tHe soutHern afriCan migration programme

Heading nortH: tHe Zimbabwean diaspora in Canada

migration poliCy series no. 62 Heading nortH: tHe Zimbabwean diaspora in Canada

JonatHan CrusH, abel CHikanda and belinda maswikwa

series editor: prof. JonatHan CrusH

soutHern afriCan migration programme (samp) 2012 aCknowledgements The authors wish to thank the following for their contributions to the research on which this report is based: Mary Caesar, Cassandra Eberhardt, Ashley Hill, Wade Pendleton and Sujata Ramachandran. Thanks also to Bronwen Dachs, Cassandra Eberhardt and Julia Seirlis for their editorial assistance. The research was funded by the IDRC.

© Southern African Migration Programme (SAMP) 2012 ISBN 978-1-920596-03-3 First published 2012 Production by Bronwen Müller, Cape Town

All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without prior permission from the publishers.

Printed by Megadigital, Cape Town Contents page exeCutive summary 1 introduCtion 4 leaving Zimbabwe 4

Zimbabwean migration to Canada 6 metHodology 9

Zimbabweans in Canada: a profile 12

Comparing Zimbabwe and Canada 15

Zimbabwean identity 17 frequenCy of visits 18 remitting beHaviour 19 diaspora engagement 21 return migration 26

ConClusion 29 endnotes 30 migration poliCy series 32 list of tables table 1: provinCe of destination of Zimbabwean immigrants to 8 Canada, 1980-2009 table 2: loCation of total and survey Zimbabweans in Canada (%) 10 table 3: Class of entry into Canada 12 table 4: demograpHiC profile of respondents 13 table 5: eduCational profile of respondents 14 table 6: Current status in Canada 15 table 7: Comparison between Canada and Zimbabwe 16 table 8: attitudes to Zimbabwean Culture 18 table 9: main uses of remittanCes in Zimbabwe 21 table 10: membersHip or partiCipation in diaspora organiZations 24 in Canada table 11: future linkages witH Zimbabwe 25 list of figures figure 1: Zimbabwean immigrants in Canada, 2006 6 figure 2: Zimbabwean immigration to Canada, 1980-2009 7 figure 3: Zimbabwean immigration to Canada by Category of entry, 8 1980-2009 figure 4: maJor Cities of settlement of Zimbabweans in Canada 9 figure 5: year of migration to Canada of respondents 11 figure 6: most important reason for Coming to Canada 13 figure 7: inCome profile of respondents 15 figure 8: frequenCy of return visits to Zimbabwe 18 figure 9: volume of remittanCes sent to Zimbabwe annually 19 figure 10: frequenCy of remitting to Zimbabwe 20 figure 11: diasporas and development 23 figure 12: likeliHood of returning to Zimbabwe 26 MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4562

eExeXECUTIVECutive sSummaryUMMARY

tudies ofealth the Zimbabwean workers are onediaspora of the tend categories to focus of on skilled migrants profession- in South SAfrica andals themost United affected Kingdom. by globalization. This is the Over first majorthe past study decade, of Zimba- bwean migrationthere tohas Canada. emerged The a substantial report presents body and of research discusses that the findingstracks of a SAMP patternssurvey conducted of international across Canadamigration in of2010. health It first personnel, discusses the Hrecent history of migration from Zimbabwe to Canada and then provides assesses causes and consequences, and debates policy responses at global aand demographic national scales. and socio-economicWithin this literature, profile the of thecase Zimbabweanof South Africa diaspora is inattracting Canada. growing The report interest. also For examines almost the15 years linkages South that Africa Zimbabweans has been in Canadathe target maintain of a ‘global with raiding’Zimbabwe, of skilled and the professionals potential for by return several migration. devel- opedAccording countries. to How the 2006 to deal Canadian with the Census, consequences there were of the 8,040 resultant Zimbabwe- out- bornflow peopleof health in Canada,professionals comprising is a core 6,525 policy immigrants issue for (permanentthe national residents gov- andernment. naturalized citizens) and 1,515 non-permanent residents (students andThis temporary paper aims workers). to to examine Immediately policy after debates independence and issues concerning in Zimbabwe inthe 1980, migration there ofwas skilled an increase health inprofessionals migration to from Canada. the country The numbers and to rose brieflyfurnish again new ininsights the late on 1980s the recruitment and then remained patterns relativelyof skilled lowhealth and per- stable forsonnel. most Theof the objectives 1990s. In of other the paperwords, are although twofold: emigration from Zimbabwe increasedQ +C
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EXECUTIVE SUMMARY with 35% of respondents noting that they are working in a job that does not make full use of their professional qualifications and experience. ealth workers are one of the categories of skilled profession- Once they have gained entry to Canada, many Zimbabweans acquire als most affected by globalization. Over the past decade, more secure status that enables them to stay permanently. Nearly 50% of there has emerged a substantial body of research that tracks the respondents indicated that they are now Canadian citizens, while 33% patterns of international migration of health personnel, are landed immigrants (permanent residents). The survey presented the H respondents with 15 quality-of-life indicators and asked them to consider assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is which country they rated more highly on each indicator. On virtually all of attracting growing interest. For almost 15 years South Africa has been the indicators, Canada was ranked better than Zimbabwe by a significant the target of a ‘global raiding’ of skilled professionals by several devel- margin. These included medical services, personal or family safety, future oped countries. How to deal with the consequences of the resultant out- of children, prospects for professional advancement, availability of employ- flow of health professionals is a core policy issue for the national gov- ment and job security, and level of income. Zimbabwe ranked more highly ernment. than Canada on only one indicator: the quality of social life. This paper aims to to examine policy debates and issues concerning Most of the respondents have a significant number of family members the migration of skilled health professionals from the country and to still in Zimbabwe: 68% have siblings, 59% have parents and 55% have furnish new insights on the recruitment patterns of skilled health per- grandparents in the country. A smaller number have children (16%) and sonnel. The objectives of the paper are twofold: spouses (5%) in Zimbabwe. Despite these family ties, just over half of the Q +C
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F97FI=H respondents (52%) said they had not visited Zimbabwe since moving to ment of skilled professionals from South Africa in the health Canada. One in five respondents visit Zimbabwe at least once every 2-3 sector. The paper draws upon a detailed analysis of recruitment years and a further 27% at least once every 5–10 years. Among those who advertising appearing in the South African Medical Journal for have visited Zimbabwe at least once since arriving in Canada, the main the period 2000-2004 and a series of interviews conducted with purpose was for family issues and events. While Zimbabweans in Canada private recruiting enterprises. are not frequent visitors to Zimbabwe, this does not mean that they do not Q 5G98
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EXECUTIVECanadaSUMMARY to contribute to the country’s reconstruction. More than half of the survey respondents (55%) agreed or strongly agreed with the statement that they haveealth an workers important are role one to of play the incategories the development of skilled of profession- Zimbabwe. Zimbabweansals in most Canada affected clearly by globalization.maintain strong Over social, the pastreligious decade, and cul- tural links withthere each has emergedother. There a substantial is a strong body sense of researchof community that tracks among Zimbabweans,patterns especially of international those in smaller migration cities, of and health it is personnel,not uncommon Hto find a large Zimbabwean presence at family events such as birthday cel- assesses causes and consequences, and debates policy responses at global ebrations,and national weddings scales. andWithin funerals. this literature, Many also the belong case ofto Southorganizations Africa is and associationsattracting growing in Canada interest. with ForZimbabwean almost 15 identities years South or linkages. Africa has been theThe target survey of a found‘global that, raiding’ given of theskilled opportunity, professionals the Zimbabwean by several devel- diaspo- raoped in Canada countries. is primed How to to deal engage with directly the consequences in development-related of the resultant activities. out- Atflow present, of health only professionals a minority areis a involvedcore policy with issue development for the national organizations gov- thaternment. have links and programmes in Zimbabwe, but there are high levels of interestThis inpaper activities aims to such to examine as skills policytransfer debates through and training, issues concerning educational exchanges,the migration working of skilled in Zimbabwe health professionals and providing from distance the country teaching and viato the internet.furnish new Financial insights support on the would recruitment take the patterns form of of fundraising skilled health for projects per- insonnel. Zimbabwe, The objectives investment of the in business,paper are sendingtwofold: remittances for develop- mentQ projects, +C
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EXECUTIVE SUMMARY introduCtion ealth workers are one of the categories of skilled profession- imbabwe has become a major global migrant-sending country over the als most affected by globalization. Over the past decade, Zpast two decades. Although the country began to lose skilled workers there has emerged a substantial body of research that tracks and professionals in the 1980s, the magnitude of the post-2000 move- 1 patterns of international migration of health personnel, ment has been unprecedented in scope and volume. Runaway inflation, H deepening poverty and political oppression are the main push factors for assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is most Zimbabweans. Migrants from the country now include the skilled attracting growing interest. For almost 15 years South Africa has been and unskilled, men and women, young and old. Migration has become a the target of a ‘global raiding’ of skilled professionals by several devel- way of life for many Zimbabweans who play a major role in the survival of oped countries. How to deal with the consequences of the resultant out- their families still in Zimbabwe. As the scale of migration from Zimbabwe flow of health professionals is a core policy issue for the national gov- continues to rise, concerns have been raised about the long-term impacts 2 ernment. on Zimbabwe’s chances of economic recovery. This paper aims to to examine policy debates and issues concerning The precise number of people who have left Zimbabwe is not known. 3 the migration of skilled health professionals from the country and to Some “guesstimates” put the figure at between 1.5 and 3 million. What furnish new insights on the recruitment patterns of skilled health per- is certain is that the Zimbabwean diaspora has grown rapidly and become sonnel. The objectives of the paper are twofold: global in its distribution. In 2001, 192 of the 222 countries reported in Q +C
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EXECUTIVEin 1974.SUMMARY The departure of white professionals in the late 1970s and early 1980s marked the start of Zimbabwe’s skills drain, although some of the losses were ealthoffset workersby returning are one black of theresidents categories who ofhad skilled acquired profession- training and skills inals other most countries. affected byThe globalization. most affected Over sectors the pastwere decade, engineering and its alliedthere fields, has medical emerged and a substantialrelated professions, body of researchand secondary that tracks school education. patterns of international migration of health personnel, HA second large-scale movement of skilled Zimbabweans out of the assesses causes and consequences, and debates policy responses at global countryand national was triggeredscales. Within by the this adverse literature, effects the of casethe ofEconomic South Africa Structural is Adjustmentattracting growing Programme interest. (ESAP) For almost introduced 15 years in South 1991. Africa8 Rising has inflation been ledthe totarget an increaseof a ‘global in raiding’ the cost of of skilled living professionals while remuneration by several for devel- workers remainedoped countries. stagnant. How For to manydeal withprofessionals, the consequences emigration of wasthe resultantthe only soluout-- tionflow toof maintaininghealth professionals a decent is standard a core policy of living. issue The for healththe national and education gov- sectors,ernment. in particular, experienced a significant loss of skilled professionals.9 TheThis emigration paper aims of skillsto to examine from Zimbabwe policy debates intensified and issues after theconcerning constitu- tionalthe migration referendum of skilled and controversial health professionals general fromelection the ofcountry 2000. 10and In to 2001, thefurnish Zimbabwean new insights government on the recruitment abolished dualpatterns citizenship. of skilled Holders health ofper- dual citizenshipsonnel. The (mainly objectives white) of thewere paper forced are totwofold: renounce one or other of their citizenships.Q +C
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EXECUTIVE SUMMARY Zimbabwean migration to Canada ealth workers are one of the categories of skilled profession- racking Zimbabwean migration to Canada is complicated by the fact als most affected by globalization. Over the past decade, Tthat Canadian immigration data are only available from 1980 onwards there has emerged a substantial body of research that tracks and therefore exclude the first wave of (white) emigration before inde- patterns of international migration of health personnel, pendence. Post-1980 data may also under-count the number of Zimbabwe- H ans in Canada. Step-migration is relatively common among Zimbabwean assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is professionals who first move to South Africa or the United Kingdom before 13 attracting growing interest. For almost 15 years South Africa has been relocating to North America. Some individuals may spend long periods the target of a ‘global raiding’ of skilled professionals by several devel- of time in the intermediate destination and acquire permanent residence oped countries. How to deal with the consequences of the resultant out- or even citizenship there before they move on. As a result, they may not flow of health professionals is a core policy issue for the national gov- necessarily be classified as Zimbabweans when they move to Canada. ernment. Despite these data limitations, it is still possible to map the contours This paper aims to to examine policy debates and issues concerning of the Zimbabwean diaspora in Canada. According to the 2006 Canadian the migration of skilled health professionals from the country and to Census, there were 8,040 Zimbabweans in Canada, comprising 6,525 furnish new insights on the recruitment patterns of skilled health per- immigrants (permanent residents and naturalized citizens) and 1,515 non- sonnel. The objectives of the paper are twofold: permanent residents (students and temporary workers) (Figure 1). Q +C
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F97FI=H Figure 1: Zimbabwean Immigrants in Canada, 2006 ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment 9,000 advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with 8,000 private recruiting enterprises. Q 5G98
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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. 1,000 Section Three reviews research on the global circulation of health pro- 0 fessionals, focusing in particular upon debates relating to the experience Before 1991 1991–1995 1996–2000 2001–2006 Non-permanent Total stock of countries in the developing world. Section Four moves the focus from residents international to South African issues and provides new empirical mate- Source: Statistics Canada rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Data for intercensal migration shows a significant increase over the past Section Five addresses the questions of changing policy interventions in decade. While 1,880 Zimbabwean immigrants arrived in Canada before South Africa towards the outflow of skilled health professionals and the 1991, fewer than 700 immigrated between 1991 and 2000. However, recruitment of foreign health professionals to work in South Africa. The between 2001 and 2006, the number rose to 3,490 and has continued to increase since 2006 (Figure 2). Citizenship and Immigration Canada

