ZIMBABWE EZEKIEL GUTI UNIVERSITY

FACULTY OF HERITAGE, HUMANITIES AND SOCIETAL ADVANCEMENT

DEPARTMENT OF DEVELOPMENT, PROGRAMMING AND MANAGEMENT

‘Brain drain hemorrhage’! Emigration of Zimbabwean health care workers

and the implication on the health delivery services : Case of four clinics in
Zengeza community in Chitungwiza.

Dissertation submitted in partial fulfillment of the Bachelor of Science Honors Degree in

Development Studies

BY - : CHRISTINA KAGURA R210419D

SUPERVISOR - : DR K ZVOKUOMBA
 RELEASE FORM

NAME OF STUDENT : CHRISTINA KAGURA

TITLE OF RESEARCH PROJECT : 'Brain drain hemorrhage'! Emigration of

Zimbabwean health care workers and the
Implications on the health delivery services
: the case of four clinics in Zengeza community
In Chitungwiza

YEAR GRANTED : 2023

Permission is hereby granted to the Zimbabwe Ezekiel Guti University to produce single copies
of this project and to lend or sell such copies for private, scholarly, or scientific research
purposes only. The author reserves the publication rights and neither the project nor extensive
extracts from it may be printed or otherwise reproduced without the author's written permission.

SIGNED ..............................................

PERMANENT ADDRESS 1150 Crescent Ruwa, Harare

 DECLARATION

I, Christina Kagura do hereby declare that the works contained in this dissertation is my original
and unaided intellectual work. To the best of my knowledge, it has not been submitted before for
any degree or examination in any other university or anywhere else. I additionally accept that
any direct citation or paraphrase from unpublished or published works of other academic writers
has been appropriately acknowledged in the work which I present for examination and is being
submitted in partial fulfillment of my bachelor's degree in Development Studies at the Zimbabwe
Ezekiel Guti University (ZEGU).

Signature .........................................

Date ...........................................
 APPROVAL FORM

The undersigned certify that they read and recommend to Zimbabwe Ezekiel Guti University for
acceptance. A project entitled : 'Brain drain hemorrhage'! Emigration of Zimbabwean health care
workers and the implication on the health delivery system : The case four clinics in Zengeza
community in Chitungwiza by R210419D in partial fulfillment of the requirements and
expectations of the Bachelor of Science Honors Degree in Development Studies offered by the
Zimbabwe Ezekiel Guti University.

SUPERVISOR : DR K ZVOKUOMBA DATE....................................

 DEDICATION

This piece of work is specially dedicated to my departed loving husband Reverend Dr John
Kagura who was promoted to glory in June 2022. Lossing him was a great blow and I almost
quitted.
To my three beloved daughters, Takundanashe, Tadiwanashe and Tinovimbanashe, thank you for
being my pillar of strength through it all.

Thank you so much.

 ACKNOWLEDGEMENTS

First and foremost, I give all the glory to God Almighty for enabling me to finish this degree
program through thick and thin.
I would like to appreciate my daughters and son in law Dennis Mpofu and my best friend Mrs
Denga for the support rendered throughout this whole research project. I salute you guys.
Doctor K. Zvokuomba, my dedicated supervisor, deserves special recognition for his continuous
support, guidance, advice, assistance, patience and above all helping me to develop an analytical
mindset that can articulate problems and come up with sustainable solutions. He also assisted me
with the necessary information and layout which contributed to this dissertation. Preparing and
coming up with this academic study project would extremely tough without his scholarly
guidance which helped me to have a very clear picture of the matter under study.
Credit also goes to my classmates, friends and all the lecturers for their unwavering support.
Special mention goes to my study mate and my class rep , Belshur Martha Muchemwa,I
remember when I wanted to quit and let it go, you lifted me up and encouraged me to continue.
God bless you for being a loyal friend. All those whom I have not mentioned individually, thank
you all for your invaluable support. God bless you richly.
 ABSTRACT

This study explores the brain drain hemorrhage and its implications to the health delivery
system and the emigration of health care workers in Zimbabwe. The student undertook the study
to identify the causes of brain drain hemorrhage in the health sector, examined the impact of
brain drain in the health delivery system in Zengeza clinics in Chitungwiza and also
recommended possible resolutions that can be harnessed to minimize the mass exodus of health
care professionals.
The study used mixed research methods which included collecting, analyzing and interpreting
quantitative and qualitative data in a single study or in a series of studies that investigates the
same underlying phenomenon. Using both probability and non-probabilities purposive sampling
techniques 25 participants were drawn, 60% females and 40% males contributed.
The results indicated that brain drain is mainly caused by poor working conditions, poor
renumeration, unstable political environment among others. The student has also made some
recommendations that the government must review its policies pertaining to health care workers.
There is need for better policies in regard to health care professionals, working conditions,
renumerations, welfare guarantees and freedom. There is also news for a positive way to respond
to health care workers grievances. Their concerns must not be politicized. There is need for
investing in modern infrastructure and the refurbishment of the existing hospitals and clinics in
Zimbabwe.
 Table of Contents

RELEASE FORM ………………………………………………………………………………………………………………………………………..i

DECLARATION …………………………………………………………………………………………………………………………………………ii

APPROVAL FORM …………………………………………………………………………………………………………………………………..iii

DEDICATION …………………………………………………………………………………………………………………………………………..iv

ACKNOWLEDGEMENTS ……………………………………………………………………………………………………………………………v

ABSTRACT ………………………………………………………………………………………………………………………………………………vi

CHAPTER ONE
1.0 Introduction……………………………………………………………………………………………………………………………………….1

1.1 Background of the Study……………………………………………………………………………………………………………………1

1.2 Problem Statement……………………………………………………………………………………………………………………………5

1.3 Aim of the Study………………………………………………………………………………………………………………………………..6

1.4 Research Objectives…………………………………………………………………………………………………………………………..6

1.5 Research Questions……………………………………………………………………………………………………………………………6

1.6 Justification……………………………………………………………………………………………………………………………………….7

1.7 Delimitations……………………………………………………………………………………………………………………………………..7

1.8 Limitations…………………………………………………………………………………………………………………………………………7

1.9 Definition of terms…………………………………………………………………………………………………………………………….8

1.10 Chapter Summary…………………………………………………………………………………………………………………………….8

CHAPTER TWO
LITERATURE REVIEW……………………………………………………………………………………………………………………..........9

2.0 Introduction……………………………………………………………………………………………………………………………………….9

2.1 Theoretical framework………………………………………………………………………………………………………………………9

2.2 Brain drain in the health sector: International perspective………………………………………………………………10

2.3 Health workers emigration: An African perspective…………………………………………………………………………12

2.4 The loss of health workers: Literature from Zimbabwe……………………………………………………………………14

2.5 Chapter summary……………………………………………………………………………………………………………………………16

CHAPTER THREE…………………………………………………………………………………………………………………………….18
RESEARCH METHODOLOGY…………………………………………………………………………………………………………………18

3.0 Introduction…………………………………………………………………………………………………………………………………….18

3.1 Research Design………………………………………………………………………………………………………………………………18

3.2 Population……………………………………………………………………………………………………………………………………….21

3.3 Sampling Procedure…………………………………………………………………………………………………………………………21

3.3.1 Sampling……………………………………………………………………………………………………………………………………….22

3.4 Research Instruments………………………………………………………………………………………………………………………23

3.4.1 In-depth Interview………………………………………………………………………………………………………………………..23

3.4.2 Researcher Observations………………………………………………………………………………………………………………24

3.4.3 Structured Questionnaire……………………………………………………………………………………………………………..25

3.4.4 Document Analysis……………………………………………………………………………………………………………………….27

3.5 Data Analysis……………………………………………………………………………………………………………………………………28

3.6 Ethical Considerations……………………………………………………………………………………………………………………..28

3.7 Chapter Summary…………………………………………………………………………………………………………………………….29

CHAPTER FOUR………………………………………………………………………………………………………………………………30
DATA PRESENTATION, ANALYSIS AND INTERPRETATION…………………………………………………………………..30

4.0 Introduction…………………………………………………………………………………………………………………………………….30

4.1 Demographic characteristics ……………………………………………………………………………………………………………30

4.1.1 Response rate………………………………………………………………………………………………………………………………30

4.1.2 Respondents gender……………………………………………………………………………………………………………………..31

4.1.3 Age Group…………………………………………………………………………………………………………………………………….32

4.1.4 Educational Level………………………………………………………………………………………………………………………….33

4.2 An Overview of the health workers migration…………………………………………………………………………………33

4.3 Causes of brain drain……………………………………………………………………………………………………………………….35

4.4 Epidemiological impact of health workers migration……………………………………………………………………….36

4.5 Socio-economic impact……………………………………………………………………………………………………………………38

4.6 Chapter Summary…………………………………………………………………………………………………………………………….39

CHAPTER FIVE…………………………………………………………………………………………………………………………………40
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS……………………………………………………………….………40

5.0 Introduction…………………………………………………………………………………………………………………………………….40

5.1 Summary of research findings………………………………………………………………………………………………………….40

5.2 Major Conclusions……………………………………………………………………………………………………………………………41

5.3 Recommendations…..………………………………………………………………………………………………………………………42

5.4 Chapter Summary……………………………………………………………………………………………………………………………43

References…………………………………………………………………………………………………………………………………………….44

Appendices …………………………………………………………………………………………………………………………………………..48
 CHAPTER ONE

1.0 Introduction
The primary goal of the research is to look at the implications of Zimbabwean Health care
emigration on the Health delivery services: The case of four clinics in Zengeza Community in
Chitungwiza. Recently in Zimbabwe, there has been an increase in the widespread migration of
medical experts to the metropolitan world in search for greener pastures. These include the United
Kingdom, Canada, Australia, and New Zealand to mention a few, but statistics have proven UK
as the major country to be drawing most of the human capital from Zimbabwe. The emigration of
health workers had been attributed to a number of both pull and push factors. The pull factors
mainly lucrative opportunities in the more economically developed countries better living
standards, sound health Care system, standard education etc. Amongst the push factors, there have
been issues of economic, political and social woes that have contributed to the emigration of health
professionals. In nations like Zimbabwe and other African nations that have faced economic
difficulties, the movement of labor from one country to another has been an unpleasant challenge.
This chapter presents the background, statement of the problem, aim, research objectives, research
questions, justification, ethical principles, delimitation and limitation of the study. The technical
aspects presented by this chapter give the study a framework that enhances the interrogation of
critical issues developed from the funnelled background of the study.

