Abstract the Geography of Brain Drain Migration in the Health Sector
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ABSTRACT THE GEOGRAPHY OF BRAIN DRAIN MIGRATION IN THE HEALTH SECTOR: FROM ZIMBABWE TO THE UK By Tatenda Mambo This thesis is about the immigration of Zimbabweans to the UK and their participation in the National Health Service (NHS). Given the global movements of nurses, this thesis seeks to document the migrant experience of Zimbabwean nurses and determine whether they represent a brain drain. Data for this study were collected in Zimbabwe and the UK during the summer of 2007 through semi‐structured interviews, use a survey and analysis of secondary data. The thesis finds that, immigration of Zimbabweans to the UK and their participation in the NHS in the result of place specific attributes that highlighting the importance of geography. For Zimbabwe to stem the emigration of nurses and realize return migration of this human capital, the Zimbabwean government needs to create opportunity that is globally competitive. Essential factors to address are political, economic and social concerns of everyday life. Without addressing these concerns, the status quo will continue. THE GEOGRAPHY OF BRAIN DRAIN MIGRATION IN THE HEALTH SECTOR: FROM ZIMBABWE TO THE UK A Thesis Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Masters of Arts Department of Geography By Tatenda Mambo Miami University Oxford, OH 2009 Advisor_______________________ (Dr. Ian E. A. Yeboah) Reader ________________________ (Dr. Carl Dahlman) Reader _________________________ (Dr. Mark A. Peterson) Table of contents…………….……………………………………………………………………………………Page List of tables …………………………………………………………………………………………………………………………..iii List of figures ………………………………………………………………………………………………………………………….iv Acknowledgements ………………………………………………………………………………………………………………..v Chapter One: Introduction ………………………………………………………………………………………….1 1.1: Introduction……………………………………………………………………………………………………………..1 1.2: Background Information…………………………………………………………………………………………..3 1.3: Research questions ………………………………………………………………………………………………….7 1.4: Research Methodology…………………………………………………………………………………………….7 1.5: Data Collection ………………………………………………………………………………………………………11 1.6: Organization of the thesis ……………………………………………………………………………………..12 Chapter Two: Literature Review on Brain Drain Migration and the Health Sector………14 2.1: Introduction ………………………………………………………………………………………………………….14 2.2: Migration Theory …………………………………………………………………………………………………..16 2.3: What are the Costs and Benefits of Migration to Source Areas? ……………………………21 2.4: Global Health Labor Shortage ……………………………………………………………………………….25 2.5: Mitigation of brain drain migration: Landscapes of the source and destination …….27 2.6: Missing Links …………………………………………………………………………………………………………29 2.7: Conceptual Framework and Research Questions……………………………………………………32 Chapter Three: Trajectory of Zimbabwean Emigrants to UK: Place Attributes of Zimbabwe ………………………………………………………………………………………………………………..37 3.1: Introduction ………………………………………………………………………………………………………….37 3.2: Who Migrates? ………………………………………………………………………………………………………38 3.3: Reasons for Emigration out of Zimbabwe ……………………………………………………………..42 3.4: How they Migrate ………………………………………………………………………………………………….51 3.5: Brain Drain on Zimbabwe?……………………………………………………………………………………..52 ii 3.6: Conclusion: Trajectory of Zimbabwean Emigrants in the UK ………………………………….57 Chapter Four: Experiences in the UK: Place attributes of the UK ….…………………………..59 4.1: Introduction……………………………………………………………………………………………………………59 4.2: Settlement Patterns ………………………………………………………………………………………………60 4.3: How and Why Zimbabweans fit into the UK Nurse Industry …………………………………..61 4.4: Zimbabwean Nurses participation in the UK nurse industry …………………………………..69 4.5: Zimbabwean Nurse Experiences in the UK: Giving up Dignity for Cash ………………….71 4.6: Conclusion …………………………………………………………………………………………………………….80 Chapter Five: Transnational Activities: Maintaining connections between Zimbabwe and the UK……………………………………………………………………………………………………………………….83 5.1: Introduction …………………………………………………………………………………………………………..83 5.2: Transnational Activities ………………………………………………………………………………………….84 5.3: Future plans and Return Migration ………………………………………………………………………..87 5.4: Establishing Roots …………………………………………………………………………………………………94 5.5: The Role of Government in Return Migration ………………………………………………………..97 5.6: Conclusion …………………………………………………………………………………………………………..100 Chapter Six: Zimbabwean Nurses future in the changing UK nursing industry………….102 6.1: Introduction …………………………………………………………………………………………………………102 6.2: The Code of Conduct for the Recruitment of International Nurses ………………………102 6.3: Shortage Occupation List and the European Union directive ……………………………….106 6.4: Changes to pay Negotiation …………………………………………………………………………………108 