Addressing the Brain Drain of Skilled Professionals from Zimbabwe and Zambia to South Africa

Policy Solutions for Health Workforce Retention and Regional Collaboration

1. A Human Story Behind the Numbers

In 2023, Mbali, a nurse from Lusaka, left her district hospital for a private facility in Johannesburg. She had been the only midwife trained in obstetrics at her post. Her departure left a major gap. Maternity complications rose, and the remaining nurse became overstretched.

This is common. Zimbabwe’s 2022 Census recorded about 908,000 emigrants, with 84% leaving for work opportunities (ZIMSTAT 2022). Zambia’s Ministry of Health also reports large outflows of nurses and doctors seeking better pay abroad (Amref Health Africa, 2020).

Across the region, Zimbabwe and Zambia rank among the highest in physician emigration—51% and 57%, respectively (SADC 2022). These departures create uneven health access, weaken rural services, and undermine national training investments.

For South Africa, the inflow of regional talent fills workforce gaps but raises questions: Are migrant professionals fully utilised? Are recruitment practices ethical? And can migration become circular, not extractive?

2. Understanding the Push and Pull Dynamics

Push Factors from Zimbabwe and Zambia

Low pay, weak infrastructure, and limited career growth remain top drivers. In Zimbabwe, wage delays and shortages of basic supplies frustrate workers (TRT Afrika, 2024). Zambian professionals cite poor incentives for rural posts and few advancement opportunities (Re-Solve Global Health, 2023).

Pull Factors into South Africa

South Africa attracts skilled professionals with better pay, safer facilities, and career mobility. The SADC Trade Review estimates that each migrating African health worker costs the continent about US $184,000 in lost investment.

3. Policy Gaps in Source Countries

Weak Retention and Monitoring

Return-of-service (bonding) schemes often fail. Tracking systems are incomplete, with only 19% of bonded workers having full data (George Institute, 2022).

Rural Incentives Lacking

Most retention programs do not reach remote regions. Zambia’s rural hardship scheme shows promise but needs scale-up.

Recognition of Returning Professionals

Zimbabwe’s qualification recognition process remains slow. Professionals who want to return often face bureaucratic barriers and salary mismatches.

4. Challenges in South Africa’s Policy Environment

Ethical Recruitment and Integration

South Africa’s dual role as both sender and receiver of professionals complicates regulation (SAFPJ, 2024). Many foreign-trained nurses and doctors face underemployment.

Limited Bilateral Agreements

No structured agreements exist between South Africa, Zimbabwe, or Zambia to manage skilled migration. This absence encourages irregular flows.

Weak Use of Diaspora Skills

While South Africa’s 2025 Labour Migration White Paper promotes “brain gain” for citizens abroad, it excludes skilled professionals from neighbouring countries.

5. Intersectional and Human Dimensions

Gender

Female professionals face heavier care burdens, making migration or return difficult. They also experience higher risks of de-skilling abroad.

Age and Career Stage

Young workers migrate early for better prospects, draining future leadership potential at home. Older professionals often remain but face stagnation.

Documentation and Status

Undocumented or asylum-seeking professionals in South Africa often cannot practise legally. Their expertise goes unused while they work in survival jobs.

6. Evidence from Major South African Cities

In Johannesburg, only 3% of Zimbabwean migrants work in health, despite 22% holding professional diplomas (IDRC, 2023). Many are underemployed due to qualification or licensing barriers.

South Africa’s Critical Skills Visa identifies health as a shortage area, but bureaucratic delays limit impact. The country benefits from regional talent but struggles to integrate it fully and ethically (Bizcommunity, 2025).

7. Voices from the Field

Samuel – Radiographer from Zambia

Samuel left a provincial hospital due to outdated equipment and burnout. Now employed in Johannesburg, he sends remittances but cannot return easily due to registration delays in Zambia.

Tendai – Nurse from Zimbabwe

Tendai left Harare after repeated strikes and shortages. In South Africa, she found work in ICU but remains on short contracts. Her South African accreditation is still pending.

Dr Chipo – Physician from Zimbabwe

Dr Chipo joined a Johannesburg hospital after Zimbabwe’s recruitment freeze. She seeks a dual-practice model to serve both countries but faces regulatory obstacles.

These personal accounts highlight the link between policy gaps and human realities—poor systems push talent away; rigid rules block return.

8. Emerging Solutions and Promising Models

Zambia’s Retention Scheme

The Health Workers Retention Scheme (HWRS) offers hardship pay, housing, and education benefits for rural staff. It has slowed attrition in pilot districts.

Task-Shifting and Expanded Roles

Delegating specific tasks to mid-level cadres helps maintain service delivery during shortages (Zimbudzi, 2024). It cannot replace doctors but reduces pressure.

Bilateral Agreements

Structured mobility deals can ensure ethical recruitment and compensation for training losses. Zimbabwe has begun exploring such frameworks with multilateral partners (TRT Afrika, 2024).

Diaspora and Return Programs

South Africa’s White Paper (2025) proposes incentives for returning talent. Expanding this model to include regional professionals could promote “brain circulation”—temporary return, mentoring, and virtual teaching.

Data and Monitoring Reforms

Improved workforce registries, exit interviews, and migration tracking can inform smarter retention strategies. Data gaps remain a major obstacle.

9. Actionable Policy Recommendations

Stakeholder	Key Action	Timeline
Zimbabwe & Zambia Ministries of Health	Implement targeted rural retention packages (housing, hardship pay, education benefits).	Short-term (0–12 months)
	Establish joint health workforce data systems to track exits and returns.	Short-term
	Negotiate bilateral agreements with South Africa for ethical recruitment and cost-sharing.	Medium-term (12–36 months)
South African Departments of Health, Labour, Home Affairs	Create a regional skilled-health pool with simplified licensing and mobility pathways.	Medium-term
	Expand the Critical Skills Visa to cover regional professionals and streamline recognition.	Short-term
Professional Councils & Universities	Develop a SADC-wide accreditation framework for health credentials.	Medium-term
	Offer remote continuing education for diaspora professionals.	Short-term
NGOs & Donors	Fund and evaluate retention and diaspora-engagement pilots.	Short-term
Researchers	Conduct intersectional migration studies on gender, age, and documentation in health-worker mobility.	Medium-term

10. Limitations and Research Gaps

Lack of detailed, disaggregated data on health-worker migration within SADC.
Limited research on gendered migration experiences among health professionals.
Few evaluations of incentive packages in rural Southern Africa.
Minimal documentation of circular migration and diaspora re-engagement outcomes.

11. Conclusion: Turning Brain Drain into Brain Circulation

The migration of skilled professionals from Zimbabwe and Zambia to South Africa is both a symptom and a signal. It reflects systemic inequities but also regional opportunity.

With strong retention policies, ethical recruitment, and regional cooperation, Southern Africa can shift from brain drain to brain circulation.

Call to Action:

Governments: Prioritise fair incentives and transparent mobility frameworks.
South Africa: Lead in regional workforce partnerships, not extraction.
NGOs and donors: Support pilots that show measurable retention outcomes.
Researchers: Close evidence gaps on intersectionality, incentives, and circular migration.

By acting collaboratively, the region can retain its skilled health professionals while promoting equitable, sustainable health systems for all.

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