1.1 Background of the Study

Globally strong economic powerhouses have become the attractive destinations for health care
workers from weaker economies. This also translates to the dictum that emphasizes the
categorisations of states based upon their developmental prowess. All Stanford Medicine Results
for Worldwide, WHO estimates there are around 60 million healthcare workers, and like any other
group of professionals, they tend to migrate to areas where working conditions are best (WHO
2010). This indicates that healthcare professionals typically emigrate from developing to
industrialized nations, leaving a shortage in healthcare professionals where demand is high. In
affluent nations, approximately 20% of doctors are typically foreign-born (WHO 2010). Globally,
rich countries continue to observe an increase in immigration for heath workers while poor
countries have significant shortages despite recent patterns in some countries showing stabilization
in health worker immigration. One of the problems with the health care systems in underdeveloped
nations is lack of human resources. This system is too fragile, structurally and systemically weak
to deliver efficient service where it is most required. It appears that brain drain has muddled the
situation making things worse. North and South America employ 37% of the global health
workforce and provide more than 50% of the total amount spent on global health despite making
up only 10% of the world’s population and 14% of its disease burden (Green 2007). To care for a
population of 12 million, Malawi in southern Africa presently had about 100 doctors and 2000
nurses.

There the so-called forms such as first world, second world and third world countries. In light of
that the first world is dominated by France, United States of America, United Kingdom, Germany,
and Canada among others. However, the United Kingdom (UK) has become a destination for many
health care workers from selected African countries (Chikanda and Dodson, 2015). African
countries are dominated by the so-called third world countries. Those with weaker economies, low
populations, poor politics among others for example Zimbabwe, Malawi, Zambia among others.
It is among the so-called third world African countries that one can locate Zimbabwe. Zimbabwean
health care workers are among the most sought after health care workers needed and offered
lucrative job opportunities in the United Kingdom (Chikanda and Dodson, 2015). The UK has
resorted to lure healthcare workers from Zimbabwe due to the consistency of Zimbabwean health
care training institutions towards offering the most sought after training. Health care personnel
from Zimbabwe are highly trained and they are on demand in the UK.

The UK continues to be the best destination for Zimbabwean health care personnel as more job
opportunities for such professionals continue to be opened. However, due to the quest to seek
lucrative job opportunities by health care personnel this study seeks to interrogate brain drain in
light of the massive migration of health care workers from Zengeza, in Chitungwiza in Zimbabwe
to the UK. The migration of workers from one country to another has been a problem in countries
that have experienced economic challenges. Bad economies strain health care workers who
struggle to cater for their own upkeep and families. Such a contextual challenge compels the health
care workers to seek solace in better economies thereby resulting in brain drain. This trend has
been identified by scholars as the main contributor to brain drain in various countries (Yahirun,
2009). According to Gaidzanwa, (1999) workers migration moving between nations in pursuit of
better working conditions and remuneration has been historically going on.

Skilled workers have been on the trend of moving to countries that offer better working conditions,
remuneration, freedoms and securities. From the pre-colonial era in Africa skilled and unskilled
workers from South Africa migrated to the Northern hemisphere (Kuznetsov, 2006). The trend
continued even during the colonial era. In that perspective even during the colonial era
Zimbabwean workers used to migrate to South Africa, though health care personnel were not in
the category. The trend later attracted health care workers when Zimbabwe began to train such
skilled workers. However, such movements of workers has been given low attention by researchers
in former colonial master’s contexts. These write to please and justify the behavior actions of
former colonial masters. Awases et al, (2004) denotes that owing to a wide range of political and
economic factors, health experts have been leaving their home countries from the African
continent to overseas destinations. Awases et al (2004) further posits that African countries are
faced with the growing problem of mass exodus of health care personnel to former colonial
destinations. This trend has adversely affected countries such as Zimbabwe.

Zimbabwean health care workers acquire training locally and after training they consider serving
or working in other countries that offer better remuneration, working conditions, better political
climate among others. Zimbabwe has trained health care personnel for years who have benefitted
other countries (Chibango, 2013). Every year health care workers are trained using state resources
but the beneficiaries are others. Resources are invested in the training of health care workers but
the dividends are never positively realized. Despite the negativity of brain drain to the Zimbabwean
health care systems, it remains an issue of concern if one is to interrogate the deterioration in the
Zimbabwean Health sector, poor infrastructure, poor working conditions, poor remuneration, and
violation of workers’ rights among other challenges in Zimbabwe. Against the advanced health
sector in UK, attractive remuneration, good working conditions, respect of workers’ rights among
others. Definitely a health care worker would be attracted to migrate to a context where one is
satisfied by the rewards of his/her sold labour and expertise. The exodus of health care workers
from Zimbabwe has become a challenge from the premillennial era to the twenty first century.
Healthcare workers from all around the world may now travel to the UK for employment more
affordably, quickly, and easily thanks to the new Health Care Visa (HSC 2019). The United
Kingdom’s government decision to deal with its own human resources for health requirements
could not have come at a more critical moment for English-speaking nations with low incomes
like Zimbabwe. Although the United Kingdom’s government action will improve its own health
system, it will undoubtedly result in an increase in the outward migration of well-trained and
experienced Zimbabwean health workers.

In Zimbabwe the loss of skilled healthcare personnel poses a severe risk to the delivery of medical
care and the accomplishment of the Sustainable Development Goals pertaining to health. There
are only 3 500 doctors in Zimbabwe to care for the 15 million people that live there, according
to the Zimbabwe Medical Association (Mandura 2023). The Zimbabwe Democracy Institute
(ZDI)'s October 2021 Access to Public Health Monitoring Report details the widespread flight
of medical professionals from the health system as they look for better opportunities. The health
sector of the nation is in crisis as a result of trained medical personnel leaving for better pay
and working conditions in other nations. According to official figures, more than 4,000 nurses
and medical professionals have fled from Zimbabwe since February
2021(www.theindependent.co.zw). While it is challenging for the Zimbabwean government to
stop this flight of experts since doing so may violate people' rights guaranteed by the nation's
constitution, the government is growing more concerned as the brain drain continues.

Indeed health care workers continue to leave Zimbabwe on an alarming rate. In essence, Zimbabwe
has lost more than half of its medical personnel over the past two decades as a result of political
and economic challenges affecting the country (IOM, 2009). Zimbabwe trains and UK benefits.
This is despite the view that UK pronounced sanctions against Zimbabwe. The sanctions remain
targeted in some areas but not in the emigration of health care workers. Politically that may imply
the weaponisation of recruiting medical skilled workers as a measure to weaken the Zimbabwean
government capabilities to govern the nation. In the interest of this study the skilled health
personnel have found their new work stations in the UK and other overseas destinations such as
USA, Canada, and Australia among others (Chibango, 2013). The trend has made Zimbabwe a
mere training hub of health care workers for other countries in the west. However, the trend has
also adversely affected the health care delivery system in Zimbabwe (IOM, 2009). Hospitals and
clinics have endured to operate with skeletal staff and in some cases dominated by trainee health
care staff (IOM, 2009). However, a lot of people accuse the government of failing to improve the
nation's healthcare system, as workers are always complaining about poor pay and outdated
medical facilities. Another factor contributing to the brain drain is the country's economic situation
and the rapidly growing cost of living. Due to their ongoing difficulties with a lack of healthcare
staff, some of the recruiting nations are also in a critical situation.

In light of such issues the research thrust of the study is more concerned with haemorrhage brain
drain perpetrated by developed countries to a developing country such as Zimbabwe. Due to the
vastness of Zimbabwe and the similarity of the brain drain across the country’s health care
institutions. The study settled for a particular context in the form of Zengeza in Chitungwiza East.
Zengeza in Chitungwiza has domiciled a huge population of health care workers who work at
Chitungwiza General Hospital, local clinic and other private hospitals such as Citimed Hospital.
In light of such discovery, the study will develop profound interest to undertake this study in
Zengeza as the selected context to undertake this research. Zengeza interrogations of emigration
of health care workers and its impact in the brain drain adversely affecting Zimbabwe is a real
problem to the government of Zimbabwe and the Zimbabwean society at large (IOM, 2009). From
the presented background the study draws a problematizing of the study in the form of migration
of healthcare workers from Zimbabwe. The migration of healthcare worker has negatively
impacted the healthcare sector in Zimbabwe prompting the undertaking of this study.

1.2 Problem Statement

African countries have been adversely affected by mass exodus of health care workers to
developed countries as their prime destination. The issue is perpetrated by deteriorating economic
and political conditions affecting the continent, (Awase et al, 2009). In the same vein, Zimbabwe’s
health sector has been adversely impacted by the emigration of health workers to countries such
as Botswana, South Africa, United Kingdom, Namibia, New Zealand, Canada, Australia among
others, (IOM, 2009). The loss of health professionals poses a severe danger to Zimbabwe's ability
to deliver healthcare and meet the SDGs pertaining to health. Only 3 500 doctors are available to
the nation's 15 million residents, according to the Zimbabwe Medical Association (Mandura
2023)This trend has resulted in a severe brain drain in the Zimbabwe health sector. High
Zimbabwean government vacancy rates in health services still persist. As of December 2019,
approximately positions for 34% of doctors, 25% of radiographers, and 64% of medical laboratory
scientists were vacant (HSB 2019) According to a ZDI (2021) study across Harare, the
polyclinics are also suffering from a severe nurse shortage. This study is problematized around
the view that brain drain is one of the critical contributing factors leading to the continual
deterioration of the health sector in Zimbabwe. The rate at which these migrations are occurring,
if left unchecked or if the government, regional bodies and the international community including
WHO do not intervene, then the country's health sector is going to be doomed once and for all.

1.3 Aim of the Study

The aim of the study is to interrogate brain drain hemorrhage in light of massive migration of
health care workers from Zengeza to the United Kingdom.