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EXECUTIVE(CIC)S UMMARYdata provide additional insights into Zimbabwean migration flows to Canada. Immediately after independence in Zimbabwe, there was an increase in migrationealth workers to Canada are one forof thethree categories years (Figure of skilled 2). The profession- numbers rose briefly alsagain most in affectedthe late by1980s globalization. and then remainedOver the relativelypast decade, low and stable for mostthere of has the emerged 1990s. Ina substantial other words, body although of research emigration that tracks from Zimbabwe increasedpatterns ofin internationalthe 1990s as economic migration prospects of health deteriorated, personnel, only Ha small number moved to Canada. This changed dramatically after 2000. assesses causes and consequences, and debates policy responses at global

Figure 2: Zimbabweanand national Immigration scales. Withinto Canada, this 1980-2009 literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been 1,600 the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- 1,400 flow of health professionals is a core policy issue for the national gov- ernment. 1,200 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 per- 1,000 sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H 800 ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment 600 advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with 400 private recruiting enterprises. Q 5G98
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K=H< 200 key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of 0 skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- 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 national debates and ‘good policy’ practice for regulating recruit- Source: Citizenship & Immigrationment. Canada The paper is organized into five sections. Section Two positions Every year from 2003 to 2009 at least 400 Zimbabweans were granted debates about the migration of skilled health professionals within a permanent residence in Canada. The peak year was 2004 when 1,456 wider literature that discusses the international mobility of talent. individuals became permanent residents. Before 2000, most Zimbabwean Section Three reviews research on the global circulation of health pro- migrants to Canada entered in the economic immigration class. After fessionals, focusing in particular upon debates relating to the experience 2002, refugees came to dominate the inflow (Figure 3). The number of of countries in the developing world. Section Four moves the focus from Zimbabweans immigrating to Canada in the family class was fairly small up international to South African issues and provides new empirical mate- to 2004, rarely exceeding 30 individuals in any one year. However, since rial drawn from the survey of recruitment patterns and key interviews 2005 there has been a significant increase in the number immigrating in undertaken with health sector recruiters operating in South Africa. this category. 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 Figure 3: Zimbabwean Immigration to Canada by Category of Entry, 1980–2009 1,400 ealth workers are one of the categories of skilled profession- als most affected by globalization. Over the past decade, 1,200 there has emerged a substantial body of research that tracks Hpatterns of international migration of health personnel, 1,000 assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is 800 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 out- 600 flow of health professionals is a core policy issue for the national gov- ernment. 400 This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to 200 furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 ment of skilled professionals from South Africa in the health Family class Economic immigrants Refugees Other immigrants sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for Source: Citizenship & Immigration Canada the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. In Canada, Ontario is by far the most popular destination for Zimba- Q 5G98
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5B8
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K=H< bweans. Between 1980 and 2009, for example, nearly 60% of all immigrants key stakeholders in the South African health sector, the paper settled first in Ontario (Table 1). Other significant populations of Zimba- offers a series of recommendations for addressing the problem of bweans in Canada are found in the provinces of Alberta (13% of the total), skilled health migration. These recommendations are grounded in both South African experience and an interrogation of inter- Table 1: Province of Destination of Zimbabwean Immigrants to Canada, 1980–2009 national debates and ‘good policy’ practice for regulating recruit- No. % ment. Ontario 4,425 59.7 The paper is organized into five sections. Section Two positions Alberta 957 12.9 debates about the migration of skilled health professionals within a British Columbia 867 11.7 wider literature that discusses the international mobility of talent. Quebec 753 10.2 Section Three reviews research on the global circulation of health pro- Manitoba 166 2.2 fessionals, focusing in particular upon debates relating to the experience Saskatchewan 79 1.1 of countries in the developing world. Section Four moves the focus from Nova Scotia 63 0.8 international to South African issues and provides new empirical mate- New Brunswick 46 0.6 rial drawn from the survey of recruitment patterns and key interviews Northwest Territories 27 0.4 undertaken with health sector recruiters operating in South Africa. Newfoundland and Labrador 19 0.3 Section Five addresses the questions of changing policy interventions in Prince Edward Island 7 0.1 South Africa towards the outflow of skilled health professionals and the Yukon Territory 6 0.1 recruitment of foreign health professionals to work in South Africa. The N= 7,415 Source: Citizenship & Immigration Canada

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EXECUTIVEBritishS UMMARY Columbia (12%) and Quebec (10%). The Zimbabwean popula- tion in Canada generally settles in the main urban centres. About 85% of Zimbabweansealth who workers have moved are one to of Canada the categories since 1980 of skilled are to profession- be found in big cities withals populationsmost affected of byover globalization. 350,000 (Figure Over 4). the Toronto past decade, is the most popular destinationthere has (41%), emerged followed a substantial by Montreal body of(9%), research Vancouver that tracks (8%), HHamilton (7%),patterns Calgary of international (6%) and Edmonton migration (5%). of health personnel, assesses causes and consequences, and debates policy responses at global Figure 4: Majorand Citiesnational of Settlement scales. Within of Zimbabweans this literature, in Canada the case of South Africa is attracting growing interest. For almost 15 years South Africa has been 3,500 the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- 3,000 flow of health professionals is a core policy issue for the national gov-

2,500 ernment. This paper aims to to examine policy debates and issues concerning

