title: Health worker migration from South Africa: causes, consequences and policy responses.
abstract: BACKGROUND
  This paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries-Jamaica, India, the Philippines, and South Africa-have historically been "sources" of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa.
  
  
  METHODS
  The study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically.
  
  
  RESULTS
  There has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself.
  
  
  CONCLUSIONS
  In the near past, South Africa's health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.
authors.affiliation: Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, Ontario, Canada. rlabonte@uottawa.ca.
authors.forename: Ronald
authors.initials: R
authors.lastname: Labonté
authors.affiliation: School of Public Health, University of Western Cape, P. B. X17, Bellville, South Africa. sandersdav5845@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.affiliation: School of Public Health, University of Western Cape, P. B. X17, Bellville, South Africa. tmathole@uwc.ac.za.
authors.forename: Thubelihle
authors.initials: T
authors.lastname: Mathole
authors.affiliation: Balsillie School of International Affairs, N2L 6C2, Waterloo, Ontario, Canada. jcrush@balsillieschool.ca.|University of Cape Town, P/B Rondebosch, South Africa. jcrush@balsillieschool.ca.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Crush
authors.affiliation: Department of Geography, University of Kansas, Lawrence, KS, USA. achikand@gmail.com.
authors.forename: Abel
authors.initials: A
authors.lastname: Chikanda
authors.affiliation: East, Central and Southern African Health Community, P.O. Box 1009, Arusha, Tanzania. yoswad@gmail.com.
authors.forename: Yoswa
authors.initials: Y
authors.lastname: Dambisya
authors.affiliation: Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, Ontario, Canada. vrunnels@uottawa.ca.
authors.forename: Vivien
authors.initials: V
authors.lastname: Runnels
authors.affiliation: Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, Ontario, Canada. cpacker@uottawa.ca.
authors.forename: Corinne
authors.initials: C
authors.lastname: Packer
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, B3H 4R2, Halifax, Nova Scotia, Canada. adrian.mackenzie@dal.ca.
authors.forename: Adrian
authors.initials: A
authors.lastname: MacKenzie
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, School of Nursing, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, B3H 4R2, Halifax, Nova Scotia, Canada. Gail.Tomblin.Murphy@dal.ca.
authors.forename: Gail Tomblin
authors.initials: GT
authors.lastname: Murphy
authors.affiliation: Telfer School of Management, University of Ottawa, 1 Stewart St., K1N 6N5, Ottawa, Ontario, Canada. Ivy.Bourgeault@uottawa.ca.
authors.forename: Ivy Lynn
authors.initials: IL
authors.lastname: Bourgeault
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D003815:Dentists / Q000600:supply & distribution; D003906:Developing Countries; D004641:Emigration and Immigration; D004651:Employment; D005260:Female; D006291:Health Policy; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009726:Nurses / Q000600:supply & distribution; D010563:Personnel Turnover; D010595:Pharmacists / Q000600:supply & distribution; D010820:Physicians / Q000600:supply & distribution; D012456:Salaries and Fringe Benefits; D013019:South Africa; D011795:Surveys and Questionnaires; D000078329:Workforce