6.5: NHS Funding for Nursing School…………………………………………………………………………..110 6.6: Conclusion……………………………………………………………………………………………………………112 References………………………………………………………………………………………………………………113 iii List of Tables Table 1.1: Top 20 contributors of nurses to the UK from 1999 to 2007 …………………………..5 Table 3.1: Demographic Attributes ……………………………………………………………………………….39 Table 3.2: Gender and Family Migration ………………………………………………………………………41 Table 3.3: Trajectories & Length of Migration ………………………………………………………………42 Table 3.4: Why Zimbabweans Emigrate from Zimbabwe ………………………………………………46 Table 3.5: Occupational & Human Capital Components………………………………………………..53 Tables 4.1: Where in the UK do they Settle……………………………………………………………………61 Table 4.2: The Role of Social Networks in Helping Immigrants Settle in the UK ……………67 Table 4.3: Nurse Experiences in the UK ………………………………………………………………………..72 Table 5.1: Transnational Activities ………………………………………………………………………………..85 Table 5.2: Retirement …………………………………………………………………………………………………..88 Table 5.3: Establishing Roots ………………………………………………………………………………………..95 List of Figures Figure 1.1: Map of the Total Number of Overseas Nurses Immigrating to the UK from 1999 to 2007………………………………..…………………………………………………………………………………4 Figure 2.1: Graphic of the Geographic Perspective ……………………………………………………….20 Figure 2.2: Conceptual framework for the immigration of Zimbabwean nurses to the UK………………………..…………………………………………………………………………………………….. 32 Figure 4.2: Inflow of Zimbabwe Nurses to the NMC registry …………………………………………70 Figure 6.1: Inflow of South African and West Indies nurses from 1999 to 2007…………..104 Figure 6.2: Inflow of nurses form a selection of countries …………………………………………..105 iv Acknowledgments I would like to thank the following people for their contributions in making the completion of this thesis possible; Professor Ian Yeboah, for his guidance through the conceptualization, analysis, writing and modification phases of this thesis; Professor Mark Peterson and Professor Carl Dahlman for the great ideas and criticisms that made the thesis a better document; The Miami University Geography Department, for the generous funding of my research; Hazel Mandisodza, for her assistance in finding research participants in the UK; The research participants in both Zimbabwe and the UK for their willingness to participate; and to my friends and family who kept me in their thoughts and prayers. v The Geography of Brain Drain Migration in the Health Sector: From Zimbabwe to the UK Chapter One: Introduction 1.1: Introduction The significance of health care workers has garnered much attention in academic study, because of the huge shortages of health care workers across the globe, both in the global core and especially in the global periphery (Clark, Stewart, Clark 2006; Dale 2005; Batata 2004). The World Health Organization has identified brain drain migration of health professionals out of Sub‐Saharan Africa as a major obstacle to achieving the Millennium Development Goals targeting health (Ahmad 2004; Lancet 2005). Immigration of health care professionals from Sub‐Saharan Africa to the global core results in manpower shortages across the African continent and drastically reduces the quality of health care (Chikanda 2006, 2008; Clark, Stewart, Clark 2006; Getahun 2006). Countries like Zambia, Malawi and Zimbabwe face major shortages of health care professionals like doctors and nurses resulting in their hospitals being manned by skeleton staff barley able to meet work loads. Collectively Sub‐Saharan Africa is believed to experience a shortfall of 600,000 nurses (Clark, Stewart, and Clark 2006). Malawi is estimated to have only 28% of nurse positions filled (Clark, Stewart, and Clark 2006). In 1997, Zimbabwe only had 28.7% of doctor positions filled and 55.6% of nurse positions filled (Chikanda 2008). The poor remuneration and work conditions encourage health professionals in these countries to seek better opportunities which typically lie outside the country. Countries of the global core where these health professionals immigrate also face manpower shortages in their health delivery systems. The USA is expected to experience a shortage of 275,000 nurses by 2010 (Clark, Stewart, and Clark 2006). The UK is expected to experience a nurse shortage of 53,000 within the next 5‐10 years and Australia is expected to have a shortage of 40,000 nurses by 2010 (Batata 2004). In light of these manpower shortages, countries like the UK, Australia and Canada have used immigrant labor to address this problem. Through recruitment campaigns and changes to immigration policy, countries of the global core have admitted health care professionals from the global periphery to fill vacancies (Crush 2002; 1 Dale 2005; Buchan 2006). These policy changes and recruitment campaigns have created