2,000 the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- 1,500 sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H 1,000 ment of skilled professionals from South Africa in the health sector. The paper draws upon a detailed analysis of recruitment 500 advertising appearing in the South African Medical Journal for the period 2000-2004 and a series of interviews conducted with 0 private recruiting enterprises. Toronto Montreal Vancouver Hamilton Calgary Edmonton Ottawa– St Kitchener Winnipeg London Q 5G98
IDCB
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=BH9FJ=9KG
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EXECUTIVE SUMMARY were conducted to boost the numbers closer to the target of 300. These 60 interviews brought the total in the sample to 280. ealth workers are one of the categories of skilled profession- Because it was impossible to construct a sample population from als most affected by globalization. Over the past decade, aggregated CIC and Census data (which do not identify individuals by there has emerged a substantial body of research that tracks name and location), there is no guarantee that the sample population is patterns of international migration of health personnel, completely representative of all Zimbabweans in Canada. It is therefore H important to see how the sample profile compares with the general CIC assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is profile for Zimbabweans in the country. First, in relation to physical loca- attracting growing interest. For almost 15 years South Africa has been tion, it is clear that the sample was drawn from across the country and in a the target of a ‘global raiding’ of skilled professionals by several devel- roughly similar distribution by province (Table 2). Zimbabweans in Mani- oped countries. How to deal with the consequences of the resultant out- toba were under-sampled and those in Ontario over-sampled. With regard flow of health professionals is a core policy issue for the national gov- to the urban concentration of the sample, Zimbabweans in large cities with ernment. populations above 1 million in the 2006 Census (Toronto, Montreal and This paper aims to to examine policy debates and issues concerning Vancouver) were under-sampled, while those in medium-sized cities were the migration of skilled health professionals from the country and to over-sampled. Generally, it was easier to reach Zimbabweans in the smaller furnish new insights on the recruitment patterns of skilled health per- cities, where they are more closely networked and seemed more willing to sonnel. The objectives of the paper are twofold: participate in the survey. Q +C
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F97FI=H ment of skilled professionals from South Africa in the health Table 2: Location of Total and Survey Zimbabweans in Canada (%) sector. The paper draws upon a detailed analysis of recruitment CIC data SAMP sample advertising appearing in the South African Medical Journal for Province the period 2000-2004 and a series of interviews conducted with Ontario 59.7 66.4 private recruiting enterprises. Alberta 12.9 13.6 Q 5G98
IDCB
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K=H< British Columbia 11.7 12.9 key stakeholders in the South African health sector, the paper Manitoba 10.2 1.8 offers a series of recommendations for addressing the problem of Saskatchewan 2.2 1.4 skilled health migration. These recommendations are grounded Quebec 1.1 1.4 in both South African experience and an interrogation of inter- Nova Scotia 0.8 1.1 national debates and ‘good policy’ practice for regulating recruit- New Brunswick 0.6 0.7 ment. Newfoundland and Labrador 0.4 0.7 The paper is organized into five sections. Section Two positions Prince Edward Island 0.3 0.0 debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. N 7,415 280 Section Three reviews research on the global circulation of health pro- Size of Urban Area fessionals, focusing in particular upon debates relating to the experience >1,000,000 63.7 46.8 of countries in the developing world. Section Four moves the focus from 500,000–1,000,000 23.9 16.2 international to South African issues and provides new empirical mate- 250,000–500,000 7.2 4.3 rial drawn from the survey of recruitment patterns and key interviews 100,000–250,000 1.0 8.3 undertaken with health sector recruiters operating in South Africa. 50,000–100,000 1.2 5.8 Section Five addresses the questions of changing policy interventions in 10,000–50,000 1.2 2.2 South Africa towards the outflow of skilled health professionals and the 1,000–10,000 0.1 1.1 recruitment of foreign health professionals to work in South Africa. The Other (please specify) 1.6 15.5 N 6,677 278

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EXECUTIVESecond,SUMMARY with regard to the chronology of immigration to Canada, the general profile of respondents resembles that of official Zimbabwean immigrationealth to Canada workers (Figures are one 2 of and the 5).categories The oldest of skilled survey profession- respondent had come toals Canada most affected as long by ago globalization. as 1964. While Over mostthe past years decade, from 1978 onwards hadthere at least has oneemerged respondent, a substantial the numbers body of dramatically research that increased tracks after 2000. Althoughpatterns of there international were annual migration variations of health(for example, personnel, 2004 was Hthe peak year for migration to Canada whereas 2001 had the most survey assesses causes and consequences, and debates policy responses at global respondents),and national scales. in general Within the this proportion literature, of the post-2000 case of South migrants Africa was is very similarattracting in both growing groups. interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- Figure 5: Yearoped of Migrationcountries. to CanadaHow to of deal Respondents with the consequences of the resultant out- 30 flow of health professionals is a core policy issue for the national gov- ernment. This paper aims to to examine policy debates and issues concerning 25 the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- 20 sonnel. The objectives of the paper are twofold: Q +C
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F97FI=H ment of skilled professionals from South Africa in the health 15 sector. The paper draws upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for 10 the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. Q 5G98
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K=H< 5 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 0 in both South African experience and an interrogation of inter-

1964 1972 1975 1978 1979 1980 1981 national1983 1984 1987 debates1988 1989 1990 and1991 1992 ‘good1994 1995 policy’1996 1997 1998 practice1999 2000 2001 for2002 2003 regulating2004 2005 2006 2007 recruit-2008 2009 2010 ment. Third,The paper the sample’sis organized class into of entry five sections.to Canada Section is roughly Two similar positions to that of alldebates Zimbabwean about the migrants migration who of entered skilled the health country professionals between 1980within and a 2009 (Tablewider literature3). Refugee that and discusses humanitarian the international migrants were mobility the largest of talent. category in bothSection groups Three (37% reviews of the research sample on and the 43% global of thecirculation total). The of health sample pro- had proportionallyfessionals, focusing greater in numbersparticular of upon economic debates immigrants relating to(22% the versusexperience 13%) andof countries fewer family in the class developing immigrants world. (17% Section versus Four 6%). moves Similar the proportions focus from enteredinternational as students. to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

111 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Heading nortH: tHe Zimbabwean diaspora in Canada

EXECUTIVE SUMMARY Table 3: Class of Entry into Canada All Respondents Class of entry Zimbabweans ealth workers are one of the categories of skilled profession- (%) als most affected by globalization. Over the past decade, (%) there has emerged a substantial body of research that tracks Asylum seeker/refugee 53.4 37.5 patterns of international migration of health personnel, Skilled worker or professional 13.0 21.7 H Family sponsorship/assisted relative class 6.0 16.6 assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Student 11.5 11.9 attracting growing interest. For almost 15 years South Africa has been Canadian experience class – 0.8 the target of a ‘global raiding’ of skilled professionals by several devel- Temporary worker 4.8 0.8 oped countries. How to deal with the consequences of the resultant out- Government-sponsored (investor, entrepreneur or self-employed) – 0.4 flow of health professionals is a core policy issue for the national gov- Provincial nominee (investor, entrepreneur or self-employed) – 0.4 ernment. Other/not specified 11.3 9.9 This paper aims to to examine policy debates and issues concerning N 16,180 253 the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: Q +C
DFCJ=89
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F97FI=H Zimbabweans in Canada: a profile ment of skilled professionals from South Africa in the health he survey sample has more female (57%) than male (43%) respond- sector. The paper draws upon a detailed analysis of recruitment Tents (Table 4). Racially, the sample is dominated by black respondents, advertising appearing in the South African Medical Journal for who comprise 63% of the total. White respondents make up 24% of the the period 2000-2004 and a series of interviews conducted with sample. Other groups represented in the survey include Zimbabweans of private recruiting enterprises. mixed race (4%) and those of Indian/Asian origin (2%). The sample is Q 5G98
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K=H< generally youthful with at least 65% below 40 years. Those older than 53 key stakeholders in the South African health sector, the paper years comprise only 9.5% of the sample. Slightly more than half (55%) offers a series of recommendations for addressing the problem of were married while a substantial proportion (35%) had never been mar- skilled health migration. These recommendations are grounded ried, which is consistent with the sample’s age profile. Over a third were in both South African experience and an interrogation of inter- under the age of 30 (36.5%) and less than 10% were over the age of 53. national debates and ‘good policy’ practice for regulating recruit- The reasons given by the respondents for coming to Canada varied ment. substantially, but were generally consistent with the class-of-entry findings The paper is organized into five sections. Section Two positions (Figure 6). For example, 21% mentioned safety and security and 11% gave debates about the migration of skilled health professionals within a political reasons, amounting to 32% (compared with the 38% who came wider literature that discusses the international mobility of talent. as asylum seekers). Again, while 17% gave education as their major reason Section Three reviews research on the global circulation of health pro- for coming to Canada, 12% entered on student permits. fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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ETableXECUTIVE 4: DemographicSUMMARY Profile of Respondents No. % Gender ealth workers are one of the categories of skilled profession- Female als most affected by globalization. Over158 the past decade,56.8 Male there has emerged a substantial body120 of research that43.2 tracks Total Hpatterns of international migration278 of health personnel,100.0 Race assesses causes and consequences, and debates policy responses at global Black and national scales. Within this literature, the176 case of South Africa63.3 is White attracting growing interest. For almost 15 years66 South Africa has23.7 been the target of a ‘global raiding’ of skilled professionals by several devel- Other 19 6.8 oped countries. How to deal with the consequences of the resultant out- Coloured 11 4.0 flow of health professionals is a core policy issue for the national gov- Indian/Asian 6 2.2 ernment. Total This paper aims to to examine policy debates278 and issues concerning100.0 Age the migration of skilled health professionals from the country and to 17–30 furnish new insights on the recruitment patterns96 of skilled health36.5 per- 31–39 sonnel. The objectives of the paper are twofold:75 28.5 40–46 Q +C
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F97FI=H38 14.4 47–52 ment of skilled professionals from South29 Africa in the 11.0health 53–90 sector. The paper draws upon a detailed25 analysis of recruitment9.5 Total advertising appearing in the South African263 Medical Journal100.0 for Marital Status the period 2000-2004 and a series of interviews conducted with Married/common lawprivate recruiting enterprises. 155 55.4 Never married Q 5G98
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K=H<97 34.6 Divorced/separated key stakeholders in the South African health22 sector, the7.9 paper Widowed offers a series of recommendations for addressing6 the problem2.1 of Total skilled health migration. These recommendations280 are100.0 grounded in both South African experience and an interrogation of inter- Figure 6: Most Importantnational Reason debates for Coming and ‘goodto Canada policy’ practice for regulating recruit- 25 ment. The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a 20 wider literature that discusses the international mobility of talent. Section Three reviews research on the global circulation of health pro- 15 fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- 10

Percentage rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. 5 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 0 Children's Safety/ Educational Economic Political Other Professional Unite with future security relatives 131 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Heading nortH: tHe Zimbabwean diaspora in Canada