1.4 Research Objectives

The research was guided by the following objectives:

❖ To identify the causes of brain drain hermorrhage in the health sector in Zimbabwe.
❖ To examine the impact of brain drain in the health delivery of Zengeza clinics in
Chitungwiza.
❖ To recommend possible resolutions that can be harnessed to minimise mass exodus of
health professionals

1.5 Research Questions

The study was guided by the following research questions:

❖ What are the causes of brain drain hermmorhage in the health sector in Zimbabwe?
❖ What is the impact of brain drain in the health delivery of Zengeza Clinics in Chitungwiza
❖ What are the possible resolutions that can be harnesses to minimize mass exodus of health
professionals
1.6 Justification
Health care delivery is a primary need for human society. This has caused governments to invest
immensely in the sector in order to improve their populations towards maintaining healthy
citizenry. In light of that perception health delivery systems and facilities have been established.
It is in these facilities that well trained health care workers are employed towards efficiency of
health care delivery. However, due to economic and political challenges in a country health care
workers tend to consider migrating to countries that offer them better remunerations and working
conditions. This study seeks to interrogate brain drain hemorrhage in light of massive migration
of health care professionals from Zengeza to United Kingdom. Indeed emigration of health care
workers to other countries have caused a severe brain drain in Zimbabwe. This has crippled the
Zimbabwean health care delivery system thereby attracting the researcher’s interest. The study is
original on the basis that the student has lived in the context under investigation and managed to
experience the adverse effects of brain drain in health sector in Zimbabwe.

1.7 Delimitations
In light of that perspective this study focused on the clinics in Zengeza suburb in Chitungwiza,
Zimbabwe.

1.8 Limitations
Despite the relevance of the delimitation of the research towards carrying out the main social
scientific research, the study is not immune to limitations. The researcher had limited time to
conduct data collection from different respondents from different clinics chosen in the study, in
relation to the deadlines that were to be met to submit the research. However, the researcher
managed to schedule specific days for data collection in order to minimise number of days intended
to collect data. Some of the responses were done using Focus group Discussions which saved time
as compared to individual interviews which are time consuming depending with the number of
respondents that you intended to get data from.

On that note the student has to work in the odd hours of the night after work, maximize on working
during weekends and taking some days off duty so as to be able to undertake a balanced research.
Financial expenses in the form of traveling and purchase of data bundles are other limitations
which the student has to wrestle with. That prompts the student to mitigate the challenge through
seeking financial support from relatives and friends towards financing the needs for the study.

1.9 Definition of key terms

Brain Drain: refers to a situation where skilled persons move across national boundaries
(Chibango, 2013). This study uses the meaning proffered by Chibango as relevant to the research
thrust.

Citizen: is a person, who by place of birth, nationality of one or both parents, or naturalization is
granted full rights and responsibilities as a member of a nation or political community, (Cornell
Law School, 2021). In this study a citizen is a person who belongs to a country by birth or
naturalization.

Migration of personnel: is the voluntary movement of workers from one employment station to
another in search of different working arrangements (Chibango, 2013).

1.10 Chapter Summary

The introductive approach dominated the chapter in aspects of the overall study. In this respect,
the main elements presented were background of the study, statement of the problem, aim of the
study, research objectives, research questions, justification, and definition of terms. Delimitation
of study was also covered which centered on key elements of the major scope of the study.
Another aspect covered in the study was the limitation of study, which encompassed elements that
hindered precision of the study’s inferences. Having been able to articulate the introductory
dimension of the study, the following chapter, that is, chapter two presents the literature review of
the study.
 CHAPTER TWO

LITERATURE REVIEW
2.0 Introduction
The introductory chapter articulated the technical aspects of the study which established the
problem under investigation. This chapter contains a presentation of the literature review, which
was done given the requirement to acknowledge the existence of related studies in the body of
knowledge about brain drain and its implications in the health sector. This indicates that the chapter
provided an opportunity to make reference to points made by others who also spoke on topics
related to brain drain hemmorhage and its implications on health delivery system. The chapter
presents the theoretical framework, brain drain in the health sector from an international
perspective, health workers emigration from an African perspective, the loss of health care workers
encompassing literature from Zimbabwe and a chapter summary is presented at the end of the
chapter. The previous chapter managed to present the introduction of the study

2.1 Theoretical framework

The study uses the pull-push theory of migration push-pull theory which is located under the broad
theory of migration. The push-pull theory was developed by Ravenstein in 1889. According to
Ravenstein 1889 in Parkins, (2010) there are several factors that can push people out of their home
country. The factors include oppressive laws, unfavorable climate, over taxation, poor working
conditions and poor remunerations. Health care workers are pushed out of Zimbabwe due to poor
working conditions, poor remunerations, harsh economic conditions and unconducive political
environment. The pull factors which influences the desire to move to another country include the
need for labour in bigger economies towards developing industry, commerce and health delivery
system (Parkins, 2010). When health care workers are pulled into UK they are offered better
remuneration, good working conditions and the political environment liberally grants them social
and economic liberties.

Ravestein’s theory is further explicated by Lee in his theory of migration. According to Lee, (1966)
four factors influence the decision for one to migrate. The four factors include factors associated
with the area of origin, factors associated with the area of destination, intervening obstacles and
personal factors (Avasarkar, 2012). The Zimbabwean context as the area of origin for health care
workers has harsh political, economic and social push factors (Chibango, 2013). The intervening
factors are ameliorated by sponsors who meets the bills for a health care worker to emigrate from
Zimbabwe to the UK (Willett & Hakak, 2022). Personally despite dedication to work one also
endeavors to afford meeting the needs of his/her family hence the decision to seek greener pastures
in the UK. In light of the presented push-pull theory, brain drain in the health sector remains a
challenge in the international system.

2.2 Brain drain in the health sector: International perspective

Brain drain is an issue that has negatively affected some nations in the area of health care provision.
An explication of brain drain posits that it is a migration of health care workers from developing
world to a developed country, (Shakil, 2016). The migration of health professionals in the form of
doctors, nurses, nurse aides, pharmacists among others is also underpinned by economic drivers.
The exodus of health care workers has done more harm than good to the affected countries. Shakil,
(2016) further averts that smaller economies have been reduced to training contexts for health
personnel. When health workers are trained in developing countries (smaller economies) they will
be later attracted to bigger economies that offer better living standards, access to advanced
technology, stable political conditions, better working conditions and remuneration, (Misau et al,
2010). To a greater extent brain drain in the health sector have become a global public health issue
prompting debates on how to combat it, (Bradby, 2014). This loss of health care personnel has
immensely contributed to global health inequalities. However, the debate on how to combat brain
drain also takes into consideration the positive impact of brain drain to countries that lure health
care workers.

On another perspective brain drain has positively impacted the nations that lure the health care
personnel to their countries. OECD, (2010),averts that the movement of the health care personnel
from the developing countries to the developed countries is also underpinned by respecting
individual rights. One has a right to choose where he/she endeavors to offer services. When the
health care services are offered in the context that a healthcare worker emigrates to, the population
in that country benefits. According Wikramasekara, (2014) migrant health care workers have
contributed considerably to the expansion of the health delivery services in the developed
countries, since they are brought in to address particular shortages and they favorably influence
the geographical distribution of skill mix and size of health care work force (Wikramasekara,
2014).

To a greater extent developed countries boasts of good health care provision mechanisms due to
milking developing countries of their trained health care workers, (VSO, 2010). The best of the
healthcare facilities that are found in developed countries. Which also attracts government or
political leaders from developing countries, who periodically come for health care checks and
treatments have a greater population of health care workers from developing countries. Immigrant
health professionals enter destination countries in search of higher wages, better living conditions
and favorable political environment (Bradby, 2014). For example Spain has proven to be a better
destination for foreign health workers from Latin America. In order to lure health workers from
Latin America Spain has kept income levels in the public sector fiscally sustainable (Kaveri, 2023).
In the same vein, United Kingdom has recruited many health workers from its former colonies in
Africa and Asia. The UK has relaxed immigration rules to bring into their country more overseas
trained health workers. Bringing health workers from other countries has enabled the UK to save
a lot of money since the health care workers would have been trained at public expense of other
developing countries. The British Medical Association estimates their National Health Services
has managed to save up to two hundred fifty thousand pounds for every doctor trained outside UK
(Wikramasekara, 2014). The same goes with foreign trained nurses. On the same note, USA,
Canada, Australia, New Zealand has continued to make substantial savings in recruiting overseas
trained doctors and nurses at the expense of developing countries (Wikramasekara, 2014).

Demographically it is estimated that quite a number of health professionals are not working in
their country of training and origin. Globally, it is estimated that about 15% of health workers are
working outside of their country of birth. The distribution varies widely by region (Kaveri, 2023).
The proportion of foreign trained nurses is alarmingly reaching 70-80% in affluent countries Gulf
countries and the Europeans as well. In the same vein, about 10-12% of foreign trained doctors
hail from developing countries (Kaveri, 2023). The developing countries are deemed vulnerable
by WHO due to their lack of sufficient numbers of indigenous health care workers. Even though
the WHA 2010 resolution did not prohibit international recruitment of health workers
(Wikramasekara, 2014). The WHO in 2010 further calls other countries, particularly the high
income countries to ensure that their recruitment does not adversely affect the health care systems
and delivery of health care services in the source countries. Despite the promulgation of the
resolution African countries remain training hubs of health workers who are lured to overseas
developed countries at the expense of the developing Africa.

2.3 Health workers emigration: An African perspective

Africa has been hard hit by brain drain of health care workers. Chimenya and Qi, (2015) confirms
that developing countries in Africa continue to lose significant number of health professionals.
The loss of health professionals in developing countries is exacerbated by social, economic and
political challenges bedeviling the developing countries, (Misau et al, 2010). In essence, health
professionals in developing countries specifically suffer from low wages, unbearable working and
living conditions in their African countries of origin (Chimenya and Qi, 2015). Due to the
challenges that health care workers endure in Africa they consider moving to developed countries
as a reprieve of their quest for a better life for their families and themselves (Misau et al, 2010).
Malawi, Zambia, Uganda, Tanzania, Kenya, Zimbabwe among others continue to lose health care
workers to UK, Australia, Canada, USA, and New Zealand among others.

Sub-Saharan Africa faces the greater challenge of inadequate health workers in their health
delivery sector. According to Misau et al, (2010) it is estimated that Sub-Saharan Africa has 11%
of the world’s population, 25% of the global disease burden yet the region has only 3% of the
global health care work force and that accounts for less than 1% of health expenditures worldwide.
Saraladevi et al, (2009) further avers that from a population density understanding Africa has 2.3
health care workers per 1000 people as compared to America that has 24.8 health care workers per
1000 people. The population density shows that Africa has inadequate health care professionals to
mitigate the huge burden of diseases in the continent. However, despite the shortages Africa
continues to train a lot of health care workers and is only able to retain a few.

