Rethinking the Medical Brain Drain Narrative

Concerns about the negative impact of the “brain drain” of health professionals from Africa have led to a dominant narrative in which those who migrate are a permanent, and costly, loss to the country of origin and a permanent, and valuable, gain for the country of destination. This brain drain narrative has a powerful hold on the way in which the migration of doctors is conceptualized and measured and its impacts are understood. National and international policy responses are similarly premised on the notion that all forms of cross-border migration are advantageous to destination countries in the Global North and damaging to health outcomes in origin countries in the Global South. South Africa is often seen in the migration literature as an archetypal African medical “brain drain” story. The post-apartheid departure of graduates from South Africa’s medical schools has even been labelled “brain fight” and “brain haemorrhage” and a “deepening crisis” for the country’s health system. This report first examines the temporary employment opportunities for South African doctors in countries such as the United Kingdom, Ireland, Canada, and Australia. These include residencies, fellowships, locums, and various temporary worker programs. A 2013 SAMP survey of out-of-country employment found that nearly half of the South African doctors who completed the survey had worked in at least one other country. Fifteen percent had worked in at least two other countries. Some had worked in three or more countries, with a maximum of seven countries. As many as 61% of those with work experience outside South Africa had been to the United Kingdom. Canada was second at 10%, followed by some European countries combined (including Germany, the Netherlands, and Belgium) at 9%, Ireland (9%), and Australia and New Zealand (both 6%). Around 5% had worked in newer destinations such as the United Arab Emirates and Saudi Arabia. Most doctors who go overseas to work do so temporarily and for a limited period. Some 80% had worked in their first overseas country of employment for three years or less. Their reasons included financial inducements (including paying of student debts) and a desire to gain further training and skills.