealth Coverage workers are of oneCross-Border of the categories Migration of skilledin Southern profession- Africa since 2000 (2005)als ISBN most 1-919798-91-9 affected by globalization. Over the past decade, 38. Northern Gateway:there Cross-Border has emerged Migrationa substantial Between body of Namibiaresearch that and tracks Angola (2005)H ISBN 1-919798-92-7patterns of international migration of health personnel, assesses causes and consequences, and debates policy responses at global 39. Early Departures: The Emigration Potential of Zimbabwean Students (2005) and national scales. Within this literature, the case of South Africa is ISBN 1-919798-99-4 attracting growing interest. For almost 15 years South Africa has been 40. Migrationthe target and Domesticof a ‘global Workers: raiding’ of Worlds skilled of professionals Work, Health by several and Mobility devel- in Johannesburgoped countries. (2005) HowISBN to 1-920118-02-0 deal with the consequences of the resultant out- 41. The Qualityflow of health of Migration professionals Services is a core Delivery policy in issue South for Africathe national (2005) gov- ISBN 1-920118-03-9ernment. 42. States of ThisVulnerability: paper aims The to Futureto examine Brain policy Drain debatesof Talent and to Southissues Africaconcerning (2006) ISBNthe 1-920118-07-1 migration of skilled health professionals from the country and to 43. Migrationfurnish and new Development insights on inthe Mozambique: recruitment patternsPoverty, ofInequality skilled health and Survival per- (2006)sonnel. ISBN The1-920118-10-1 objectives of the paper are twofold: Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H 44. Migration, Remittances and Development in Southern Africa (2006) ISBN ment of skilled professionals from South Africa in the health 1-920118-15-2 sector. The paper draws upon a detailed analysis of recruitment 45. Medical Recruiting:advertising The appearing Case of in South the South African African Health Medical Care Journal Professionals for (2007) ISBN the1-920118-47-0 period 2000-2004 and a series of interviews conducted with 46. Voices From theprivate Margins: recruiting Migrant enterprises. Women’s Experiences in Southern Africa (2007) ISBN 1-920118-50-0Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< 47. The Haemorrhagekey stakeholders of Health Professionals in the South From African South health Africa: sector, Medical the Opinionspaper (2007) ISBN offers978-1-920118-63-1 a series of recommendations for addressing the problem of 48. The Quality ofskilled Immigration health andmigration. Citizenship These Services recommendations in Namibia (2008) are grounded ISBN 978- 1-920118-67-9in both South African experience and an interrogation of international debates and ‘good policy’ practice for regulating recruit- 49. Gender, Migrationment. and Remittances in Southern Africa (2008) ISBN 978-1- 920118-70-9The paper is organized into five sections. Section Two positions 50. The Perfectdebates Storm: about Thethe migration Realities ofof Xenophobiaskilled health in professionals Contemporary within South a Africa (2008)wider ISBN literature 978-1-920118-71-6 that discusses the international mobility of talent. 51. MigrantSection Remittances Three reviews and Household research Survival on the inglobal Zimbabwe circulation (2009) of ISBNhealth 978-1-pro- 920118-92-1fessionals, focusing in particular upon debates relating to the experience 52. Migration,of countries Remittances in the and developing ‘Development’ world. in Lesotho Section (2010) Four moves ISBN 978-1-920409-the focus from 26-5 international to South African issues and provides new empirical mate- 53. Migration-Inducedrial drawn from HIV the and survey AIDS of inrecruitment Rural Mozambique patterns and and key Swaziland interviews (2011) ISBNundertaken 978-1-920409-49-4 with health sector recruiters operating in South Africa. 54. MedicalSection Xenophobia: Five addresses Zimbabwean the questionsAccess to Healthof changing Services policy in South interventions Africa (2011) in ISBNSouth 978-1-920409-63-0 Africa towards the outflow of skilled health professionals and the 55. The Engagementrecruitment of foreign the Zimbabwean health professionals Medical Diaspora to work (2011)in South ISBN Africa. 978-1- The 920409-64-7

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EXECUTIVE SUMMARY 56. Right to the Classroom: Educational Barriers for Zimbabweans in South Africa (2011) ISBN 978-1-920409-68-5 ealth workers are one of the categories of skilled profession- 57. Patients Without Borders: Medical Tourism and Medical Migration in Southern als most affected by globalization. Over the past decade, Africa (2012) ISBN 978-1-920409-74-6 there has emerged a substantial body of research that tracks 58. The Disengagement of the South African Medical Diaspora (2012) ISBN 978-1- Hpatterns of international migration of health personnel, 920596-00-2 assesses causes and consequences, and debates policy responses at global 59. The Third Wave: Mixed Migration from Zimbabwe to South Africa (2012) ISBN and national scales. Within this literature, the case of South Africa is 978-1-920596-01-9 attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- 60. Linking Migration, Food Security and Development (2012) ISBN 978-1-920596- oped countries. How to deal with the consequences of the resultant out- 02-6 flow of health professionals is a core policy issue for the national gov- 61. Unfriendly Neighbours: Contemporary Migration from Zimbabwe to Botswana ernment. (2012) ISBN 978-1-920596-16-3 This paper aims to to examine policy debates and issues concerning 62. Heading North: The Zimbabwean Diaspora in Canada (2012) ISBN 978-1- the migration of skilled health professionals from the country and to 920596-03-3 furnish new insights on the recruitment patterns of skilled health personnel. The objectives of the paper are twofold: Q +CDFCJ=895B5I8=HC:H<9CF;5B=N5H=CB5B8D5HH9FBGC:F97FI=H ment 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. Q 5G98IDCBH<956CJ95B5@MG=G5B8588=H=CB5@=BH9FJ=9KGK=H< 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 material 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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southern AfricAn MigrAtion ProgrAMMe