African trained health care personnel consider immigrating to developed countries outside Africa,
since the developing countries prove to be conducive to attract the services of professional health
care workers. According to Upretty, (2019) emigration rates for tertiary qualification holders in
developing countries continues to swell up. For countries like Kenya, Ethiopia, DRC, Nigeria
among others. Such migration of skilled health care workers further negatively impacts education,
income, poverty, politics and economic development of both pushing and pulling countries,
(Upretty, 2019).

Despite the emigration to overseas destinations there is also a growing challenge of movement of
health care workers within Africa itself. For example SADC has established that migration of
health workers is significantly rising within the region, there is now a mismatch between supply
and demand of heath care workers, poor workforce planning capacity, privatization of public
health sector due to challenges and effects of HIV and AIDS of health care workers, (EQUINET,
2008). Research has established the incessant migration of health care workers to other countries
as a challenge in Africa. However, the push factors remains another issue of concern when it comes
to further interrogate brain drain in Africa.

Nurses and doctors remunerations have been established as one of the key push factor exacerbating
brain drain. WHO recommends a minimum of two physicians per 10 000 population. However,
most countries in Sub-Saharan Africa are operating below this level, (Chamunogwa, 2021).
Secondary literature research presents salary discrepancies discovered from African countries. For
example, in Uganda a Nurse is paid around US$150 per month as compared to US$3000 plus per
month in the USA, (Bradby, 2014). However, if nurses in Sub-Saharan Africa were paid as those
in USA then African trained nurses would be less likely to consider emigration. On the contrary
increasing salaries in many African countries to match the ones in the USA is economically
unrealistic, (Kaveri, 2023). The economic performance of many sub-Saharan African countries is
below the expected capacity which retains trained health care workers.

On another plane many African countries are experiencing conflict. These conflicts ranges from
volatile wars to negative peace which continues to haunt health care workers. The conflicts, wars
and civil strife in Africa emanates from inter and intra tribal tensions (Rwiza, 2012). It is under
such unconducive environments that can even trigger the brain drain of professional health care
workers in Africa. The tribal tensions in many African countries generates political instability and
in some cases continuous political crises (Rwiza, 2012). For the safety of their lives and families
health care workers will consider moving to liberal peaceful developed states.

In the same vein, human rights violations which characterize the African continent have pushed
more health care workers out of the continent. Chamunogwa, (2021) opines that it remains
conflictual to endure living in a country or continent riddled by human rights violations. These
human rights violations immorally manifests in the violations of economic, political, social and
cultural rights of people in Africa. Human rights violations among other conflicts are a cause for
concern if Africa is to positively thrive to retain her health care workers.

The brain drain that African continues to endure has a fair share of benefits. Chief among them are
diaspora remittances from the health care personnel working in the developed countries. Economic
experts argue that on a positive note the migration of health care professionals from developing
countries provides a substantial financial benefit to both the economies of the developed and
developing countries (OECD, 2010). For example a developed country such as UK 200 000 -250
000 pounds are saved from training a doctor if they pull one from a developing country. Every
foreign trained doctor in the UK is appropriating human capital at zero cost for the use of UK
health services (Bradby, 2014). However, the benefit for the developing country is the remittance
of foreign currency that can be realized through the UK employed doctor. The benefit for the
developing country remains far below the one for the developed country. Brain drain continues to
be a challenge in the African context. The research further opines that unless African governments
positively attracts their trained workers through better salaries, good working conditions and
political certainties they cannot be able to contain brain drain (Kuznetsov, 2006). Brain drain as a
challenge in Africa also impacts intensively on Zimbabwe.

2.4 The loss of health workers: Literature from Zimbabwe

Health care workers have been the back bone of the Zimbabwean health care system from both the
pre and post independent eras. When Zimbabwe gained her independence in 1980 the health sector
had numerous whites as health care workers in the country, (Tevera & Zinyama, 2002). However,
due to political and economic shift that came along with black majority rule. The continued
retention of the skilled white population in the health care sector suffered a blow. Zinyama, (1990)
further notes that the deterioration of whites as workers in the health care sector began during the
protracted war of liberation struggle fought in Zimbabwe.

Due to deterioration of security before independence and in the first decade after independence
during the Gukurahundi. Bloch, (2006) notes that an estimated 50 000 to 60 000 whites left
Zimbabwe between 1980-1984. Indeed a large number of whites who worked in the health care
sector left Zimbabwe. The first decade after independence proved unbearable for white health care
workers. However, the black health care workers enjoyed working and serving in their country.

When Zimbabwe gave in to the international developmental trajectories influenced upon

developing countries, by international financial institution black health care. The Economic
Structural Adjustment Programme (ESAP) which was introduced in 1991 triggered brain drain of
black health care workers in Zimbabwe (Tevera & Crush, 2003). Rising inflation and high cost of
living while workers’ remuneration remained stagnant and worker retrenchments were rampant.
Under such circumstances, for health care workers emigration was the only available alternative.
This emigration to better economically performing countries would guarantee the attainment of a
decent standard of living (Chibango, 2013). The health care sector in Zimbabwe began to
massively suffer brain drain as health care workers moved to UK, USA, and South Africa among
others (Tevera & Crush, 2003). Emigration of health care workers which exacerbated brain drain
was sporadic as Zimbabweans moved to various regional and international destinations.

From the dawn of the millennium into the millennium itself, Zimbabwe had economic and political
challenges which further infuriated brain drain in the country. 1997 paying of gratuities to war
veterans and 1998 food riots coupled by massive demonstrations in Zimbabwe were clear signs
pointing to the need for emigration among professionals. Zimbabwe was facing economic and
political uncertainties. Rodgerson & Crush, (2008) posits that after the constitutional referendum
and 2000 elections complimented by the fast track land reform life in Zimbabwe became both
politically and economically unbearable. During that period both skilled and unskilled workers left
Zimbabwe and health care personnel were not an exception (Chamunogwa, 2021). Most health
care workers left Zimbabwe for South Africa, Botswana, Namibia and international destinations
in the form of UK, USA, Australia, New Zealand, and Canada among others. Politically those
were suspected to be aligned to the MDC which was the main opposition party were purged and
those who survived had to seek asylum abroad, (Raftopoulos, 2004).

Political and economic factors continued to be the key push factors behind brain drain of health
care workers in Zimbabwe. The period between the years 2000-2008 was politically volatile in
Zimbabwe (Chamunogwa, 2021). The same period plunged Zimbabwe into economic crises under
which inflation rose an athlete’s stopwatch timer. However, the period around late 2008-2012
brought a reprieve under the Government of National Unity (Munemo & Nciizah, 2014). The
economic stability of that period translated into very minimal brain drain in the health care sector.
However, from 2013 into the contemporary new dispensation, economic tantrums continued and
political crises as well. These were worsened by the Covid-19 pandemic economic shocks
(Chamunogwa, 2021). As a result of such factors more brain drain has been triggered such that the
demand of nurse aides and care workers from Zimbabwe to UK swelled up. Doctors, nurses,
pharmacists, medical scientists, radiologists, and other health care workers continue to be pulled
to the UK at alarming levels. That has prompted the WHO to raise a concern since Zimbabwe is
red flagged as having a health sector crisis. The WHO has recently as of April 2023 echoed the
banning of pulling health care workers from Zimbabwe to the UK so as to mitigate the crippling
of Zimbabwe’s health sector.

In the thrust of this study scholarly views have managed to establish the challenge of brain drain
in the health sector. Brain drain has been established to be a challenge from international, African
and Zimbabwean perspective. However, the thrust of this study has a special focus on Chitungwiza
Zengeza clinics. The global challenge of brain drain which has impacted Africa and Zimbabwe
has also been negatively experienced in Zengeza. The emigration of health care workers to
developed countries and developing countries that offer better salaries and good working
conditions has become a thorn in the flesh for the communities in Zengeza. In light of the negative
impact of brain drain of health care workers in Zengeza Chitungwiza both community and public
health delivery services have suffered a huge blow. Control of diseases such as typhoid, cholera
and even the ravaging Covid-19 has lost the desired pace. Brain drain will continue to haemorrhage
the Zengeza community until mitigation measures are put in place by both the government and
development partners.

2.5 Chapter summary

A study of the literature on brain drain and implications in the health delivery system was the
chapter's main focus. This served more as a reminder and appreciation that the body of literature
already contained knowledge about the topic under study previous to this research project. It
follows that the chapter's goal was to identify and investigate any gaps in the body of knowledge.
The chapter managed to present the theoretical framework of the study. That was followed by an
articulation of brain drain in the health sector from an international perspective, health workers
emigration from an African perspective and the loss of health care workers encompassing literature
from Zimbabwe. Furthermore, the chapter constructively linked key issue of the literature with the
thrust of the research. That link will be complimented by secondary data in chapter four. However,
the next chapter will present the methodology of the study.
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction
This chapter presents the research methodology utilised for the actual data collection. The study
used a range of methodological approaches in performing the study. In this regard the chapter
tackles the research design, research approach, population procedures which consisted of everyone
eligible to participate in the study, sampling procedure, research instruments, data analysis and
ethical and the sample selected from the target population. Sampling techniques that allowed for
the choice of equally representative sample subjects are among the other topics covered in this
chapter. After unpacking the listed aspects the chapter presents a summary at the end.

3.1 Research Design

Research methods denotes tools and techniques that are scientifically used when investigating an
inquiry, (Walliman, 2011). Research in the academic and public domain follows a methodology
enhances the researcher to engage necessary steps, approaches and use compatible tools in order
to succeed in tackling the demands of the study. A research method enables the researcher to
uncover interesting new facts, (Bhattacherjee, 2012). Furtheremore, the research methodology
thrives on using research designs.

In order to integrate a variety of research methodological elements logically and coherently, the
research design was chosen as a comprehensive strategy (Braun & Clarke, 2019). This allowed the
researcher to address the research topic at long last. Additionally, the tools to be used for data
collection, presentation, and analysis were all directed by the research design as a whole (Mignone,
Chase, & Roger, 2019).

