Guest blogger: Nomathemba Tshuma, Masters in Migration Studies program student, University of San Francisco:

In this piece, I discuss “special skills visas” that form part of many countries’ immigration policies, especially the developed countries in the Global North. For over three decades Zimbabwe, like many countries in the Global South, has been losing her skilled personnel, in different fields to counties in the Global North, especially the United Kingdom (U.K.). Australia, Canada, and the United States (U.S.) have risen in popularity as destinations for Zimbabwe’s labor.  While teachers, social workers, engineers, technicians, and other groups of skilled workers have been lured by the Global North’s greener pastures”, the concern of this paper is the country, is the country’ s health workers, physicians, nurses, physiotherapists, laboratory technicians ,et cetera (Farge, 2023).  Tedros Adhanom Ghebreyesus, the World Health Organization (WHO) director-general sis reported by Reuters to have said, “Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems do not have enough and many are losing their health workers to international migration” (Reuters, 2023,p.1). Zimbabwe is one of the  eight extra countries  that were added to a new WHO list of  vulnerable countries, last published in 2020.

A brief background about Zimbabwe: it is a landlocked country in Southern Africa, previously colonized by Britain and has been independent since 1980. Like most  other African countries, the country is classified as a developing country. (). The definition of a developing country is not always clear with different criteria used by different agencies, for the purposes of this paper, the United Nations (UN) ‘s “Human Development Index,” seems appropriate as it combines the framework conditions of daily life such as nutrition, medical care, education, and income into a comparable index. The concern of this opinion paper is the migration of Zimbabwe’s health workers to other countries especially the Global North countries. Given that the state of health care in a country is one of the indicators of the country’s development status, the question of concern in this write up is how Zimbabwe’s health sector can be expected to develop in the face of mass emigration of its experienced and skilled health personnel? According to Lee and Barro (1993, p. 7) cited in Lowell (2001), it is suggested that a country’s  human capital assets are one its most important tools for  economic growth, with positive relation between a country’s average level of education and economic growth reported. It therefore follows that when a nation loses significant numbers of its most educated, what has come to be called brain drain, it stands to lose a critical asset that can damage the earnings of its low-skilled workers, increase poverty, and widen inequality. While some countries have employed restrictive emigration policies that make it harder for nationals to emigrate and take up jobs abroad, Zimbabwe has not. The Zimbabwean nationals have been free to exercise their right to leave over the last three decades causing critical shortages of manpower in the health sector that are seriously undermining country’s whole health care system.

Proponents of liberalism would argue it is market forces at play, with skilled workers being channeled where there are shortages and where their labor would fetch them the greatest returns. Developed countries have seen immigration as one way of addressing this problem (Lemaitre, 2009), leading them to introduce of policies aimed at facilitating the recruitment of such workers. The United States, for example admits professionals holding an advanced degree and at least five years progressive experience in the profession and persons with exceptional ability in the arts, sciences, or business. Other developed countries such as Canada, the United Kingdom, Australia, et cetera, have similar arrangements, globalization, with its improvements in transport and communication , have enabled these countries to attract skilled workers from all over the world.

What has been the impact of such emigration in the source countries who in most cases have been?  Lowell (2001, p. 5), has stated that “the problem lies in the fact that this demand is largely met by developing countries, triggering an exodus of their skilled personnel. While  some amount of mobility is obviously necessary if developing countries are to integrate into the global economy, a large outflow of skilled persons poses the threat of a brain drain, which can adversely impact local growth and development”. In Zimbabwe for example, there are four hospitals that train doctors, with two in their infancy. A total of about 200 new medicine students are admitted annually, given that they undergo paid training that takes a total of seven years inclusive of the two-year post qualification training, the amount of funds invested are enormous. The following report by the WorldData.info (2023) does not come as a surprise, “
With about 1,220 physicians in Zimbabwe, there are about 0.08 doctors per 1000 inhabitants. In comparison: worldwide this standard is 1.50 physicians per 1,000 inhabitants and in the EU is 3.5” The US. has 2.6 physicians per 1000 people (Fleck, 2023).  Given such comparisons, can it be ethical for countries like the U.S. and Canada to be “poaching” () health workers from developing countries? Do ethics matter at all or from the international relations lens, the Global North forget about ethics and employ the realism theoretical concepts by which each country looks out for its own interests. The World Health Organization (WHO) has tried to regulate the movement of health workers through the WHO Global Code of Practice on the International Recruitment of Health Personnel (Sixty-third World Health Assembly – WHA63.16 May 2010), which although voluntary, “provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small island states”.
Two guiding principles of this code maybe worth highlighting, the acknowledgement of the health of all people as fundamental to the attainment of peace and security ( (Article 3.1) and the need for the international recruitment of health personnel to be conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health systems in developing countries (Article 3.5).Despite Zimbabwe being added to the WHO’s Code of Practice Red list in March 2023, for the recruitment nurse aides, there has not been a stop to the emigration of nurse aides to the developed countries.

