Overall disconcerting evidence shows that nearly half of our health professionals are considering emigrating, particularly to the United Kingdom. Heavy workloads, violence and crime, unsatisfactory work conditions, better salaries, promotion and growth opportunities as well as safer environs for their children came out at as the main reasons for considering leaving the country. However, and vital for policy makers and health service managers, are the reasons that will motivate health professionals to stay. Better salaries, improved work environments, reasonable workloads, more educational and promotional opportunities and better leadership and management within the sector are fundamental elements to retain the staff that we do have, and to attract new staff.

A 5% systematic sample of all health professionals in hospitals in three selected provinces in the country was taken. The provinces

Dr Anthony Joffe died tragically on his birthday 19 November 2006.

selected were two well resourced provinces viz. Gauteng and Western Cape and one poorly resourced province in the Eastern Cape. Health professionals were interviewed by self administered questionnaires over a three month period from April to June 2002. A response rate of 80% was obtained and a total of 559 health workers in 23 hospitals in the three provinces responded. Almost 60% of the sample consisted of nurses, 15% were doctors, 11% were therapists, while midwives, nurse tutors and dentists made up the rest. Almost all respondents were South Africans (8 were foreign Africans). Overall more than half of the interviewees considered leaving the country. In the Eastern Cape this figure rose to almost 70%. There were no significant differences between males and females in terms of intention to migrate. Younger professionals were significantly more likely to migrate than older ones. Pharmacists and midwives were more likely to consider migration than other professionals but this difference was not statistically significant. Of those considering migration to a new country, more than half (52%) considered the United Kingdom as a destination, 10% considered Australia, 9% considered the USA, 7% Canada, 5% New Zealand and the rest preferred other countries.

Reasons for migration were given as follows:

1. 43% would leave to gain international experience.
2. 27% wanted a safer environment for their children.
3. None of the respondents cited ‘seeing no future in the country’ as a reason.

1. Nearly 10% would leave because they could not find a suitable job in this country. This increased to 255 (nearly half of all respondents) in the Eastern Cape.
2. More than 20% would emigrate in order to upgrade their qualifications. This was highest in Gauteng where nearly 25.6% of respondents stated this as a reason.
3. A substantial proportion (41%) felt that heavy workloads were a reason for their considering emigration. In Gauteng this rose to nearly 50%.
4. 38% cited a general decline in the health care services of the country as a reason for emigration.
5. 38% saw violence and crime as reasons for emigrating.

Other reasons cited were:

1. Family related matters (3.2%), joining family or friend (4%),to save money quickly (25%), and so on.

1. 16% cited poor management of the health services as a reason to migrate. Senior professionals were significantly more critical of the quality of management of the health services. However, none of the respondents of the Western Cape mentioned this as a reason.
2. 25% would emigrate for better pay.
3. Nearly 11% found unacceptable expectations about their pace of work as a reason to emigrate.
4. One eighth of the respondents cited the general sense of despondency as reason for emigration.
5. Almost 20% felt that the general decline in the country’s economy contributes to their leaving the country although the Western Cape again proved the exception (0.3%).
6. 18% cited a lack of opportunities for promotion and 18% felt that the lack of health resources and facilities lead to emigration.

The questionnaire asked respondents what would motivate health professionals to remain in their home country, and the responses were as follows:

1. The vast majority (77.5%) indicated that better salaries would motivate health professionals to remain here.
2. 67.8% cited a healthy working environment.
3. 66.4% cited better fringe benefits as a factor.
4. 58.7% said that a reasonable workload was key to them considering staying.
5. 52.6% indicated better quality education and training in the professional field as a reason.
6. 51.9% indicated more accessible education and training facilities for their children as important reasons.
7. Some cited provision of adequate day care facilities for children of employees (39.7%), better working relationships in the public sector (26.1% ), better leadership in the health sector (24.9%), a more peaceful social environment in the country (24.5%), and the appointment of more competent health service managers (23.8%) as motivation for health professionals to stay.