Research designs are in various forms which include qualitative, quantitative and mixed method,
(Carol, 2007). The qualitative and quantitative research designs are manifestly visible in the
manner in which they present their data. Researches undertaken by researchers who investigates
various problems in order to identify solutions maximise on research designs. The qualitative
research design presents quality data in the form of descriptive and analytical statement. Whereas
quantitative research design quantifies data in form of figures, pie charts and graphs, (Bless &
Smith, 1995). The mixed method combines the two designs qualitative and quantitative designs
(Bhattacherjee, 2012). In essence, research designs makes the research work of data collection and
presentation conform to the nature of the research (Carol, 2007). In the context of this study which
investigates attitudes, experiences, responses and feeling of commnuties on brain drain in the
health sector. The mixed research design is ideal towards presenting the best data required for this
research.

Mixed methods research is a research that include collecting, analyzing and interpreting
quantitative and qualitative data in a single study or in a series of studies that investigates the same
underlying phenomenon, (Cameron, 2015). This research design has both positivistic and
interpretivistic philosophical assumptions as well as methods of inquiry. As a methodology, it
guides the direction, collection and analysis of data and the mixture of qualitative and quantitative
data in a single study or series of studies. Its central premise is that the use of quantitative and
qualitative approaches in combination provides a better understanding of research problems that
either approach alone (Cameron, 2015). However, as alluded to above this study seeks investigate
brain drain in the health sector focusing on Zengeza clinics using the mixed method design.

The researcher turned to the pragmatism research philosophy primarily to adopt methodologies
which enable the researcher to address all of the research questions raised, the issue, and allow for
the integration of research methods (Abdullah, 2019). Because of the pragmatic research
philosophy, the researcher gathered qualitative and quantitative data from the chosen research
participants (Belgrave & Seide, 2019). Having a combination of two different data components
was ideal. The researcher was able to triangulate responses that were acquired through two separate
research instruments that were utilized in the study by combining diverse research methods using
the pragmatic philosophy (Tie, Birks & Francis, 2019). The researcher believed in external world
independent of the mind as well as that lodged in the mind. Rorty (1990) affirms that mixed
methods researchers opens doors to multiple methods, different worldviews, and different
assumptions as well as different forms of data collections and analysis.

Furthermore, Cherryholmes (1992) asserts that pragmatist researchers concentrate their decisions
on what and how to research on the outcomes they hope to achieve. Mixed approaches help to
explain a study problem, the researcher adopted them. Researchers who use mixed methods should
develop a purpose for their mixing and justifying why it is necessary to combine quantitative and
qualitative data in the first place. The researcher employed mixed methods because they
incorporate the postmodern turn, a theoretical lens that is reflective of social justice and political
goals, according to Rorty (1990), who claims that pragmatics agree that research always takes
place in social, political, historical, and other contexts. According to Tashakkori and Teddlie
(2010), the following steps were created for expanding mixed methods:

• Methods for integrating quantitative and qualitative data, such as databases, might be used to
assess the validity and correctness of the other databases.

• One database may provide clarification for the other database and/or investigate other types of
queries than the other database.

• When instruments are not suitable for a sample or population, one database may lead to better
instruments.

• During a longitudinal study, one database could build upon other databases and alternate back
and forth with other databases.

Halcomb, & Hickman, (2015) mixed methods research has the potential to combine qualitative
and quantitative characteristics across the research process, from the philosophical underpinnings
to the data collection, analysis and interpretation phases. Brain drain issues in the health sector
require insertion of the researcher in the case under study. The insertion of the researcher into the
case under investigation enables the researcher to observe phenomena, interview participants,
distribute questionnaire and analyse documents which relates to the research thrust. However, data
collected for a study is drawn from a selected population.

On the other hand, the biggest problem on the part of the researcher as a result of adopting the
pragmatism research philosophy was time, especially when it came to the requirement to combine
various research methods and all the data that had been gathered using the research instruments.
This indicates that the philosophy also made the researcher aware of the need for more resources,
given the adoption of more research approaches, while the researcher lacked sufficient resources.
This could be one of the justifications given by Barnes (2019) for his claim that using enough
research resources is necessary to ensure accuracy of the study results anytime the pragmatic
philosophy is employed.
3.2 Population
Population of a research denotes the selected group of people upon which the researcher
investigates inorder to draw a conclusion about the problem being studied, (Bless & Khan, 1993).
This is a group of people who have one or more characteristics that are of interest to the researcher,
(Carol, 2007). In the same vein the selected population has vital knowledge and manifestations
that are critical towards addressing key issues of the research thrust, (Hoepfi, 1997). A population
typically has many members for practical research, therefore an examination is limited to one or
more samples taken from it. A well-chosen sample will reveal details of a given population
parameter, however the relationship between the sample and the population must be such that
accurate population inferences may be drawn from it.

3.3 Sampling Procedure

The researcher used both probability and non-probability purposive sampling technique.
According to Creswell, (2014), purposive sampling enables the researcher to seek individuals and
sites that can best answer the raised questions. According to Saunders et al. (2012), probability
samples provided the known and generally uniform probability that each example will be picked
from the population. This suggests objectives need statistical estimation of the population's
characteristics from the sample might be met in order to answer research questions and achieve
goals. Using the non-probability purposive sampling, the researcher managed to sample a
population made up of participnants who are familiar with health care workers issues under
investigation. Purposive sampling is the dominant strategy in mixed research beacause it enables
the researcher to extract relevant primary data from the participants, (Hoepfi, 1997). The non-
probability aspect gave every participant an equal chance to contribute relevant data for the
research. However, the selected population participated in the research under mixed research
instruments or data collection tools.

According to Mignone, Chase, and Roger (2019), judgmental sampling, also known as purposeful
sampling, refers to the process of choosing the study's sample subjects based on the researcher's
knowledge of the characteristics of the sample that made them eligible to participate in the study.
Creswell (2019) added that the judgment of the researcher is heavily relied upon when choosing
the sample participants in a judgmental sampling strategy.
By using the purposive sampling methodology, the researcher was able to approach and engage
conversation with sample subjects directly and collect the necessary quantity and quality of data
for accurate inferences. Additionally, the researcher managed to take into account specific
characteristics that were essential for the research study's participant population. The purposive
sampling made it possible for the researcher to integrate qualitative elements of the research study
in terms of data. Matlala & Matlala (2018) cited that judgmental sampling method allows for data
collection within the limited resources and time frame which was the other justification and benefit
why the researcher resorted to the sampling method.

3.3.1 Sampling
The research included a sample of real individuals who had been chosen to take part in a study
based on their remarkable qualities (Quinlan, Babin, Carr, Griffin & Zikmund, 2019). The
techniques for data processing and presentation were estimated by Quinlan et al. (2019), which
further assured that it was simple to draw inferences from the data acquired. Butler, Copnell, and
Hall (2018) repeatedly underlined the need for a sample size that is neither too little nor too large
to improve data precision and reliability. As a result, researchers should always check that the
sample size they are using is appropriate and reasonable.
Consequently, the first vital characteristic of a sample is that each person in the population from
which it is chosen must have a known non-zero probability of being included in it; it follows
naturally that these probabilities should be equal. In other words, the selection of one issue won't
affect the others because we want the decisions to be made independently.

The selected population for this study is made up of health care workers who are employed in
Zengeza Clinics in Chitungwiza. From the selected group of people, 30 participants shall comprise
the total population for this study. However, the sampling procedure used to come up with this
population was a non-probability sampling procedure.
3.4 Research Instruments
Study instruments were tools the researcher used to gather the necessary study data from actively
participating research subjects, in this case, the respondents (Cayir & Saritas, 2017). The study
utilized a questionnaire and an interviewing guide based on the research tools for gathering
quantitative and qualitative data, respectively. Accordinng to Caroll, (2007), when a researcher
uses a case study thriving under a mixed research design, mixed research instruments should be
used. The recommended data collection tools for a mixed designed research selected by the
researcher are interviews, observation, questionnaire, and document analysis. Furthermore, a
quantitative data collection tool in the form of a questionnaire enhanced the mixed method aspect
of the study.

3.4.1 Indepth Interview

Interview is defined as a proffessional conversation aimed at enabling participants to talk freely
about their experiences and perspectives, (Carol, 2007). The use of interviews enabled the
researcher to be able to engage in a conversation with the participants selected for the research.
The researcher will be capturing the language and ideas of the participants which relate to the
research thrust, (Bhattacherjee, 2012). The researcher maximised on interviews as they enhanced
face to face discussions of the research thrust. The researcher asked questions and participants
responded with perspectives embedded with primary data for the research.

However, the resercher used unstructured interviews because this allows for flexibility. Through
the use of unstructured interviews flexibility was realised which allowed the interviewee to ramble
and in the process contributing critical insights for the research, (Walliman, 2011). The researcher
thoroughly interrogated brain drain issues in the health sector from the selected population using
unstructured interviews. In order to stick to the fundamentals of the research thrust the researcher
controlled the interviews so as to avert digression to unnecessary discourses which are irrellevant
for the research.

The advantages of using the indepth interviews helps the researcher to establish peronal contact
with the participants. Such participants in this study are development practitioners, government
officials and community members and leaders. The data obtained through interviews was assumed
to be accurate, reliable and valid. This is hinged on the direct access that a researcher has to a
participant.The researcher has room to discern responses from participants facial and bodily
expressions as these enhances the determination of the quality of data extracted from a participant.
The use of interviews has a high response rate from participants than other data collection tools.
Interviews enable probing of answers that are not clear.

The disadvantages of using the in depths interviews can be time consuming as the researcher
sometimes fumbled to access participants.It is also costly to enagage into an interview with a
participant. Costs are incurred through travelling, buying airtime or data for online and telephone
interviews.There was possibility of collecting false data as participants can be conditioned by
circumstances to respond in a manner deemed safe for their community ethos.There is also limited
standardisation of intervews thereby compromising the relevance of the collected data. Interviews
can be controlled and directed to satisfy the assumptions of the researcher.

Aware of the given disadvantages and their effects to the study. The researcher embarked on
interviews with a cautious attention over the challenges that may arise from disadvantages of
interviews. The researcher made use of chat interviews to mitigate time constraints, ability to
access participants and as a cheaper way to communicate. Ethical considerations were spelt out to
participants and the issue of confidentiallity was made clear to make participants feely share their
views. The researcher controlled the interview by guiding participants through questioning around
the research thrust.

3.4.2 Researcher Observations

The other instrument which the researcher considered pertinent for this study is observation.
Observation refers to an undertaking whereby the researcher looks closely at a phenomenon as it
naturally manifests itself, (Bhattacherjee, 2012). In the same vein Mahesh, adds that obsrvation is
a systematic and deliberate study through watching spontaneous occurances at the time they occur,
(2011). When the researcher uses observation it can be participant where the researcher
participates in the activities of the population under observation. The researcher can also be a non-
participant observer whereby the researcher just examines the activities of the population under
study without involvement in the activities undertaken, (Walliman, 2011). In the interest of this
study the researcher was closely examining the activities of the population under interrogation at
times as a non-participant observer. Non-participant observation enabled the researcher to
interrogate the feelings of health care workers and their attitudes towards those who emigrated.
Observation enhances organic interaction of the researcher and the population under investigation.
During the organic interaction the researcher is able to extract raw data critical for the research.
Observations contributed relevant data because the researcher is compelled to observe occurrences
that responds to the thrust of the research. When undertaking an observation the researcher has
room to interview salient participants who are experienced in the issues under investigation.
Through observations the researcher was exposed to various trajectories of the research thrust
thereby obtaining the lenses to identify gaps. Observation immerses the researcher into the
fundamental tenets of the research thrust.

Observations can mislead the researcher especially if the researcher has introduced him/herself
and issues that he/she is looking for. In order to evade giving the real picture of occurrences
suspicious participants may superficially give a false narrative of their experiences. Observations
may digress the researcher to other irrelevant but interesting researchable issues during
occurrences. Participant observation may influence biases in the researcher. Observations are time
consuming as the researcher has to take time to observe occurrences as they happen at a given
time. Observations are costly as the researcher at times has to travel in order to observe occurrences
in a community.

The researcher used non-participant observation due to her profession as a pastor who engages the
community at various ministerial platforms. On that plane during field work the researcher would
use the meetings with communities or hospital visits for the sick as platforms to observe
occurrences. However, the researcher suspended he preconceived ideas, assumptions and biases
during observations. That enhanced collection of relevant and raw data. The researcher controlled
her biases through phenomenologically treating the issues under investigation as ideally prime for
the study. The researcher had access to observations during field work. That helped her to counter
the issue of costs.

3.4.3 Structured Questionnaire

The researcher selected the questionnaire as another data collection tool critical for a qualitative
research on community related issues. The researcher employed the questionnaire as an alternate
research tool to acquire data from the chosen respondents (Clark & Veale, 2018). According to
Silverman (2010), a common approach of acquiring data used by many scientists is the use of
questionnaires. Comprising corporate bodies, public entities, and private a typical questionnaire-
driven survey will include the following components: a social demographic profile, close-ended
research questions, and open-ended research questions. Surveys have the potential to reach a
sizable number of people quickly and very easily, they save money on travel and other expenses,
making them very practical and assisting in funding other research logistics. Computable data is
also provided using questionnaires (Ng and Coakes 2013).

A questionnaire can qualitatively covers attitudes experiences and opinions deduced using a
simple question format, (Foddy, 1994). Furthermore, a questionnaire is typically a mix of close
ended and open ended questions, (Questionpro, 2022). The researcher used close ended questions
which were coined to relate to the data to be collected from interviews, document analysis and
observations. The questionnaire was prepared in a simple and straight forward manner so that it
does not consume the time of the respondent when answering the questions. The questionnaire is
a simple, flexible and suitable way of collecting data from a large sample. A questionnaire was a
cheaper way to collect data as it helps the researcher to cut other data collection tools’ expenses.
The closed ended questions are not time consuming as the respondent simply place a tick on one
of the possible answers or add a word in a blank space. The questionnaire permits anonymity which
helps the researcher to acquire information without any prospects of victimisation of the
respondent. The questionnaire makes it easier for the researcher to classify answers and further
relate them to findings from other tools.

The questionnaire sometimes lacks the ability to clearly measure the respondent’s attitudes and
behaviors. It created categorisation of responses further limiting broader quality data from
respondents. Can generate a low response rate if the respondents are busy with their work
schedules. The questionnaire cannot be suitable for illiterate people due to its demand of responses
after reading and understanding. Questionnaires do not probe respondents if they either give
inadequate or an interesting response which requires more elaboration. The researcher simplified
the questionnaires making them rich towards extracting relevant data. The simplicity of the
questionnaire made it easier for people of various levels of education to be able to respond. That
triggered a positive response rate. The questionnaire was used to complement other data collection
method hence designing it to conform to the research thrust.
3.4.4 Document Analysis
Bowen, (2009) explicates that document analysis involves the process of collecting data from
recorded materials which can be in the form of videos, pictures, journal articles, reports among
others. Leedy, (1997), posits that document analysis can be defined as the process whereby the
researcher accesses relevant documents and extracts data relevant for the area under investigation.
Furthermore, when using document analysis meaning of data is deduced from the insights drawn
from the recorded materials, (Rapley, 2007). The researcher accessed recorded many videos and
reports on brain drain in the health sector. The documents were extended to other parts of the
Ministry of Health and Child Welfare areas but with critical importance in the case under
interrogation. The recorded materials gives the researcher a broad view of data since some of the
recorded cases can be in different places from the case under study. It gives easy access to data
usable in the research. Does not consume time when looking for data from recorded materials.
Familiarises the researcher with online current data on the area under investigation eg YouTube
Videos, Journal Publications and current reports accessed online. Can contribute original relevant
data as occurrences in recorded materials will not be under the influence or control of the
researcher. The researcher also had a chance to visit the four clinics under investigation in Zengeza
and was given some record books, registers and other journals where they record the number of
patients who visit the clinics in a daily basis. Through these records it indicated how the issue of
brain drain has greatly affected the health care delivery system in the area under review.

It may contribute excess data to the researcher which may require intense selection towards
obtaining relevance. Electricity and network challenges may impede access to online recorded
materials. Costs of airtime and data can also affect access to most of online platforms which may
have critical recorded materials. Pre-recorded materials can mislead the researcher since some
videos are edited towards expressing a biased narrative to the producing organisations. Can confine
the researcher to desk research with minimal quest to embark on field work.

The researcher accessed various documents which remain confidential and pre-recorded video
materials online which enhanced the collection of data for the researcher. However, some of the
accessed videos on YouTube were interesting to the researcher but lacked relevance to the context
under research. The researcher had to contextualise some of such data to suit the insights of the
research thrust. The data extracted through document analysis was focused on the research thrust.
The researcher accessed Wi-Fi to counter costs of watching You Tube videos. The researcher
further made use of reports which were attached to the videos as a way to establish their
authenticity. With other complementary data collection tools the researcher countered desk
research limitations perpetrated by document analysis.

3.5 Data Analysis

Data collected through using the instruments adopted by the study were presented, analysed and
discussed using themes. The thematic presentation, analysis and discussion of data were drawn
from the objectives of the research. Using the Braun and Clark model’s six steps the researcher
managed to familiarise with the data, generate initial codes, search for themes, review the themes,
defining and naming themes and produced a report, (Braun & Clark, 2006). Audio and video
recorded data was transcribed so as to enhance conformity to other collected data. From the
understanding that this research is a mixed design the data was inductively organised into
thematically relevant categories, (Carol, 2007). The data analysis was handled so as to enhance the
development of solutions to the problem under investigation.

3.6 Ethical Considerations

The researcher was guided by the following ethical considerations and the principle of informed
consent, the principle of voluntary participation and the principle of confidentiality. The researcher
embarked on the study after obtaining permission from the Zimbabwe Ezekiel Guti University to
undertake the research. The researcher was granted permisions to penetrate contexts, communities
and organisations for the carrying out of the research. The research interviewed and observed
adults and no children were involved in the research. Research participants were made to
understand the thrust of the research that it was merely academic and those who did participant,
did so voluntarily without any force or intimidation. Participants were told the nature of the study
and asked if they were willing to participate and signed the consent forms. Names of participants
were used upon seeking their consent and those who refused to use their real identities permission
was sought to use pseudo names. Participants were allowed to disengage from the research when
they felt uncomfortable by the process. Personal privacy and confidentiality information of
participants was central to the research and interview pseudo names were used. In essence, the
ethical considerations which were used by the researcher included informed consent, applying
confidentiality, honesty, the right of the participant to discontinue with the research is he/she feels
so, right to privacy, respecting the participant’s time and ethical consideration towards vulnerable
populations.

3.7 Chapter Summary

Chapter 3 managed to unpack the methodology of the research. Research method was explicated,
research design was presented and explained, research approach, population, sampling procedure,
research instruments, data analysis and ethical procedures were all tackled. The next chapter shall
present, analyse and discuss the collected primary data.
 CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.0 Introduction
The aim of this chapter is to evaluate the response rate from the research participants as part of
data presentation and analysis. The chapter starts by examining the research participants’
demographic characteristics which are important in the whole study. The presentation in this
chapter focused and satisfied the research objectives as they are enlisted in the first chapter.
Presentation and analysis made use of the Microsoft excel 2013, tables, charts and graphs adopted
exhaustive analysis. Data was also thematically presented as per the objectives
comprehensiveness. The first segment of the chapter articulates demographic data whilst the
second thematically presents and discusses the material.

4.1 Demographic characteristics

This section, paid consideration to personal details of all respondents who contributed to the study
in terms of their profiles presenting the overall participants response rate. Other elements presented
are respondents’ ages, gender, and respective educational levels, among others.

4.1.1 Response rate

The table below is a presents the participants response rate for the interview and the questionnaire
which were used for data collection from selected respondents

Table 4.1 Response Rate for the questionnaire and interview Guide

Sample Size (n) Responses Response

Percentage %84%
Responses 30 25 84
Non Responses 5 5 16
Total Response Rate 84%
Sources: Primary Data, (2023)
The table above indicates the number of questionnaires that were dispensed to interviewees was
30 and 25 responded to an 84% response rate. A total of 84% rate of response has been confirmed
by Clarke and Veale (2018) that a response rate of at least 70% is imperative for gathering data
thorough and accurate data from any chosen respondents who participate in any research study.
Unequivocal questions about data collection may have led to a high response rate since they made
it simpler for respondents to reply and return the distributed questionnaires.

4.1.2 Respondents gender

In the first part of the questionnaire and interviews, data was gathered to reveal the actual gender
for each of the respondents from whom data was collected. Frequency distribution table 4.2 below
presents data regarding respondent’s gender.

Figure 4.1 Gender Distribution

40%
Gender
Male
Female
60%

Sources: Primary Data, (2023)

Figure 4.1 indicates the respondent’s gender distribution. The female contributed quite a
substantive amount, which is 60% of the total population and men contributed 40%. This is a clear
indication that women participated more than men in the research’s study. This indicates that in
the clinics there are more females than male, in the community. The gender distribution also proves
that females are more willing to contribute and participate than men, men could be unwilling to
participate and could be busy as well.
4.1.3 Age Group
Figure 4.2 Age Group

12

10

6
Series1
4

0
21-30 years 31-40 years 41-50 years 51 years and
above

Sources: Primary Data, (2023)

Figure 4.2 above shows the respondents age groups. The majority of the respondents were 31 years
to 40 years of age which contributed 40%, with 10 participants. The second highest group of
respondents were 21 to 30 years with 8 participants contributing 32%. The third age group had 5
respondents (41-50 years), thus 20%. Lastly 2 respondents were from the Age group of 51 years
old and above contributing 8%. This shows a considerable number of people are from the ages 31-
40 years, and this represents a majority are adults and youths.
4.1.4 Educational Level
Figure 4.3 Educational Level

12%
20%
Education level
O' and A Level
28% Certificate of Diploma
Degree
Masters
40%

Sources: Primary Data, (2023)

Figure 4.3 above indicates the respondent’s educational level. The highest percentage turned into
certificate or diploma 40% of the respondents. Followed by 28% with undergraduate degrees.
Those with master’s degree constituted 12% and 20% of the respondents had O and A level
certificates. This indicates that the majority of respondents that have been interviewed hold
diplomas and certificates. There is therefore high literacy level among the sample population. All
of the respondents being educated and holding at least a certificate, diploma, or degree is a sign
that the researcher was able to gather expert information from the respondents and, as a result,
extensive study data. Tobi & Kampen (2018) have hinted that the respondents' educational
backgrounds are taken into account when determining whether or not they have some credentials
in various areas, which is a guarantee for the collecting of detailed data. Chen (2018) asserts that
gathering data from knowledgeable respondents is a confirmation of accurate study inferences.

4.2 An Overview of the health workers migration

Zimbabwe as a country has been losing health care workers due to various reasons. These health
care workers decided to seek a better life and working conditions in the United Kingdom, Canada,
and Australia among others. Every year a mass exodus of health care workers is experienced. That
has made Zimbabwe a training ground for health care workers, who after receiving training under
the support of the government graduate and offer service to other countries. In essence, Zimbabwe
trains, then UK, Canada, Australia, New Zealand, and Namibia among others benefit. “At our local
clinic and others in Zengeza we are now used to seeing new faces of health care workers nearly
every month. As concerned citizen you ask where is the nurse that served me the last time I came.
The response that you receive is he/she has left for the UK. Honestly for how long shall we
continue to be attended by different health care workers periodically? Has anyone thought of the
need for patients to be attended to by same personnel for proper continuity of health care checks
and balances” response from Participant 1. Zengeza community and Zimbabwean society at large
have concerns indeed about the mass exodus of health care workers they experience. That has
made some people to loose trust in the health delivery system in Zimbabwe. In light of the same
perception, Participant 1 further opined that, “these mass exodus of health care workers have made
private health care very expensive. If one needs proper medical care, you now have to go to
Citimed? Now the question is how many people can afford the huge medical bills charged by
Citimed here in Chitungwiza?” The health care workers that are migrating from Zimbabwe to other
countries include doctors, nurses, health technicians, ambulance personnel, nurse aids,
radiologists, laboratory technicians among others. One can imagine money invested in training
those personnel by the government against the number of health care workers that are lost in
Zimbabwe per year. The participants agreed in the questionnaires that migration of health care
workers is now a serious crisis to health care delivery system in Zimbabwe.

From the presented findings the migration of health care workers from Zimbabwe to other
countries is an evident reality. According to Chikanda, (2005), “Zimbabwe has been facing a
growing problem of emigration of skilled labour. Health care professionals in particular are
migrating in search of greener pastures outside the country’s borders.” From Chikanda’s
perspective the emigration of health care workers in Zimbabwe has been a challenge to the country
from the dawn of the new millennium to date. On the same note Gaidzanwa (1999) had averred a
similar perception noting that skilled health care workers began to consider emigrating from as
way back as 1998/99. In that perspective what is experienced in Zimbabwe’s health care system
has been a challenge for the country for more than twenty five years now. Even in the post
economic relief period of the Government of National Unity of 2008-2013 the challenge has
remained painful to the Zimbabwean populace.
The hemorrhage brain drain experienced in Zimbabwe’s health sector relates to the global
phenomenon associated with human quest for better opportunities in life. Poor economic
conditions in Zimbabwe coupled with bad governance have pushed more health workers out of
Zimbabwe, (IOM, 2010). The increase in health care mass exodus calls for policy reforms in the
Zimbabwe health sector. If the Zimbabwe government does not do something to make staying at
home more attractive and rewarding, the brain drain hemorrhage will continue unabated? The
driving force seems to be as powerful as the forces pulling health care professionals away from
Zimbabwe. The two forces appear to be operating in mutual reinforcement. According to WHO,
(2023) Zimbabwe is now among the countries that have been listed as countries with vulnerable
health force. “Health care workers, are the backbone for every health care system, and yet for 55
countries (Zimbabwe included) with some of the world’s fragile health care systems do not have
enough and many are losing their health workers to international migration” Dr Tedros Adhanom
Ghebreyesus WHO Director General (WHO, 2023). Indeed Zimbabwe’s health systems have been
negatively affected by brain drain. The critical question then remains, what are the causes of brain
drain in Zimbabwe?

4.3 Causes of brain drain

The study established and pointed out from the interviewed participants that economic challenges
pushed health care workers to migrate to developed countries. The cardinal push factor that was
unanimously emphasised in the findings was the poor remunerations, infrastructure and working
conditions that health care workers experienced in Zimbabwe. One interviewee Participant 2
shared that, “…the salary earned by a health care worker in Zimbabwe cannot sustain a family of
four for half a month. In that case do you expect people to endure when there are better paying
opportunities out of the country?” Another Participant 3 echoed that, “it is unfortunate health care
workers are not given the dignity that they deserve as people who work as life givers to humanity.
It is not easy to work with minimal or inadequate equipment. Such that at times you watch patients
dying not because they were supposed to die but they die due to inadequate supply of needed
materials to sustain their lives. Some they die because the infrastructure in the clinic failed to
sustain the care and support expected on such a patient.” At times when health care workers try to
embark on a strike for their conditions to be improved the ruling political elites uses militant force
to suppress them. Some were dismissed from work due to striking an issue which violates the right
of an employee in an organisation. These conditions in which health care workers are exposed to
on a daily basis demotivates proper execution of duties. In that perspective many end up deciding
to leave the country for greener pastures.

The data which was collected through the structured questionnaires showed that major causes of
brain drain in Zimbabwe are economic challenges that have been affectingng the country. These
economic challenges emanate from government bad policies, bad politics, poor governance and
unfriendly foreign policy related that strain relations with other states and international non-
governmental organizations. According to the WHO, (2023) the negative economic challenges
affecting some states have resulted in the luring of health care workers to better economies
characterised by high income earning. Economic challenges have been triggering migration of
health care workers from countries that have poor health care systems and low health workforce
densities. Chigariro and Mhloyi, (2022) maintain that non-availability of economic and social
opportunities, poverty, fear of persecution and loss of wealth have been contributing to the brain
drain in Zimbabwe’s health sector. On an important note most of the migrating health workforce
are in the youthful age. This is underpinned by the quest of the young to invest and build a future
for their families. The future in the form of having a home, transportation, quality education among
others. The developed countries tend to pull the productive age groups offering better job
prospects, better living conditions, political freedom, better education facilities, assisted welfare
systems among others, (Chigariro and Mhloyi, 2022). The Zimbabwean context has been found
wanting in terms of giving a better life to her citizenry. On that note health care workers cannot
withstand the temptation from developed countries.

4.4 Epidemiological impact of health workers migration

The migration of health care workers from public clinics has triggered many challenges to the
Zengeza community. These challenges include lack of experienced personnel who can handle
special medical cases, the rise in the price of health care service, high rate of spread of diseases,
high mortality rate among others. Participant 4 averred that “It is now risky to go for maternity
labour because you will always find new staff at the clinics. Some of the staff prove inexperienced.
For example a woman gave birth in a toilet after one inexperienced nurse allowed her to visit the
toilet alone during extreme labour pains.” Participant 5 also echoed similar sentiment “Ukaenda
kuchipatara uine pamuviri wodzoka wakabata mwana wako iwe uri mutano ito tenda Mwari.
Nekuti dzimwe nguva vana mukoti vatsva ava vanotodzidzira basa pauri nemwana wako. (If you
go to the clinic to deliver a baby and both you and your baby come out alive you must thank God.
Because in some cases the new nurses experiment to learn their work through you and your baby)”.
The issues of lack of experienced nurses to tackle certain types of sicknesses and conditions was
also raised. This include those who can effectively manage cancer, HIV, Tuberculosis among
others.