Singh, et al, (2003) in their article  “ The Ethics Of Nurse Poaching From The Developing World”, use the term ‘poaching” of nurses to  the UK from Malawi. With a figure of 0.02 physicians per 1000 inhabitants, compared to the U.K.’s 2.46, the emigration of Malawian nurses for work in the UK does appear like poaching. Consider Zimbabwe’s 0.08 physicians per 1000 inhabitants against Canada’s 2.61, the USA’s 2.59, and Australia’s 3.59, is it ethical for these countries to actively recruit from Zimbabwe. The BBC carried a report on the UK’s recruitment drive for medical professionals to plug its own staff shortages due to the impact of the pandemic and Brexit. The Global North countries generally have restrictive immigration policies , with many in the Global South, especially, Africans, lacking legal pathways of migrating from their countries to The Global North countries. When the Global North countries begin to actively recruit skilled personnel from African countries, the message they send is that Africans are desirable, but only as skilled workers, which is the result of their governments’ investment. The expectation is for the well-resourced Global North countries to invest in training as a mechanism to mitigate against shortages. Because Zimbabwe has a long history of underpaying its public sector workers, there has been an exodus of health workers to the UK, with Nyoka from BBC reporting how health clinics in Zimbabwe were facing a crisis as increasing numbers of nurses leave the country in search of better prospects.

The story cannot be complete without considering the rights of individuals to emigrate in search of a better life given the great discrepancies in salaries between the Global North and South countries. Some blame the Global South countries for doing very little to improve working conditions and in the process, retain their own skilled labor. The Global North countries maybe equally blamed for failing to use their developed infrastructure and abundance of capital to build capacity to address labor shortages instead of relying on the Global North countries who have minimal resources and infrastructure. Zimbabwe has four teaching hospitals, a quick search on the net of teaching hospitals in the U. S. produces a nine-page document with  1390 entries.

The issue of brain drains and present inequalities in income between the Global North and the Global South cannot be exhaustively discussed without revisiting history, especially the legacy of colonialism and its intersections with capitalism and racism. The goal of colonialism was to dominate for the purposes of exploiting both human and natural resources for maximum profit (capitalism). The work of Du Bois as explained by Wendland-Liu (2020), exposes the capitalist roots of white supremacy. Wright (2020), unpacking Rodney’s “How Europe Underdeveloped Africa”, “postulates two main mechanisms of underdevelopment: exploitation through trade and exploitation through investment (i.e., imperialism).” Africa “ s mineral prices are not determined by the Global North countries , who set them low in comparison to their own finished goods sold back to Africa.

Africa’s underdevelopment that is often represented as the result of its leaders’ corruption and bad governance, has its foundations rooted in colonialism. Even beyond colonialism, the international economy is structured for African to remain poor and perennially in debt to the West. Galeano rightly writing about the same subject but in the context of Latin America rightly states that, “Poverty is not written in the stars; under development is not one of God’s mysterious designs” (Galeano, 1973, p.21.). The so-called corrupt leaders loot with the help of the West and even hide their loot in the West. The recent expose by the Aljazeera News undercover of Zimbabwe’s Mafia reveals that the smuggled gold looted from Zimbabwe  by the elite eventually finds its way to Europe at discounted prices because the country is under sanctions. Du Bois states that “European thinkers had imagined Africa as a place without a history, as subjected solely to the will of nature and thus suitable  for subjugation” (). The same mindset is still firmly in place, there can be no justification why in a world facing shortages of skilled labor, the Global North views itself as deserving to be served by  African skilled labor at the expense of Africans.

Conclusion

Visa regimes that attract skilled workers from poorer countries to the developed countries in the Global North may be a form of injustice. The Global North countries are the founding members of the United Nations whose Charter emphasize the equality of all,  they however do not depict this principle of equality when they “poach” skilled workers from the Global South countries, especially, health workers, against the guidelines set by the WHO. There has been mention of and advocacy for the Global North compensate the Global South countries for their investment in training. The Global South counties, including must begin to develop emigration management strategies, currently Zimbabwe is unable to determine, how many people exit for migration purposes .                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             

References

Chaloff J, Lemaitre G. 2009. Managing highly skilled labor migration: a comparative analysis of migration policies and challenges in OECD countries. [Google Scholar]

Fleck, A.(2023). The countries with the Highest Density of Doctors. https://www.statista.com/chart/amp/21168/doctors-per-1000-inhabitants-in-selected-countries/

https://www.mylifeelsewhere.com/country-size-comparison/zimbabwe/california-usa

Nyoka, S. (2022). Zimbabwe clinics struggle for nurses after exodus to the UK. BBC News Africa. https://www.bbc.com/news/world-africa-60524576

Rodney,(2020). How Europe underdeveloped Africa. Published by: Bogle-L’Ouverture Publications, London and Tanzanian Publishing House, Dar-Es-Salaam 1973, Transcript from 6th reprint, 1983; Transcribed: by Joaquin Arriola.

Walton-Roberts M. (2022) The ethics of recruiting foreign-trained healthcare workers. Healthcare Management Forum. Jul;35(4):248-251. doi: 10.1177/08404704221095129. Epub 2022 May 31. PMID: 35642337; PMCID: PMC9234775.

Wendland, J. (2020). W.E.B.Du Bois exposed capitalist and colonial roots of white supremacy. People’s World

Farge, E. (2023) Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/exodus-healthcare-workers-poor-countries-worsening-who-says-2023-03-14/

Singh JA, Nkala B, Amuah E, Mehta N,  & Ahmad A. (2003). The ethics of nurse poaching from the developing world. Nurse Ethics. 2003 Nov;10(6):666-70. doi: 10.1191/0969733003ne655oa. PMID: 14650484.

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