The flight of South Africa's medical professionals seems unending, despite the country's pleas for rich countries to stop poaching its doctors and nurses (CMAJ 2001;164[3]:387-8). This year the number of South Africa-trained physicians practising in Canada has risen by 174, to 1738. Many more have left for the United Kingdom, Australia, New Zealand and the US.
The exodus, which is largely driven by a burgeoning crime rate and problems within the health care system, has also been encouraged by an economic downturn. In 2001 the rand plummeted by 30% against the US dollar before rebounding somewhat this year.
The South African Health Review reports that the public sector's doctor–patient ratio declined from 21.9 physicians per 100 000 people in 2000 to 19.8 per 100 000 in 2001. The ratio for nurses also shrank, from 120.3 per 100 000 in 2000 to 111.9 per 100 000 last year.
An estimated 20 000 professionals flee Africa annually, a brain drain that costs billions; about 10 000 South Africans emigrate annually, half of them professionals.
Researchers at the University of Cape Town researchers argue that the brain drain in South Africa is more significant than the government admits (www .queensu .ca/samp/Publications.html). Their study tallied 41 496 professional emigrants from South Africa between 1989 and 1997 — almost 4 times more than the official figure of 11 255. “The analysis clearly shows that there is significant official underestimation of the extent of South Africa's brain drain,” authors Mercy Brown and colleagues conclude. Neither figure includes the many young South Africans who never officially emigrate, but simply leave the country a few years after graduating and never return. The authors refer to the exodus as the “skilled South African diaspora.”
The International Organization for Migration says the cost to South Africa has been more than $5 billion in “lost human capital” since 1997.
The South African government was pushing to put the brain-drain issue on the agenda of the World Summit of Sustainable Development, scheduled for Johannesburg this summer. “We must really have a pact on this between north and south,” Finance Minister Trevor Manuel says. “We need to retain our doctors.” — Colin McClelland, Johannesburg