EXECUTIVE SUMMARY Even though immigration from Zimbabwe to Canada is dominated by refugees, the survey showed that most possessed good professional quali- ealth workers are one of the categories of skilled profession- fications upon entry. For instance, at least 30% had a university degree als most affected by globalization. Over the past decade, before migrating from Zimbabwe (Table 5). However, 42% were asked there has emerged a substantial body of research that tracks to re-certify or re-train in Canada to enable them to work in a field for patterns of international migration of health personnel, which they were already trained. This highlights the more general problem H of recognition of qualifications that foreign-trained professionals face in assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Canada.15 After moving to Canada, 72% continued to study, including attracting growing interest. For almost 15 years South Africa has been technical or vocational diplomas or certificates (29%), bachelor’s degrees the target of a ‘global raiding’ of skilled professionals by several devel- (29%), master’s degrees (8%) and professional degrees (6%). oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- Table 5: Educational Profile of Respondents ernment. No. % This paper aims to to examine policy debates and issues concerning Highest level of education acquired in Zimbabwe the migration of skilled health professionals from the country and to Less than secondary school 20 7.4 furnish new insights on the recruitment patterns of skilled health per- Secondary school 84 31.0 sonnel. The objectives of the paper are twofold: Technical/vocational diploma/certificate 75 27.7 Q +C
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F97FI=H Bachelor’s/honour’s degree 48 17.7 ment of skilled professionals from South Africa in the health Master’s degree 18 6.6 sector. The paper draws upon a detailed analysis of recruitment Professional degree 18 6.6 advertising appearing in the South African Medical Journal for Ph.D. degree 3 1.1 the period 2000-2004 and a series of interviews conducted with Other 5 1.8 private recruiting enterprises. Total 271 100.0 Q 5G98
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K=H< Highest level of education achieved/in progress outside Zimbabwe key stakeholders in the South African health sector, the paper offers a series of recommendations for addressing the problem of Less than secondary school 1 0.5 skilled health migration. These recommendations are grounded Secondary school 21 11.0 in both South African experience and an interrogation of inter- Technical/vocational diploma/certificate 55 28.8 national debates and ‘good policy’ practice for regulating recruit- Bachelor’s/honour’s degree 56 29.3 ment. Master’s degree 16 8.4 The paper is organized into five sections. Section Two positions Professional degree 11 5.8 debates about the migration of skilled health professionals within a Ph.D. degree 8 4.2 wider literature that discusses the international mobility of talent. Other 23 12.0 Section Three reviews research on the global circulation of health pro- Total 191 100.0 fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from Students made up 15% of the sample, while other common occupa- international to South African issues and provides new empirical mate- tional categories include finance, business and banking (13%), sales and rial drawn from the survey of recruitment patterns and key interviews service (11%), health (10%), social services (8%) and technical and trades undertaken with health sector recruiters operating in South Africa. (7%). Immigrants to Canada frequently discover that their foreign creden- Section Five addresses the questions of changing policy interventions in tials are less desirable on the job market and they have to settle for signifi- South Africa towards the outflow of skilled health professionals and the cantly less skilled jobs than they had in their countries of origin. Thirty-five recruitment of foreign health professionals to work in South Africa. The percent of Zimbabwean respondents noted that they were working in a job that did not make full use of their professional qualifications and experi-

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EXECUTIVEence.S InUMMARY terms of income, just over half (52%) of the sample earned less than CAD50,000 annually (Figure 7). Slightly more than 10% earned more than CAD100,000ealth workers a are year. one of the categories of skilled profession- als most affected by globalization. Over the past decade, Figure 7: Income Profile thereof Respondents has emerged a substantial body of research that tracks 35 Hpatterns of international migration of health personnel, 30 assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is 25 attracting growing interest. For almost 15 years South Africa has been 20 the target of a ‘global raiding’ of skilled professionals by several devel- 15 oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- Percentage 10 ernment. 5 This paper aims to to examine policy debates and issues concerning 0 the migration of skilled health professionals from the country and to Less than CAD26,000– CAD51,000– CAD76,000– CAD101,000– More than Prefer not to CAD25,000furnish CAD50,000new insightsCAD75,000 on the recruitmentCAD100,000 CAD200,000patterns of CAD201,000skilled healthanswer per- sonnel. The objectives of the paper are twofold: Q +C
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F97FI=HAnnual income ment of skilled professionals from South Africa in the health Comparing Zimbabwesector. The andpaper Cdrawsanada upon a detailed analysis of recruitment advertising appearing in the South African Medical Journal for ncethe they period have 2000-2004 gained entry and to a Canada,series of interviewsmany Zimbabweans conducted acquire with Omoreprivate secure recruiting status that enterprises. enables them to stay permanently. While 37% of theQ respondents 5G98
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K=H< entered Canada as refugees, only 5% indicated that they stillkey hold stakeholders asylum seeker in the or Southrefugee African status. Nearlyhealth sector,50% indicated the paper that they areoffers now Canadiana series of citizensrecommendations while 33% havefor addressing landed immigrant the problem status. of skilled health migration. These recommendations are grounded Table 6: Current Statusin both in Canada South African experience and an interrogation of inter- national debates and ‘good policy’ practice for regulating% recruit- Citizen ment. 48.5 Permanent resident/landedThe paper immigrant is organized into five sections. Section Two positions33.1 Non-permanentdebates resident about – work the permit migration of skilled health professionals within6.5 a Asylum seeker/refugeewider literature that discusses the international mobility of talent.5.0 Non-permanentSection resident Three – student reviews research on the global circulation of health5.0 pro- Not specifiedfessionals, focusing in particular upon debates relating to the experience2.0 N of countries in the developing world. Section Four moves the 260focus from international to South African issues and provides new empirical mate- rialThis drawn would from suggest the survey that ofZimbabweans recruitment inpatterns Canada and do keynot interviewssee their stay asundertaken temporary. with The health obvious sector question recruiters then operating is whether in they South have Africa. a high or lowSection opinion Five of addresses their adopted the questions country. of The changing survey policypresented interventions the respond in- entsSouth with Africa 15 quality-of-lifetowards the outflow indicators of skilled and asked health them professionals to consider and which the countryrecruitment they of rated foreign more health highly professionals on each indicator. to work inOn South almost Africa. all of The the indicators, Canada was ranked better by a significant margin (Table 7).

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EXECUTIVE SUMMARY These included medical services (95% better in Canada), personal or family safety (88% better in Canada), future of children (82% better in ealth workers are one of the categories of skilled profession- Canada), prospects for professional advancement (73% better in Canada), als most affected by globalization. Over the past decade, availability of employment and job security (72% better in Canada) there has emerged a substantial body of research that tracks and level of income (71% better in Canada). Given Zimbabwe’s recent patterns of international migration of health personnel, economic circumstances, none of these answers is surprising. Zimbabwe H ranked more highly than Canada on only one indicator: social life (49% assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is better in Zimbabwe, 38% better in Canada). attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- Table 7: Comparison between Canada and Zimbabwe oped countries. How to deal with the consequences of the resultant out- Better in Better in No Don’t know Canada Zimbabwe difference flow of health professionals is a core policy issue for the national gov- (%) (%) (%) (%) ernment. This paper aims to to examine policy debates and issues concerning Medical services/treatment 94.6 1.2 0.8 3.3 the migration of skilled health professionals from the country and to Upkeep of public amenities 89.6 2.1 2.1 6.3 furnish new insights on the recruitment patterns of skilled health per- My personal/my family’s safety 88.3 1.7 6.3 3.8 sonnel. The objectives of the paper are twofold: Future of my children 82.5 4.2 3.8 9.6 Q +C
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F97FI=H Honesty/integrity of politicians 74.6 1.3 14.6 9.6 ment of skilled professionals from South Africa in the health Environmental protection 73.6 10.3 5.8 10.3 sector. The paper draws upon a detailed analysis of recruitment Prospects for professional/job advancement 73.3 15.6 4.9 6.2 advertising appearing in the South African Medical Journal for Availability of a suitable job/job security 71.8 14.1 8.3 5.8 the period 2000-2004 and a series of interviews conducted with My level of income 70.5 14.1 5.8 9.5 private recruiting enterprises. Cost of living 61.3 25.5 4.5 8.6 Q 5G98
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K=H< Attitudes to foreigners/immigration/ 59.9 16.9 11.6 11.6 key stakeholders in the South African health sector, the paper treatment of refugees offers a series of recommendations for addressing the problem of Racial/ethnic/cultural tolerance 50.0 23.1 16.5 10.3 skilled health migration. These recommendations are grounded Affordable housing 42.1 39.7 5.0 13.2 in both South African experience and an interrogation of inter- Social life 38.1 48.8 8.2 4.9 national debates and ‘good policy’ practice for regulating recruit- Level of taxation 37.0 32.8 9.2 21.0 ment. N=241 The paper is organized into five sections. Section Two positions debates about the migration of skilled health professionals within a Many qualitative responses confirmed that Canada is perceived to be a wider literature that discusses the international mobility of talent. better place to live: Section Three reviews research on the global circulation of health pro- Zimbabwe is still a possibility for me to go back but I presently fessionals, focusing in particular upon debates relating to the experience worry about the health care system and what I would do if of countries in the developing world. Section Four moves the focus from my kids got sick. Here, I can dash to a walk-in-clinic whereas international to South African issues and provides new empirical mate- back home it may not necessarily be the case (Respondent rial drawn from the survey of recruitment patterns and key interviews No. 3). undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in We immigrated to Canada mainly because my mother had South Africa towards the outflow of skilled health professionals and the been victimized for political reasons. She was a principal at recruitment of foreign health professionals to work in South Africa. The a school in Zimbabwe and had received threats because she

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EXECUTIVE SrefusedUMMARY to participate in the ruling party’s rally (Respondent No. 47). ealth workers are one of the categories of skilled profession- I fear alsvery most much affected for my by life globalization. and my family’s Over lives, the Mugabe past decade, and his followersthere has will emerged kill us (Respondenta substantial No.body 49). of research that tracks patterns of international migration of health personnel, HI came to Canada to obtain a university degree that I could assesses causes and consequences, and debates policy responses at global use anywhere in the world. I chose to study in Canada and national scales. Within this literature, the case of South Africa is because it was cheaper than in the United States or the attracting growing interest. For almost 15 years South Africa has been United Kingdom (Respondent No. 35). the target of a ‘global raiding’ of skilled professionals by several devel- oped countries.I chose CanadaHow to deal because with ofthe their consequences welcoming of immigrationthe resultant out- flow ofpolicy. health Other professionals countries is likea core the policy USA issueclaim for to the accept national immi gov-- ernment.grants but they do not offer the same support that Canada Thisdoes, paper for aimsexample, to to inexamine social welfare, policy debates health care,and issueslegal aidconcerning etc. the migration(Respondent of skilled No. 35).health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: ZimbabweanQ i +C
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EXECUTIVE SUMMARY Table 8: Attitudes to Zimbabwean Culture Do you: No. % ealth workers are one of the categories of skilled profession- Want your children to know about the culture of Zimbabwe? 203 82.5 als most affected by globalization. Over the past decade, Listen to music from Zimbabwe? 182 74.0 there has emerged a substantial body of research that tracks Make or buy traditional foods from Zimbabwe? 180 73.2 Hpatterns of international migration of health personnel, Want your children to learn the language(s) of Zimbabwe? 150 61.0 assesses causes and consequences, and debates policy responses at global Read a newspaper from Zimbabwe online? 146 59.3 and national scales. Within this literature, the case of South Africa is Find that most of your best friends in Canada are from Zimbabwe? 112 45.5 attracting growing interest. For almost 15 years South Africa has been N=246 the target of a ‘global raiding’ of skilled professionals by several devel- oped countries. How to deal with the consequences of the resultant out- flow of health professionals is a core policy issue for the national gov- frequenCy of visits ernment. This paper aims to to examine policy debates and issues concerning amily ties and frequency of visits are generally good indicators of the the migration of skilled health professionals from the country and to Fmaintenance of transnational linkages by migrants. Most of the survey furnish new insights on the recruitment patterns of skilled health per- respondents have a significant number of family members still in Zimba- sonnel. The objectives of the paper are twofold: bwe: 68% have siblings, 59% have parents and 55% have grandparents Q +C
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1 18 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4562

