Article Text
Abstract
Introduction Although health labour migration is a global phenomenon, studies have neglected the flow of health workers into low-income and middle-income countries (LMICs). In compliance with the data-monitoring recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (Code), we estimated post-Code physician net migration (NM) in South Africa (SA), and SA’s net loss of physicians to Organisation for Economic Co-operation and Development (OECD) countries from 2010 to 2014.
Methods We sourced data from the National Reporting Instrument reports, the OECD and the General Medical Council. Using the numbers of foreign nationals and international medical graduates (IMGs) registered in SA, and SA medical graduates registered in OECD countries (South African-trained international medical graduates (SA-IMGs)) as respective proxies for immigration and emigration, we estimated ‘NM’ as the difference between immigrant physicians and emigrant physicians and ‘net loss’ as the difference between OECD-trained IMGs and OECD-based SA-IMGs.
Results In 2010, SA hosted 8443 immigrant physicians, while OECD countries hosted 14 933 SA-IMGs, yielding a NM of −6490 physicians and a NM rate of −18% in SA. By 2014, SA-based immigrant physicians had increased by 4%, while SA-IMGs had decreased by −15%, halving the NM rate to −9%. SA-to-OECD estimated net loss of physicians dropped from −12 739 physicians in 2010 to −10 563 in 2014. IMGs represented 46% of 2010–2014 new registrations in SA, with the UK, Nigeria and the Democratic Republic of the Congo serving as leading sources. Registrants from conflict-scarred Libya increased >100-fold. More than 3400 SA-IMGs exited OECD-based workforces.
Conclusion NM is a better measure of the brain drain than simply the emigration fraction. Strengthened health personnel data management and reporting through implementation of the Code-related system of National Health Workforce Accounts will further increase our understanding of health worker mobility in LMICs, with policymakers empowered to make more informed policies to address shortage.
- Brain drain
- global health
- health worker migration
- in-migration
- international medical graduates
- migrant data monitoring
- net migration
- NRI data
- out-migration
- South Africa
- WHO Code of Practice
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
Handling editor Seye Abimbola
Contributors AST conceived and designed the study, analysed the data and wrote the first draft of the manuscript. AH and SHV revised the manuscript critically for important intellectual content. All the authors read and approved the final draft of the manuscript.
Funding SHV was supported, in part, by a grant from the National Institutes of Health (P30MH062294). This funder had no role in the study design, collection, analysis and interpretation of the data, writing of the report or decision to submit the paper for publication.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository.