Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements

Abstract

BackgroundThe loss of human resource capacity has had a severe impact on the health system in South Africa. This study investigates the causes of migration focussing on the role of salaries and benefits. Health professionals from public, private and non-governmental (NGO) health facilities located in selected peri–urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration.MethodsThe study uses cross-sectional data collected in 2009. A total of 694 health professionals (430 in the public sector, 133 in the NGO sector and 131 in the private sector) were surveyed. An additional 11 health professionals were purposively selected for in-depth interviews. Odds ratios with 95% confidence intervals were calculated to determine whether salaries influenced HWs decisions to migrate.ResultsHWs decision to move was not positively associated with lower salaries. It was found, instead, that the consideration to move was determined by other factors including age, levels of stress experienced and the extent to which they were satisfied at their current place of work.ConclusionsThe OSD appears to have lowered the risk of HWs migrating due to low salaries. However, the results also indicate that the South African Department of Health needs to improve working conditions for HWs within the public health sector to assist in retention.

Predictors of Workforce Retention Among Malawian Nurse Graduates of a Scholarship Program: A Mixed-Methods Study

“…Most of the nurses did not indicate these as reasons to consider requesting a different deployment site through the MOH or CHAM, but lack of resources was mentioned as a reason to consider leaving the public system for private NGOs. As in many other countries, salary, perceived to be better within the private sector, appears to be the most important factor in prompting a move from the public to the private sector 21 , 27 , 29 – 34 …”

“…Other studies have suggested that non-salary retention strategies are associated with increased job satisfaction and retention. These include incorporating opportunities for education and advancement, ensuring adequate accommodations near the hospital, reducing workload, and creating a work environment that encourages collaboration among staff and appreciation from management 7 , 27 , 29 – 34 …”

Determinants of health professionals’ migration in Africa: a WHO based assessment

“…Technical and financial support to source countries is needed, though non-financial factors have also been documented to be responsible for the health issues in Africa (Njoh, 2012) and there is growing emphasis that the debate on health policy ought to be refocused on social inequality (Obeng-Odoom, 2012). Moreover, the decision to move is not always positively associated with lower salaries, it could be the result of other factors like the degree of stress experienced, age, level of work-place satisfaction…etc (George et al, 2013).…”

An evaluation of factors influencing perceptual experiences and future plans of final-year medical interns in the Free State, 2013–2014

“…17 Although some local studies indicate remuneration to have lessened as an important pull factor, especially after the corrective measure taken by the South African Department of Health in 2007 to even out the gap between the private and public sectors, other studies still show salaries as a top reason for migration. 18 The HIV/AIDS epidemic, workload, work environment, security and racial tensions are all major push factors. 17 The movement of doctors from primary health care (and especially rural areas) towards speciality, different provinces or even migration is also prominent in the Free State.…”