EXECUTIVEwho haveSUMMARY gone back at least once since arriving in Canada. Only a few visited for business activities (4%) or tourism (3%). While Zimbabweans in Canada areealth not workers frequent are visitors one of to the Zimbabwe, categories this of skilleddoes not profession- mean that they do notals maintain most affected links by there. globalization. For example, Over 29% the havepast decade, active bank accounts inthere Zimbabwe, has emerged while 24%a substantial own a house, body of19% research own landthat andtracks 8% Hhave investments.patterns of international migration of health personnel, assesses causes and consequences, and debates policy responses at global remittingand nationalbeHaviour scales. Within this literature, the case of South Africa is attracting growing interest. For almost 15 years South Africa has been then target Zimbabwe, of a ‘global economic raiding’ and of social skilled collapse professionals has meant by several that devel- migrants Iopedhave countries. become theHow mainstay to deal ofwith household the consequences survival and of thesignificant resultant drivers out- offlow national of health development. professionals Remittances is a core policy have issue been for credited the national with avertinggov- theernment. total collapse of Zimbabwe’s economy and alleviating acute poverty at householdThis paper level.aims 16to Sixty-sixto examine percent policy ofdebates the survey and issues respondents concerning send moneythe migration to Zimbabwe of skilled (Figure health 9). professionalsThe average amountfrom the of country money andsent toannu- allyfurnish is CAD2,703, new insights similar on the to recruitment the amounts patterns sent byof skilled Zimbabweans health per- in the Unitedsonnel. Kingdom.The objectives17 However, of the therepaper is are great twofold: variability in the amounts sent by theQ survey +C
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10.0 fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- 5.0 rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. 0.0 Section Five addresses the questions of changing policy interventions in CAD1–CAD999 CAD1,000– CAD2,501– >CAD4,000 None South Africa towardsCAD2,500 the outflowCAD4,000 of skilled health professionals and the recruitment of foreign healthAmount professionals to work in South Africa. The

191 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Heading nortH: tHe Zimbabwean diaspora in Canada

EXECUTIVE SUMMARY Nearly one-third of the respondents send money to Zimbabwe at least once a month. A further 28% said they send cash remittances home at few ealth workers are one of the categories of skilled profession- times a year (Figure 10). Over 60% of those sending money to Zimbabwe als most affected by globalization. Over the past decade, remit to close family members while another 20% send money to members there has emerged a substantial body of research that tracks of their extended family. Only 4% said they deposit funds into a bank patterns of international migration of health personnel, account for their own future use. Formal channels such as money transfer H agencies (69%) and banks (12%) are the main mechanism for sending assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is money to Zimbabwe. Informal transfer channels are used by only 7% and attracting growing interest. For almost 15 years South Africa has been hand-to-hand transfer by 12%. The use of formal transfer mechanisms the target of a ‘global raiding’ of skilled professionals by several devel- contrasts markedly with the Zimbabwean diaspora in South Africa, where oped countries. How to deal with the consequences of the resultant out- informal channels predominate.18 flow of health professionals is a core policy issue for the national gov- ernment. Figure 10: Frequency of Remitting to Zimbabwe This paper aims to to examine policy debates and issues concerning 30 the migration of skilled health professionals from the country and to furnish new insights on the recruitment patterns of skilled health per- 25 sonnel. The objectives of the paper are twofold: Q +C
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1 20 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4562

ETableXECUTIVE 9: Main UsesSUMMARY of Remittances in Zimbabwe No. % Buy food ealth workers are one of the132 categories of skilled79.5 profession- Pay medical expenses als most affected by globalization.104 Over the past 62.7decade, Pay educational/school feesthere has emerged a substantial96 body of research57.8 that tracks Meet day-to-dayH householdpatterns expenses of international migration86 of health personnel,51.8 Buy clothesassesses causes and consequences, and debates70 policy responses42.2 at global Pay transportationand national costs scales. Within this literature,57 the case of South34.3 Africa is For specialattracting events growing interest. For almost 1552 years South Africa31.3 has been the target of a ‘global raiding’ of skilled professionals by several devel- Build, maintain, renovate their dwelling 32 19.3 oped countries. How to deal with the consequences of the resultant out- For agricultural inputs/equipment 29 17.5 flow of health professionals is a core policy issue for the national gov- Start or run a business 13 7.8 ernment. For savings This paper aims to to examine policy12 debates and issues concerning7.2 Purchase livestockthe migration of skilled health professionals8 from the country4.8 and to Buy propertyfurnish new insights on the recruitment 7patterns of skilled health4.2 per- N sonnel. The objectives of the paper are166 twofold: 100.0 Note: Question allowedQ +C
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211 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Heading nortH: tHe Zimbabwean diaspora in Canada

EXECUTIVE SUMMARY concept of development in the diaspora describes the social and economic networks that form among migrants in the country of destination and ealth workers are one of the categories of skilled profession- facilitate their integration and economic progress there (Figure 11). Sec- als most affected by globalization. Over the past decade, ond, development through the diaspora describes the social and economic there has emerged a substantial body of research that tracks progress within a geographically-separated space precisely because of the patterns of international migration of health personnel, networks that they maintain with one another. Third, development by the H diaspora describes the role of migrants as development actors in their coun- assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is try of origin. To some extent, the Zimbabwean diaspora in Canada exhibits attracting growing interest. For almost 15 years South Africa has been features of all three categories (Table 10). Although slightly more than the target of a ‘global raiding’ of skilled professionals by several devel- half of the respondents (54%) reported that they do not participate in any oped countries. How to deal with the consequences of the resultant out- home-country-focused activities in Canada, there is significant participa- flow of health professionals is a core policy issue for the national gov- tion in activities that link them to other Zimbabweans in Canada and in ernment. Zimbabwe. This paper aims to to examine policy debates and issues concerning First, with regard to development in the diaspora, Zimbabweans in the migration of skilled health professionals from the country and to Canada maintain strong social, religious and cultural links amongst furnish new insights on the recruitment patterns of skilled health per- themselves. A good example is the Zimbabwe Assemblies of God Africa sonnel. The objectives of the paper are twofold: (ZAOGA) church, also known as the Forward in Faith Ministries Interna- Q +C
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1 22 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk Migration Policy SerieS no. 62

Figure 11: Diasporas and Development

Development IN the Diaspora

Development THROUGH the Diaspora

Development BY the Diaspora

23 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Heading nortH: tHe Zimbabwean diaspora in Canada

EXECUTIVE SUMMARY of this paper, the survey findings suggest that the Zimbabwean diaspora in Canada is primed to engage directly in development-related activi- ealth workers are one of the categories of skilled profession- ties, given the right opportunity. At present, only a few are involved with als most affected by globalization. Over the past decade, development organizations that have links and programmes in Zimbabwe: there has emerged a substantial body of research that tracks 20% belong to charitable organizations with links to Zimbabwe, 19% patterns of international migration of health personnel, with religious associations and 11% with NGOs (Table 10). Looking H ahead, however, there are high levels of interest in becoming involved assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is (Table 11). Capacity-building projects likely to be supported include skills attracting growing interest. For almost 15 years South Africa has been transfer through training (49%), educational exchanges (44%), working the target of a ‘global raiding’ of skilled professionals by several devel- in Zimbabwe (40%), and providing distance teaching via the internet oped countries. How to deal with the consequences of the resultant out- (30%). Financial support would take the form of fundraising for projects flow of health professionals is a core policy issue for the national gov- in Zimbabwe (51%), investment in business (45%), sending remittances ernment. for development projects (39%) and making charitable donations (38%). This paper aims to to examine policy debates and issues concerning Economic activities of interest include investment in infrastructure (32%), the migration of skilled health professionals from the country and to exporting Canadian goods to Zimbabwe (31%) and importing goods to furnish new insights on the recruitment patterns of skilled health per- Canada from Zimbabwe (29%). Only 11% said they had no interest in any sonnel. The objectives of the paper are twofold: of these activities. Q +C
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1 24 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4562

