Commentary International flow of Zambian nurses

This commentary paper highlights changing patterns of outward migration of Zambian nurses. The aim is to discuss these pattern changes in the light of policy developments in Zambia and in receiving countries. Prior to 2000, South Africa was the most important destination for Zambian registered nurses. In 2000, new destination countries, such as the United Kingdom, became available, resulting in a substantial increase in migration from Zambia. This is attributable to the policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering Voluntary Separation Packages: early retirement lump-sum payments promoted by the government, which nurses used towards migration costs. The dramatic decline in migration to the United Kingdom since 2004 is likely to be due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses are also leaving Zambia for other destination countries, a significant new development. This paper stresses the need for nurse managers and policy-makers to pay more attention to these wider nurse migration trends in Zambia, and argues that the focus of any migration strategy should be on how to retain a motivated workforce through improving working conditions and policy initiatives to encourage nurses to stay within the public sector. Introduction Nurses and midwives constitute the largest of the health professional groups in Zambia and other low-income countries. Therefore it is the attrition and movement of such workers, particularly through migration, that can cripple a health system in sub-Saharan African countries. There has been a considerable volume of analysis and commentary on migration trends of health workers from Africa to the United Kingdom and other well-resourced countries in the early 2000s, but little detailed mapping and analysis with data from African 'sending' countries. Since that period, it is clear that the situation has changed significantly (Fig 1), with dramatic increases in nurse migration from 2000 to 2004. This paper addresses the factors involved in trends both before and after that change, using a detailed analysis of Published: 11 November 2009 Human Resources for Health 2009, 7:83 doi:10.1186/1478-4491-7-83 Received: 2 June 2008 Accepted: 11 November 2009 This article is available from: http://www.human-resources-health.com/content/7/1/83 © 2009 Hamada et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.