Factors contributing to “brain drain” in the South African healthcare system.

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The phenomenon known as brain drain is not only common to South Africa but it’s a worldwide phenomenon that is believed to have more drastic impacts in developing countries (World Global Summit, 2017, TVC News, 2015, Misau, 2010:20, Groenhout, 2012:4, ENCA, 2017).

Brain drain in its simplistic view is the movement of skilled people from one country which is usually less developed to another which is more developed; in search of better opportunities in various aspects of their lives such as career, financial, health and the overall standard of living (Misau, 2010;20, Groenhout, 2012, Labonte et al., 2015:3 ). In short, brain drain is the migration of highly skilled health workers out of developed countries to more developed countries (Labonte et al., 2015:3, Pang, Lansang and Haines, 2002:499).

The major factors that contribute to brain drain in in the South Africa healthcare system can be divided into two; they are often divided into two assuming the dichotomous approach of push and pull factors (Misau, 2010:20, Labonte et al.,2015:7). Push factors are those factors that drive skilled professionals outside of their countries and pull factors on the contrary are those that attract these highly skilled professional to mostly developed countries (Labonte et al., 20127). South Africa is known as the power house of Africa, due to its economic status in comparison with other African countries (ENCA, 2017); however this puts South Africa in a difficult position when compared to other countries because when compared to the United States of America (USA) or other developed countries, South Africa is losing its skilled professionals while also attracting other skilled professionals from mostly Sub-Saharan countries such as Zimbabwe (Labonte et al., 2015:10). Factors that lead to the migration of skilled healthcare professionals in South Africa vary from, better remuneration, better job opportunities, better healthcare system, career development, and better safety and security and lower crime rate (Labonte et al., 2012, Pang, Lansang and Haines, 2002:500, TVC News, 2015, TV2 Africa,2014, SABC Digital News, 2016).

Other factors such as political uncertainty and economic instability as shown by recent economic downgrades by rating agencies have also been cited (SABC Digital News, 2016), considering these factors it is not surprising that one-third of professionals in Africa have left the continent resulting in a loss of intellectual capital for the continent (TVC News, 2015). South Africa represents a microcosm of what the entire continent is experiencing with regards to the challenge of brain drain. Pull factors such as corruption, poor management of healthcare funds and poor working conditions have been said to cut across most African countries (Labonte et al., 2015:7, Groenhout, 2012:5).




Poor working conditions are also another factor that is really driving healthcare professionals out of South Africa (Mahlathi and Dlamini, 2017:19). The standard of most of our public healthcare facilities is shocking, the long working hours coupled with as shortage of essentials such as personal protective equipment and medication is really appalling. Township and rural hospitals and clinics are the most neglected and affected; Pholosong Hospital for instance in the Gauteng region is notoriously known as “Nyulosong” a derogatory word that has been coined by the locals meaning rubbish. People within the KwaTsaDuza communities in Ekurhuleni even believe if one gets sick and gets admitted to this hospital their condition will deteriorate; even though this is stigma, it points out to a problem of perception which if not properly addressed may escalate into a major problem. Corruption is one driving factor that cannot be ignored and continues to cripple the South African healthcare system (Labonte et al., 2015:12).


Albeit Einstein, arguably one of the greatest scientists to have ever walked on earth once said, “We cannot solve our problems with the same thinking we used when we created them”. South Africa needs respond differently to the challenge of brain drain in the health care sector. Groenhout, (2012) argues that a different approach to policy is required; one that is different from the usual and draws heavily on the notion of ethics of care from a Ghanaian perspective. According to Groenhout, (2012), the solutions offered and implemented to tackle brain drain have not worked. Africa alone sees an annual emigration rate of about 23000 qualified academic professionals; in South Africa, a third to a half of the medical graduates migrate to developed countries (Pang, Lansang and Haines, 2002:499). 47% out of 3500 professionals who took part in a survey in South Africa said they have considered living the country (SABC Digital News, 2016). The numbers go on and on and depict a shocking picture. Clearly whatever it is that the African governments have tried has not yielded satisfactory results. South Africa has made certain strides in addressing the brain drain phenomenon; there have been a number of policies aimed at this such as the White Paper on International migration which is mainly aimed at keeping skilled professionals from leaving the country (Crown Publication, 2019). The Southern African Development Community (SADC) agreement which prohibits the poaching of medical professionals between the countries in the SADC region (ENCA, 2017) is another measure that has been put in place. Bilateral agreements such as the common Wealth Code which includes South Africa was introduced to promote ethical recruitment, however due to its voluntary nature it proved to be ineffective in dealing with brain drain (Labonte et al.,20129:9). The policy statement issued by the SA government in 2006 in which they commit to not recruiting medical professionals from SADC countries is said to have not been able to curb the migration of professionals from other SADC countries into South Africa (Labonte et al., 2015;10).


There have been areas where the South African government has managed to find small pockets of success against brain drain and turn it to brain gain (Labonte et al., 2015:12, Mahlathi and Dlamini, 2017:5). One of these has been the Policy on Remuneration of Health Professionals Working in the Public Health Service or the OSD program which has managed to attract healthcare professionals especially nurses back into the country while improving the satisfaction levels of those already practicing in the country (Mahlathini and Dlamini, 2017, Labonte et al., 2015:12). The slow progress made with regards to the National health Insurance NHI has also been noted to be a discouraging factor for many doctors in South Africa and has virtually cancelled the success made by the implementation of the OSD program (Labonte et al., 2015:12).


The idea of increasing the supply of medical professionals as a solution to brain drain has also proved to be a fallacy and has not yielded satisfactory results (Groenhout, 2012: 6). The major challenge with this idea is that one there countries which train and supply these skills are not compensated when these skills are taken outside, thus putting a strain on their finances and rendering their funding models ineffective. The other factor is that developing countries simply cannot compete with developed countries in terms of resources; the developed countries have more factors that attract skilled professionals (Groenhout, 2012:6). The training of South African Medical students in Cuba has also not made any noticeable dent in the challenge of brain drain that the country faces, in fact; the same can be said for other African countries that are part of the same program (Mahlathi and Dlamini, 2017:9, Groenhout, 2012:6). The program has been criticized for its cost to the South African fiscal, which has faced declining budget allocations especially the health budget (Mahlathini and Dlamini, 2017:9), the program has also been criticized for its lack of support for the returning doctors to integrate into the South African healthcare system which has different challenges and disease burden than that of the Cuba in which they were trained (Mahlathini and Dlamini, 2017:9).


In spite of all these challenges, the College of Surgeons of East, Central and Southern Africa (COSECSA) has managed to retain 93% of its surgeon graduates within the Sub-Saharan region (Chowles, 2018). This is commendable and perhaps there are lessons that can be drawn from this success story. There is a need for developing countries like South Africa to address issues such as corruption, structural, political and economic problems in order to mitigate the impacts of brain drain in their healthcare system (Pang, Lansang and Haines, 2002:499).

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