EXECUTIVE SandUMMARY subsequent loss of development potential (Respondent No. 39). ealth workers are one of the categories of skilled profession- I am als currently most affected involved by globalization. in charity workOver tothe helppast decade, obtain sustainablethere has livelihoods emerged a in substantial Africa (Zimbabwe) body of research because that oftracks first-handpatterns experiences of international I have witnessedmigration asof wellhealth as havingpersonnel, an Hopportunity to share how much some people are suffering due assesses causes and consequences, and debates policy responses at global and nationalto dysfunctional scales. Within education this literature,systems, poverty, the case sickness, of South mainly Africa is attractingHIV growing and AIDS. interest. Many For of thesealmost people’s 15 years cries South for Africahelp are has left been the targetunheard of a ‘globalfor one raiding’ reason ofor skilledthe other professionals and it is bymy severalhope and devel- oped countries.prayer to makeHow toa change deal with (Respondent the consequences No. 25). of the resultant out- flow of health professionals is a core policy issue for the national gov- I am doing everything I can to help children in poor families ernment. with school supplies. This is all my charitable organization This paper aims to to examine policy debates and issues concerning can offer at the present moment (Respondent No. 30). the migration of skilled health professionals from the country and to furnishHowever, new insightsa significant on the change recruitment in the patterns current of economic skilled health and political per- climatesonnel. inThe Zimbabwe objectives was of seenthe paper by many are twofold:as a prerequisite for their partici- pationQ in +C
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K=H< with Zimbabwe If you had the opportunity, in which of the following ways would you key stakeholders in the South African health No.sector, the paper% like to contribute to developmentoffers a series in Zimbabwe? of recommendations for addressing the problem of Fundraising for projectsskilled health migration. These recommendations115 are grounded50.7 Transfer skills throughin training both Southpeople African experience and an interrogation112 of49.3 inter- Participating in developmentnational projects debates and ‘good policy’ practice for105 regulating46.3 recruit- Investment in businessment. 103 45.4 Educational exchangesThe paper is organized into five sections. Section100 Two positions44.1 Transfer skillsdebates through about working the in Zimbabwemigration of skilled health professionals91 within40.1 a Sending remittanceswider literature (money) that discusses the international mobility88 of talent.38.8 Making charitableSection donations Three reviews research on the global circulation86 of health37.9 pro- Volunteer workfessionals, in Zimbabwe focusing in particular upon debates relating83 to the experience36.6 Investmentof in infrastructurecountries in the developing world. Section Four moves72 the focus31.7 from Exporting goodsinternational to Zimbabwe to South African issues and provides new70 empirical30.8 mate- Providing distancerial drawn teaching from (via the internet) survey of recruitment patterns and69 key interviews30.4 Importing goodsundertaken from Zimbabwe with health sector recruiters operating in 66South Africa.29.1 Sending non-monetarySection Five gifts addresses the questions of changing policy60 interventions26.4 in South Africa towards the outflow of skilled health professionals and the Other 5 2.2 recruitment of foreign health professionals to work in South Africa. The I prefer not to contribute 24 10.6 N=227

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EXECUTIVE SUMMARY return migration ealth workers are one of the categories of skilled profession- risis-driven migration from countries such as Zimbabwe has the poten- als most affected by globalization. Over the past decade, Ctial to generate a counter-flow of migrants once the crisis conditions there has emerged a substantial body of research that tracks are resolved. Studies among Zimbabweans in the diaspora elsewhere have patterns of international migration of health personnel, shown that 67% of those based in the United Kingdom and 65% of those H in South Africa are likely to return at some time in the future.24 What, assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is then, is the likelihood of return of Zimbabwean migrants in Canada? The attracting growing interest. For almost 15 years South Africa has been survey respondents were almost equally divided, with 52% indicating that the target of a ‘global raiding’ of skilled professionals by several devel- they have given some thought to return and at least 45% saying that they oped countries. How to deal with the consequences of the resultant out- had given no or hardly any thought to the possibility. The survey then flow of health professionals is a core policy issue for the national gov- asked the respondents about the actual likelihood of their returning to ernment. Zimbabwe in the immediate future (within two years), the near future This paper aims to to examine policy debates and issues concerning (within five years) or the distant future (Figure 12). Only 8% indicated the migration of skilled health professionals from the country and to that it is likely or very likely that they will return to Zimbabwe within two furnish new insights on the recruitment patterns of skilled health per- years. The likelihood of return rises to 20% within five years and to 49% sonnel. The objectives of the paper are twofold: at some point in the future. It is clear that Zimbabweans in Canada are Q +C
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F97FI=H worried by the current state of Zimbabwe’s economy and political environ- ment of skilled professionals from South Africa in the health ment and that they expect things to improve, which will set a platform for sector. The paper draws upon a detailed analysis of recruitment their return. advertising appearing in the South African Medical Journal for Figure 12: Likelihood of Returning to Zimbabwe the period 2000-2004 and a series of interviews conducted with private recruiting enterprises. 90 Q 5G98
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EXECUTIVEthe conditionsSUMMARY that might influence return include changes in economic conditions (cited by 76%), improved safety and security (73%), change in the politicalealth system workers (69%) are and one improved of the categoriesjob opportunities of skilled (68%). profession- Qualitativeals most responses affected from by theglobalization. survey show Over that, the whilepast decade, there is sig- nificant interestthere in has return emerged migration, a substantial most adopt body a of “wait research and see”that attitude.tracks Some believepatterns that Canada of international does not offer migration them theof health opportunity personnel, to achieve Htheir professional goals and that a return to Zimbabwe is the only solution: assesses causes and consequences, and debates policy responses at global and nationalI strongly scales. believe Within that thisthere literature, is still a thecultural case ofglass South ceiling Africa in is attractingcorporate growing Canada interest. (i.e. For very almost few 15people years from South Africa Africa can has get been the targetpositions of a ‘global as very raiding’ senior executives of skilled professionalsno matter their by experienceseveral devel- oped countries.and education How evento deal if thatwith education the consequences was primarily of the obtained resultant out- flow ofin health Canada) professionals and I don’t is believe a core policyI can progress issue for to the reach national my full gov- ernment.potential beyond a certain level. I can only do that if I go back Thishome paper so aimsI maintain to to examine these links policy as adebates way to andkeep issues in touch concerning in the migrationcase I want of skilled to progress health in professionalsmy career beyond from whatthe country I can get and in to furnishCanada new insights (Respondent on the No.recruitment 53). patterns of skilled health per- sonnel. The objectives of the paper are twofold: OthersQ +C
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EXECUTIVE SUMMARY I am over 50 and I would not be able to get a job in my pro- fession in Zimbabwe. My children are here and I have grand- ealth workers are one of the categories of skilled profession- children born in Canada. My children have no intention of als most affected by globalization. Over the past decade, going back to Zimbabwe. I want to be close to my children there has emerged a substantial body of research that tracks and grandchildren (Respondent No. 31). patterns of international migration of health personnel, H I would never go back to live in Zimbabwe because my chil- assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is dren have grown up in Canada and would have a hard time attracting growing interest. For almost 15 years South Africa has been adjusting, and I have become accustomed to the way of life in the target of a ‘global raiding’ of skilled professionals by several devel- Canada. I will maintain links with relatives, organizations and oped countries. How to deal with the consequences of the resultant out- will visit as often as I can (Respondent No. 36). flow of health professionals is a core policy issue for the national gov- Although some respondents cited age as a factor hindering return to ernment. Zimbabwe, others anticipated returning in their old age: This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to I will go back home at some time in the future because I furnish new insights on the recruitment patterns of skilled health per- believe the elderly are better catered for in Africa than here sonnel. The objectives of the paper are twofold: in Canada. In Canada it is more expensive to live once one is Q +C
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F97FI=H old (Respondent No. 83). ment of skilled professionals from South Africa in the health For many, current conditions in Zimbabwe are a major barrier to return sector. The paper draws upon a detailed analysis of recruitment migration. For instance, the lack of good governance and democracy was advertising appearing in the South African Medical Journal for cited as a hindrance: the period 2000-2004 and a series of interviews conducted with I would rather stay here and help Zimbabwe develop from private recruiting enterprises. here until there is real democracy there (a government with Q 5G98
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1 28 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4562

CEXECUTIVEonClusionSUMMARY

imbabweanealth migration workers are to one Canada of the hascategories occurred of skilled steadily profession- since the Zfoundingals of most the post-colonial affected by globalization. state in 1980. Over The therecent past economic decade, and political crisisthere in hasZimbabwe emerged has a substantialresulted in bodyan accelerated of research movement that tracks of people frompatterns the country. of international Canada has migration become ofan healthincreasingly personnel, important Hdestination for Zimbabwean migrants. Furthermore, human rights viola- assesses causes and consequences, and debates policy responses at global tionsand national in Zimbabwe scales. haveWithin made this it literature, easier for the asylum case seekersof South to Africa gain entryis intoattracting Canada. growing interest. For almost 15 years South Africa has been the target There of are a ‘global distinct raiding’ patterns of skilled of settlement professionals among by theseveral Zimbabwean devel- diasporaoped countries. in Canada How withto deal evidence with the of consequences spatial clustering of the around resultant certain out- geographicalflow of health localities. professionals Ontario is a iscore by policyfar the issue most for popular the national destination gov- for Zimbabweanernment. migrants to Canada (the home of at least 60% of the Zim- babweanThis paper diaspora aims in to 2006). to examine Urban policyclustering debates is another and issues feature: concerning big cities suchthe migration as Toronto, of skilledMontreal health and professionals Vancouver from have the the country largest and population to offurnish Zimbabweans new insights in Canada. on the recruitmentToronto alone patterns is home of toskilled at least health 40% per- of all Zimbabweanssonnel. The objectives in Canada. of Even the paper though are the twofold: majority of Zimbabweans came to CanadaQ +C
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EXECUTIVE SUMMARY endnotes ealth workers are one of the categories of skilled profession- 1 J. Crush and D. Tevera, “Exiting Zimbabwe” In Crush and Tevera, eds, Zimba- als most affected by globalization. Over the past decade, bwe’s Exodus: Crisis, Migration, Survival (Cape Town and Ottawa: SAMP and there has emerged a substantial body of research that tracks IDRC, 2010), pp. 1-51; J. Crush, A. Chikanda and G. Tawodzera, The Third patterns of international migration of health personnel, Wave: Mixed Migration from Zimbabwe to South Africa SAMP Migration Policy H Series No. 59, Cape Town, 2012. assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is 2 A. Chikanda, “Skilled Health Professionals’ Migration and its Impact on Health attracting growing interest. For almost 15 years South Africa has been Delivery in Zimbabwe” Journal of Ethnic and Migration Studies 32(4) (2006): 667- the target of a ‘global raiding’ of skilled professionals by several devel- 80; UNDP, “The Potential Contribution of the Zimbabwe Diaspora to Economic oped countries. How to deal with the consequences of the resultant out- Recovery” Working Paper No 11, Harare, 2010. flow of health professionals is a core policy issue for the national gov- 3 D. Makina, “Zimbabwe in Johannesburg” In Crush and Tevera, Zimbabwe’s Exo- ernment. dus, pp. 225-43. This paper aims to to examine policy debates and issues concerning 4 D. Kapur, “Remittances: The New Development Mantra?” In S. Maimbo and D. the migration of skilled health professionals from the country and to Ratha, eds., Remittances: Development Impact and Future Prospects (Washington, furnish new insights on the recruitment patterns of skilled health per- D.C.: The World Bank, 2005), pp. 331-60; R. Adams, “Remittances, Poverty, sonnel. The objectives of the paper are twofold: and Investment in Guatemala” In Ç. Özden and M. Schiff, eds., International Q +C
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F97FI=H Migration, Remittances, and the Brain Drain (Washington, D.C. and Basingstoke: ment of skilled professionals from South Africa in the health World Bank and Palgrave Macmillan, 2006), pp. 53-80; R. Brown and J. Con- sector. The paper draws upon a detailed analysis of recruitment nell, “The Migration of Doctors and Nurses from South Pacific Island Nations” advertising appearing in the South African Medical Journal for Social Science & Medicine 58(11) (2004): 2193-210; M. Kangasniemi, A. Win- the period 2000-2004 and a series of interviews conducted with ters and S. Commander, “Is the Medical Brain Drain Beneficial? Evidence from private recruiting enterprises. Overseas Doctors in the UK” Social Science & Medicine, 65(5) (2007): 915-23; Q 5G98
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K=H< Y. Kuznetsov, “Leveraging Diasporas of Talent: Toward a New Policy Agenda” key stakeholders in the South African health sector, the paper In Y. Kuznetsov, ed., Diaspora Networks and the International Migration of Skills: offers a series of recommendations for addressing the problem of How Countries Can Draw on Their Talent Abroad (Washington, D.C.: The World skilled health migration. These recommendations are grounded Bank, 2006), pp. 221-237; N. Ndiaye, S. Melde and R. Ndiaye-Coic, “The in both South African experience and an interrogation of inter- Migration for Development in Africa Experience and Beyond” In S. Plaza and national debates and ‘good policy’ practice for regulating recruit- D. Ratha, eds., Diasporas for Development in Africa (Washington, D.C.: World ment. Bank, 2011), pp. 231-59. The paper is organized into five sections. Section Two positions 5 L. Zinyama, “International Migrations to and from Zimbabwe and the Influ- debates about the migration of skilled health professionals within a ence of Political Changes on Population Movements, 1965-1987” International wider literature that discusses the international mobility of talent. Migration Review 24 (1990): 748-67; A. Mlambo, “A History of Zimbabwean Section Three reviews research on the global circulation of health pro- Migration to 1990” In Crush and Tevera, Zimbabwe’s Exodus, pp.52-78. fessionals, focusing in particular upon debates relating to the experience 6 Zinyama, “International Migrations to and from Zimbabwe.” of countries in the developing world. Section Four moves the focus from 7 Ibid. international to South African issues and provides new empirical mate- 8 D. Tevera and J. Crush, The New Brain Drain from Zimbabwe SAMP Migration rial drawn from the survey of recruitment patterns and key interviews Policy Series No. 29, Cape Town, 2003. undertaken with health sector recruiters operating in South Africa. 9 R Gaidzanwa, Voting with their Feet: Migrant Zimbabwean Nurses and Doctors in Section Five addresses the questions of changing policy interventions in the Era of Structural Adjustment (Uppsala: Nordiska Afrikainstitutet, 1999); C. South Africa towards the outflow of skilled health professionals and the Chetsanga, An Analysis of the Cause and Effect of the Brain Drain in Zimbabwe recruitment of foreign health professionals to work in South Africa. The (Harare: Scientific and Industrial Research and Development Centre, 2003); Chikanda, “Skilled Health Professionals’ Migration and its Impact on Health Delivery in Zimbabwe.” 1 30 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MMIGRATIONigration PPOLICYolicy SERIESerieS NnOo. 4562

10EXECUTIVE J. McGregor,SUMMARY “Associational Links with Home among Zimbabweans in the UK: Reflections on Long-distance Nationalisms” Global Networks 9(2009): 185-208; Tevera and Crush,ealth New workers Brain Drain are one from of Zimbabwethe categories. of skilled profession- 11 The 2001 Citizenshipals most Amendment affected by globalization. Act stated that Over any the Zimbabweanpast decade, with any claim to foreignthere citizenship has emerged would a substantial be stripped body of ofZimbabwean research that citizenship tracks (obtained at birth)patterns unless ofthey international legally renounced migration that of claim. health Zimbabweans personnel, who couldH not afford the expensive or laborious process of legal renunciation and assesses causes and consequences, and debates policy responses at global those andwho national found that scales. they Within had no this basis literature, for legal the renunciation case of South of foreignAfrica isciti- zenshipattracting were effectively growing renderedinterest. Forstateless. almost Their 15 years status South as foreigners Africa has is beenmarked on theirthe identitytarget of cards a ‘global and theyraiding’ have of difficultyskilled professionals voting, obtaining by several passports devel- and accessingoped education countries. forHow their to dealchildren. with theDespite consequences a 2001 Supreme of the resultant Court ruling out- that theflow Act of healthwas unconstitutional professionals is anda core despite policy a issue2003 for amendment the national exempting gov- descendantsernment. of “African” immigrants from SADC, Zimbabweans still need to legally renounceThis paper any aims claims to tothey examine might havepolicy to debates any other and citizenship. issues concerning 12 W. Shaw,the migration “‘They Stoleof skilled Our health Land’: professionals Debating thefrom Expropriation the country and of to White Farmsfurnish in Zimbabwe” new insights Journal on of the Modern recruitment African patterns Studies 41of skilled(2003): health pp. 75-89; per- I. Scoones,sonnel. N. Marongwe, The objectives B. Mavedzenge, of the paper J. are Mahenehene, twofold: F. Murimbarimba and C. Sukume,Q Zimbabwe’s +C
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F97FI=H Land Reform: Myths & Realities (Harare: Weaver Press, 2010); Crushment and Tevera,of skilled Zimbabwe’s professionals Exodus from. South Africa in the health 13 A. Chikanda,sector. “Emigration The paper of Medical draws uponDoctors a detailed from Zimbabwe: analysis of Migrant recruitment Experi- ences, Transnationaladvertising Linkages appearing and inProspects the South for African Diasporic Medical Engagement” Journal forPhD Thesis, Universitythe period of Western 2000-2004 Ontario, and London,a series of2010. interviews conducted with 14 For further detailsprivate of recruiting the study enterprises. methodology see J. Crush, C. Eberhardt, M. Caesar, A.Q Chikanda, 5G98
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K=H< W. Pendleton and A. Hill, “Diasporas on the Web: New Networks, Newkey Methodologies”stakeholders in Inthe C. South Vargas-Silva, African healthed., Handbook sector, the of paperResearch Methods in Migrationoffers a series(Cheltenham: of recommendations Edward Elgar, for 2012), addressing pp. 345-65. the problem of 15 J. Reitz, “Immigrantskilled healthSkill Utilization migration. in These the Canadian recommendations Labour Market: are grounded Implica- tions of Humanin bothCapital South Research” African Journal experience of International and an interrogation Migration and of Integrainter-- tion 2 (2001):national 347-78. debates and ‘good policy’ practice for regulating recruit- 16 F. Maphosa, “Remittancesment. and Development: The Impact of Migration to South Africa onThe Rural paper Livelihoods is organized in into Southern five sections. Zimbabwe” Section Development Two positions Southern Africadebates 24 (2007): about 123-36; the migration D. Tevera of skilledand A. health Chikanda, professionals “Development within Impacta of Internationalwider literature Remittances: that discusses Some the Evidence international from Origin mobility Households of talent. in Zim- babwe”Section Global Three Development reviews Studies research 5 (2009):on the global273–302; circulation D. Tevera, of healthJ. Crush pro- and A. Chikanda,fessionals, “Migrant focusing Remittances in particular and upon Household debates relating Survival to in the Zimbabwe” experience In Crushof and countries Tevera, in Zimbabwe’s the developing Exodus world., pp.307-23. Section Four moves the focus from 17 Bloch,international Development toof SouthPotential African Zimbabweans issues and in the provides Diaspora new. empirical mate- 18 Crush,rial Chikanda drawn from and theTawodzera, survey of The recruitment Third Wave patterns. and key interviews 19 UNDP,undertaken “Contribution with ofhealth the Zimbabwe sector recruiters Diaspora operating to Economic in South Recovery.” Africa. 20 D. Pasura,Section “A FiveFractured addresses Transnational the questions Diaspora: of changing The Case policy of interventionsZimbabweans inin Britain”South International Africa towards Migration the 50outflow (2012): of 143-61.skilled health professionals and the 21 J. McGregorrecruitment and of D. foreign Pasura, health “Diasporic professionals Repositioning to work and in South the Politics Africa. of The Re- engagement: Developmentalising Zimbabwe’s Diaspora?” The Round Table 99 (2010): 687-703. 311 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk MIGRATION POLICY SERIES NO. 45 Heading nortH: tHe Zimbabwean diaspora in Canada

