title: 'You can't stay away from your family': a qualitative study of the ongoing ties and future plans of South African health workers in the United Kingdom.
abstract: BACKGROUND
  Migration of African-trained health workers to countries with higher health care worker densities adds to the severe shortage of health personnel in many African countries. Policy initiatives to reduce migration levels are informed by many studies exploring the reasons for the original decision to migrate. In contrast, there is little evidence to inform policies designed to facilitate health workers returning home or providing other forms of support to the health system of their home country.
  
  
  OBJECTIVE
  This study explores the links that South African-trained health workers who now live and work in the United Kingdom maintain with their country of training and what their future migration plans may be.
  
  
  METHODS
  Semi-structured interviews were conducted with South African trained health workers who are now living in the United Kingdom. Data extracts from the interviews relating to current links with South Africa and future migration plans were studied.
  
  
  RESULTS
  All 16 participants reported strong ongoing ties with South Africa, particularly through active communication with family and friends, both face-to-face and remotely. Being South African was a significant part of their personal identity, and many made frequent visits to South Africa. These visits sometimes incorporated professional activities such as medical work, teaching, and charitable or business ventures in South Africa. The presence and location of family and spouse were of principal importance in helping South African-trained health care workers decide whether to return permanently to work in South Africa. Professional aspirations and sense of duty were also important motivators to both returning and to being involved in initiatives remotely from the United Kingdom.
  
  
  CONCLUSIONS
  The main barrier to returning home was usually the development of stronger family ties in the United Kingdom than in South Africa. The issues that prompted the original migration decision, such as security and education, also remained important reasons to remain in the United Kingdom as long as they were perceived as unresolved at home. However, the strong residual feeling of identity and regular ongoing communication meant that most participants expressed a sense of duty to their home country, even if they were unlikely to return to live there full-time. This is a resource for training and short-term support that could be utilised to the benefit of African health care systems.
authors: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK; katherinetaylor1@nhs.net.
authors: Katherine
authors: K
authors: Taylor
authors: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors: Claire
authors: C
authors: Blacklock
authors: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors: Gail
authors: G
authors: Hayward
authors: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors: Posy
authors: P
authors: Bidwell
authors: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors: Pallavi
authors: P
authors: Laxmikanth
authors: Centre for Primary Care, University of Manchester, Manchester, UK.
authors: Nicholas
authors: N
authors: Riches
authors: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors: Merlin
authors: M
authors: Willcox
authors: Department of Family Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors: Shabir
authors: S
authors: Moosa
authors: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors: David
authors: D
authors: Mant
mesh_terms: D002321:Career Choice; D003906:Developing Countries; D054242:Emigrants and Immigrants / Q000523:psychology*; D005195:Family Relations / Q000523:psychology*; D005260:Female; D005551:Foreign Professional Personnel / Q000523:psychology*; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D036301:Qualitative Research; D013019:South Africa; D006113:United Kingdom
keywords: South Africa; United Kingdom; doctors; migration; nurses