EXECUTIVE SUMMARY 22 G. Mohan, “Diaspora and Development” In J. Robinson, ed, Displacement and Development (Oxford: OUP, 2002), pp. 77-139. ealth workers are one of the categories of skilled profession- 23 E. Campbell and J. Crush, Unfriendly Neighbours: Contemporary Migration from als most affected by globalization. Over the past decade, Zimbabwe to Botswana SAMP Migration Policy Series No. 61, Cape Town, 2012. there has emerged a substantial body of research that tracks 24 Bloch, “Development Potential of Zimbabweans in the Diaspora”; Chetsanga, patterns of international migration of health personnel, Analysis of Cause and Effect of the Brain Drain in Zimbabwe. H 25 G. Borjas and B. Bratsberg, “Who Leaves? The Out-migration of the Foreign assesses causes and consequences, and debates policy responses at global and national scales. Within this literature, the case of South Africa is Born” Review of Economic Statistics 78(1996): 165-76; M. Beenstock, “Failure to attracting growing interest. For almost 15 years South Africa has been Absorb: Remigration by Immigrants Into Israel” International Migration Review the target of a ‘global raiding’ of skilled professionals by several devel- 30(1996): 950-78; J-P. Cassarino, “Theorising Return Migration: The Concep- oped countries. How to deal with the consequences of the resultant out- tual Approach to Return Migrants Revisited” International Journal on Multicul- flow of health professionals is a core policy issue for the national gov- tural Societies 6(2004): 253-79. ernment. This paper aims to to examine policy debates and issues concerning the migration of skilled health professionals from the country and to migration poliCy series furnish new insights on the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: 1. Covert Operations: Clandestine Migration, Temporary Work and Immigration Q +C
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F97FI=H Policy in South Africa (1997) ISBN 1-874864-51-9 ment of skilled professionals from South Africa in the health 2. Riding the Tiger: Lesotho Miners and Permanent Residence in South Africa sector. The paper draws upon a detailed analysis of recruitment (1997) ISBN 1-874864-52-7 advertising appearing in the South African Medical Journal for 3. International Migration, Immigrant Entrepreneurs and South Africa’s Small the period 2000-2004 and a series of interviews conducted with Enterprise Economy (1997) ISBN 1-874864-62-4 private recruiting enterprises. Q 5G98
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K=H< 4. Silenced by Nation Building: African Immigrants and Language Policy in the key stakeholders in the South African health sector, the paper New South Africa (1998) ISBN 1-874864-64-0 offers a series of recommendations for addressing the problem of 5. Left Out in the Cold? Housing and Immigration in the New South Africa skilled health migration. These recommendations are grounded (1998) ISBN 1-874864-68-3 in both South African experience and an interrogation of inter- 6. Trading Places: Cross-Border Traders and the South African Informal Sector national debates and ‘good policy’ practice for regulating recruit- (1998) ISBN 1-874864-71-3 ment. 7. Challenging Xenophobia: Myth and Realities about Cross-Border Migration in The paper is organized into five sections. Section Two positions Southern Africa (1998) ISBN 1-874864-70-5 debates about the migration of skilled health professionals within a wider literature that discusses the international mobility of talent. 8. Sons of Mozambique: Mozambican Miners and Post-Apartheid South Africa Section Three reviews research on the global circulation of health pro- (1998) ISBN 1-874864-78-0 fessionals, focusing in particular upon debates relating to the experience 9. Women on the Move: Gender and Cross-Border Migration to South Africa of countries in the developing world. Section Four moves the focus from (1998) ISBN 1-874864-82-9. international to South African issues and provides new empirical mate- 10. Namibians on South Africa: Attitudes Towards Cross-Border Migration and rial drawn from the survey of recruitment patterns and key interviews Immigration Policy (1998) ISBN 1-874864-84-5. undertaken with health sector recruiters operating in South Africa. 11. Building Skills: Cross-Border Migrants and the South African Construction Section Five addresses the questions of changing policy interventions in Industry (1999) ISBN 1-874864-84-5 South Africa towards the outflow of skilled health professionals and the 12. Immigration & Education: International Students at South African Universities recruitment of foreign health professionals to work in South Africa. The and Technikons (1999) ISBN 1-874864-89-6

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13.EXECUTIVE The Lives S andUMMARY Times of African Immigrants in Post-Apartheid South Africa (1999) ISBN 1-874864-91-8 14. Still Waiting for ealth the Barbarians:workers are Southone of Africanthe categories Attitudes of skilled to Immigrants profession- and Immigration (1999)als mostISBN affected 1-874864-91-8 by globalization. Over the past decade, 15. Undermining Labour:there Migrancyhas emerged and aSub-contracting substantial body in of the research South Africanthat tracks Gold MiningH Industry patterns(1999) ISBN of international 1-874864-91-8 migration of health personnel, assesses causes and consequences, and debates policy responses at global 16. Borderline Farming: Foreign Migrants in South African Commercial Agricul- and national scales. Within this literature, the case of South Africa is ture (2000) ISBN 1-874864-97-7 attracting growing interest. For almost 15 years South Africa has been 17. Writingthe Xenophobia: target of a ‘global Immigration raiding’ and of skilledthe Press professionals in Post-Apartheid by several South devel- Africa (2000)oped ISBN countries. 1-919798-01-3 How to deal with the consequences of the resultant out- 18. Losingflow Our of Minds: health Skillsprofessionals Migration is aand core the policy South issue African for the Brain national Drain gov- (2000) ISBNernment. 1-919798-03-x 19. Botswana:This Migration paper aims Perspectives to to examine and Prospects policy debates (2000) and ISBN issues 1-919798-04-8 concerning 20. The Brainthe migration Gain: Skilled of skilled Migrants health and professionals Immigration from Policy the country in Post-Apartheid and to Southfurnish Africa new(2000) insights ISBN on 1-919798-14-5 the recruitment patterns of skilled health per- sonnel. The objectives of the paper are twofold: 21. Cross-Border Raiding and Community Conflict in the Lesotho-South African Q +C
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EXECUTIVE SUMMARY 34. Medical Leave: The Exodus of Health Professionals from Zimbabwe (2005) ISBN 1-919798-74-9 ealth workers are one of the categories of skilled profession- 35. Degrees of Uncertainty: Students and the Brain Drain in Southern Africa als most affected by globalization. Over the past decade, (2005) ISBN 1-919798-84-6 there has emerged a substantial body of research that tracks 36. Restless Minds: South African Students and the Brain Drain (2005) ISBN Hpatterns of international migration of health personnel, 1-919798-82-X assesses causes and consequences, and debates policy responses at global 37. Understanding Press Coverage of Cross-Border Migration in Southern Africa and national scales. Within this literature, the case of South Africa is since 2000 (2005) ISBN 1-919798-91-9 attracting growing interest. For almost 15 years South Africa has been the target of a ‘global raiding’ of skilled professionals by several devel- 38. Northern Gateway: Cross-Border Migration Between Namibia and Angola oped countries. How to deal with the consequences of the resultant out- (2005) ISBN 1-919798-92-7 flow of health professionals is a core policy issue for the national gov- 39. Early Departures: The Emigration Potential of Zimbabwean Students (2005) ernment. ISBN 1-919798-99-4 This paper aims to to examine policy debates and issues concerning 40. Migration and Domestic Workers: Worlds of Work, Health and Mobility in the migration of skilled health professionals from the country and to Johannesburg (2005) ISBN 1-920118-02-0 furnish new insights on the recruitment patterns of skilled health per- 41. The Quality of Migration Services Delivery in South Africa (2005) ISBN sonnel. The objectives of the paper are twofold: 1-920118-03-9 Q +C
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F97FI=H ment of skilled professionals from South Africa in the health 42. States of Vulnerability: The Future Brain Drain of Talent to South Africa (2006) sector. The paper draws upon a detailed analysis of recruitment ISBN 1-920118-07-1 advertising appearing in the South African Medical Journal for 43. Migration and Development in Mozambique: Poverty, Inequality and Survival the period 2000-2004 and a series of interviews conducted with (2006) ISBN 1-920118-10-1 private recruiting enterprises. 44. Migration, Remittances and Development in Southern Africa (2006) ISBN Q 5G98
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K=H< 1-920118-15-2 key stakeholders in the South African health sector, the paper 45. Medical Recruiting: The Case of South African Health Care Professionals offers a series of recommendations for addressing the problem of (2007) ISBN 1-920118-47-0 skilled health migration. These recommendations are grounded 46. Voices From the Margins: Migrant Women’s Experiences in Southern Africa (2007) in both South African experience and an interrogation of inter- ISBN 1-920118-50-0 national debates and ‘good policy’ practice for regulating recruit- ment. 47. The Haemorrhage of Health Professionals From South Africa: Medical Opinions The paper is organized into five sections. Section Two positions (2007) ISBN 978-1-920118-63-1 debates about the migration of skilled health professionals within a 48. The Quality of Immigration and Citizenship Services in Namibia (2008) ISBN 978- wider literature that discusses the international mobility of talent. 1-920118-67-9 Section Three reviews research on the global circulation of health pro- 49. Gender, Migration and Remittances in Southern Africa (2008) ISBN 978-1- fessionals, focusing in particular upon debates relating to the experience 920118-70-9 of countries in the developing world. Section Four moves the focus from 50. The Perfect Storm: The Realities of Xenophobia in Contemporary South Africa international to South African issues and provides new empirical mate- (2008) ISBN 978-1-920118-71-6 rial drawn from the survey of recruitment patterns and key interviews 51. Migrant Remittances and Household Survival in Zimbabwe (2009) ISBN 978-1- undertaken with health sector recruiters operating in South Africa. 920118-92-1 Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the 52. Migration, Remittances and ‘Development’ in Lesotho (2010) ISBN 978-1-920409- recruitment of foreign health professionals to work in South Africa. The 26-5

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53.EXECUTIVE Migration-InducedSUMMARY HIV and AIDS in Rural Mozambique and Swaziland (2011) ISBN 978-1-920409-49-4 54. Medical Xenophobia:ealth Zimbabwean workers are Access one of to theHealth categories Services of in skilledSouth Africa profession- (2011) ISBN 978-1-920409-63-0als most affected by globalization. Over the past decade, 55. The Engagement there of the has Zimbabwean emerged a substantial Medical Diaspora body of (2011)research ISBNthat tracks 978-1- 920409-64-7 patterns of international migration of health personnel, 56. Right H to the Classroom: Educational Barriers for Zimbabweans in South Africa assesses causes and consequences, and debates policy responses at global (2011)and ISBN national 978-1-920409-68-5 scales. Within this literature, the case of South Africa is 57. Patientsattracting Without growing Borders: interest. Medical For Tourism almost and 15 years Medical South Migration Africa has in Southern been Africathe (2012) target ISBN of a ‘global978-1-920409-74-6 raiding’ of skilled professionals by several devel- 58. The Disengagementoped countries. of Howthe South to deal African with theMedical consequences Diaspora of(2012) the resultant ISBN 978-1- out- 920596-00-2flow of health professionals is a core policy issue for the national gov- ernment. 59. The Third Wave: Mixed Migration from Zimbabwe to South Africa (2012) ISBN This paper aims to to examine policy debates and issues concerning 978-1-920596-01-9 the migration of skilled health professionals from the country and to 60. Linkingfurnish Migration, new insightsFood Security on the and recruitment Development patterns (2012) of ISBNskilled 978-1-920596- health per- 02-6 sonnel. The objectives of the paper are twofold: 61. UnfriendlyQ Neighbours: +C
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K=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 inter- national debates and ‘good policy’ practice for regulating recruit- ment. 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 pro- fessionals, focusing in particular upon debates relating to the experience of countries in the developing world. Section Four moves the focus from international to South African issues and provides new empirical mate- rial drawn from the survey of recruitment patterns and key interviews undertaken with health sector recruiters operating in South Africa. Section Five addresses the questions of changing policy interventions in South Africa towards the outflow of skilled health professionals and the recruitment of foreign health professionals to work in South Africa. The

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southern AfricAn MigrAtion ProgrAMMe