The mass exodus of health care personnel have adversely affected the Zimbabwean population.
That has exposed many to the spread of diseases, adverse effects of diseases due to lack of proper
control and lack of protective clothing. According to Chibango, (2013) understaffing in critical
areas of clinics and hospitals such as neonatal unit has become a cause for concern. If such life
serving units for new born babies suffer lack of enough staff and proper care of patients. Indeed
the effects are an issue of concern. Osingabeni, (2021) lack of experienced health care personnel
and shortages of personnel in such a critical area of serving humanity results in people loosing
trust in the health care system of a country. Due to staff shortages in public health care facilities
people resort to using private ones. This is besides the exorbitant health care fees charged by
private health care institutions. The poor in such cases suffer the more and some even die before
time, (Chikanda, 2005). Zengeza community is made up of people who are mostly working in the
informal sector. These include vendors and other areas that do not pay people enough to cater for
their adequate financial needs. On that note the conditions of shortages of staff in public clinics
exposes such a population to many diseases and high mortality rates. Expecting mothers end up
going to unregistered backyard services to seek help, which is extremely risky to undertake such
a move. At times some even opt to deliver her own baby by herself in the comfort of her own home
rather than to go at the clinic where there are no qualified midwives to assist them. They opt for
other alternatives as a way to save their lives, which by so doing can further complicate their health
conditions. The decision to improvise on one’s health and even that of one’s baby emanates from
understanding the socio-economic strains that are affecting Zimbabweans.
4.5 Socio-economic impact
Brain drain in Zimbabwe’s health sector has triggered migration in search of medical help.
Conditions that require special medical attention now require patients to migrate to countries that
offer proper medical care. That situation also triggers inflation in terms of health care provision
and other supporting services. The Zengeza community as alluded to above consists mostly people
who work in the informal sector. When a family has a patient suffering from heat ailments,
kidneys, brain tumours, among others recommendations sometimes point to seek medical attention
out of Zimbabwe. Due to economic challenges in Zimbabwe some end up losing property in trying
to save a life. Participant 6 “You cannot ignore your family member because here in Zengeza local
clinics there is no proper medical specialists that can handle special cases. When help is not found
locally indeed as family we have to organise to seek medical help out of the country. Mai Chihera
had to sell her residential stand so that she can take her daughter for treatment of a heart ailment
in India”. Cases such as the one presented by participant 6 are on the rise in Zimbabwe. Families
now lose property in trying to save a life through seeking medical care beyond Zimbabwe. Other
participants would raise concerns over economic hardships as pushing people to such risk
decisions.

The economic challenges in Zimbabwe that has gripped the health sector has indeed contributed
to migration challenges of both health care workers and patients. According to IOM, (2009) the
poor economic situation prevailing in Zimbabwe has led to multiple and complex migration issues
such as brain drain, cross-border morbidity and irregular migration. Complexities of migration in
this case involves both patients and health care professionals. One cannot ignore the fact that in
some cases patients that leave Zimbabwe to go and get medical attention out of the country, may
also be attended to by Zimbabwean health care professionals in the foreign land. Chikanda and
Dodson, (2015) avers that the right to health of citizens in a country losing health care workers to
another is violated. Respecting the right to health must also include desisting from luring health
care personnel from smaller economies to bigger ones. In Zengeza people end up resorting to
visiting shrines for healing due lack of better medical care in the public health care facilities
available. Visiting shrines has raised cases of abuses, indecent assault, and rape among others.
This emanates from the lack of ethical training among some of the practitioners in the shrines.
However, such challenges indicate that having proper health care facilities can mitigate a lot of
social challenges.
On the other hand, the migration of heath care workers has left a lot of families separated and some
cases ending in divorce. Participant 7, noted that, “she has a female relative who left for the United
Kingdom in 2018 from a local Zengeza clinic, promising to take the husband and their 4 children
just after about 6 months but up to now May 2023, the husband and the children have not joined
their mother in the UK. To make matters worse, she hardly calls back home and she hardly speaks
with the husband". She always say that she is very busy. From the look of things according to
participant 7, she says “I do not think that this marriage will work out, its 5 years now and she is
not even concerned about the husband and worse still the children". These are some of the social
challenges which are being experienced in Zengeza, separation of couples, divorces, cheating on
the remaining spouses which may end up in other health complications as well. It becomes a chain
or cycle of socio- economic challenges which brain drain is continuously causing in Zengeza and
the surrounding areas. Harvey et al (2009), argue that emigrants have been detached from their
beloved families and friends which is contrary to the African culture of inclusivity, and this in turn
has caused a lot of social ills and even the rise in child- headed families not caused by death but
caused by the brain drain.

4.6 Chapter Summary

The chapter managed to present the collected data. The presentation also included articulating
demographic characteristics of the study. Armed with a positive response rate and cooperation of
participants. The study developed thematic presentations of key areas pertinent to the research
thrust. The thematic areas of the study included presenting an overview of the health workers
migration, causes of brain drain, epidemiological impact of health workers migration and socio-
economic impact. The following chapter shall present the summary, conclusions and
recommendation of the study.
 CHAPTER FIVE

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

5.0 Introduction
The previous chapter presented, analysed and presented collected data. From the presented
findings the study established that indeed brain drain has adversely affected health care service
delivery in Zengeza Chitungwiza. Health care workers are immigrating to countries that offer
better remuneration and working conditions. Furthermore, the challenges of brain drain in
Chitungwiza translates to other parts of Zimbabwe where brain drain continues to affect the right
to health care for the citizenry. It remains a challenge that requires solutions that can ameliorate
the gravity of the problem in Zimbabwe. However, this chapter seeks to present the summary,
conclusion and recommendations of the study. The summary of the study will enable the research
to draw a conclusion. On that note the researcher will proffer recommendations towards the
mitigation of the problem under interrogation.

5.1 Summary of research findings

The study tackled emigration of health care workers from Zimbabwe’s health care system focusing
on public clinics selected from Zengeza area. Emigration of health care workers has become a
challenge in Zimbabwe. Public health care facilities are running out of workers. That had
undermined the proper provision of health delivery services to the citizens in Zimbabwe.
Furthermore, the study managed to establish that indeed brain drain of health care workers has
crippled the health sector in Zimbabwe. The crippling of the health sector in Zimbabwe immensely
violates the right to heath for the citizens. Access to health care is a right which the government
has a responsibility to offer to the Zimbabwean populace. However, brain drain and emigration of
health care workers has complicated the respect of the right to health care service. From the
perspectives interrogated by the study. Brain drain of health care workers is a problem in countries
of lesser economic capabilities. Countries that have economic challenges struggle to maintain their
health care workers. These countries lose health care workers to countries with the strongest
economic capacities. Countries with better economies have the capacity to pay better
remunerations to health care workers, offer better working and living conditions. On that note
Zimbabwe is among the countries loosing health care workers to countries of better economic
prowess such as UK, Australia, Canada, among others. The push and pull factors as theorised by
the study are varied. Health care workers are pushed out of Zimbabwe due to poor working
conditions, poor remunerations, bad politics prevailing in the country, lack of freedoms, violation
of workers’ rights, economic hardships, bad governance, not upholding the rule of law among
others. In contrast, developed countries are pulling health care workers through offering attractive
salaries, freedoms, respect of the rights of workers, good political environment to work under,
guaranteed welfare policies among others. The case under investigation was also established to
have been adversely affected by brain drain of health care workers. Zengeza community in
Chitungwiza lives in myriads of health scares. This is a context that suffers water bone and
communicable diseases. Such kind of diseases require proper health care services. The glitch to
meet such a requirement zeroes in on the inadequate health care workers in the public clinics found
in Zengeza. Using the mixed methods data was collected and it was established that brain drain of
health workers has triggered socio, economic and ethical challenges among the population tackled
by the study.

5.2 Major Conclusions

From the summation presented which is informed by the study undertaken by the researcher. This
research concludes that brain drain of health workers is a real challenge in Zimbabwe. Zimbabwe
has become a training hub of health care workers and other countries benefit the service from the
trained personnel. The emigration of health care workers which has haemorrhaged into a brain
drain problem has caused the crippling of health sector in Zimbabwe. On that note the population
is reeling under health scares in their daily life. Zimbabwe has been affected by typhoid, cholera,
malaria, covid-19, HIV AIDS among others. These ailments require well trained and experienced
health care workers. Due to the increase in cases of diseases spreading in communities Zengeza
Chitungwiza community and Zimbabwe at large remains exposed to high mortality rates. That has
been acerbated by negative service endured in the public health facilities in the country. Indeed
high mortality rates, negligence, lack of experienced personnel to care for special ailments remains
a challenge. All these have been effects of brain drain of health workers in Zimbabwe. The study
established that economic challenges emanating from bad governance and other political factors
are contributing to the ballooning of brain drain in the country. Economic hardships under which
a health care worker struggles to take care of his/her her family compels one to consider moving
to greener pastures. The move to greener pastures benefits the health care worker at the cost of
access to health care of an ordinary Zimbabwean. In light of those conclusions and the effects the
study offers recommendations.

5.3 Recommendations
From the established challenge of brain drain of health workers and its effects. The study proffers
the following recommendations:

• The government must review its policies that pertain to health workers. There is need for
better policies on health workers working conditions, remunerations, welfare guarantees
and freedoms
• The government must positively respond to health workers’ grievances. That requires
desisting from using maximum force to quell strikes and demonstrations by health workers.
• The Ministry of Health must be in a position to provide necessary equipment, medicines
and all that is needed for the health workers to do their duties more efficiently
• The more specialized personnel must be given due special care in terms of housing,
vehicles and other benefits as a means to keep them so that they won't news to look for
these from the developed countries
• There is also need for good governance in the Chitungwiza local authority and
refurbishment of the health care infrastructures and facilities.
• Health care workers concerns must not be politicised but rather viewed as genuine towards
better health care systems in Zimbabwe.
• The general public must have good care of the natural environment so that the city may
also attract special health care personnel.
5.4 Chapter Summary

The chapter presented the introduction, the summary of the research findings, the major conclusion
and the study recommendations for the government, the ministry of health, the Chitungwiza local
authorities and to the general public. From the presented issues the study managed to establish that
brain drain has adversely affected Zimbabwe. The conclusions made by the study indeed pointed
to issues that have contributed to the high emigration of health care workers. In light of that
understanding the study proffered recommendations. It is the assumption of the study that the
proffered recommendations may enhance the migratory interventions by policy makers towards
addressing brain drain in Zimbabwe.
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 APPENDICES

Interview guide

POSITION OF INTERVIEWEE……………………………………………………………..
DATE …………………………………………………………………………………………..

SECTION A: DEMOGRAPHY
• Please indicate your gender Male Female
• Kindly indicate your age

21 years – 30 years
31 years – 40 years
41 years – 50 years
51 years and above

5. Kindly indicate your level of education

O and A Level [ ] Certificate/Diploma [ ] Undergraduate Degree [ ] Masters [ ]

SECTION B
3 What do you think is causing brain drain in Zimbabwe’s health sector?
4 What have been the effects of brain drain of health workers in your community?
5 From your own experiences in Zengeza are public clinics offering proper health care after
periodically losing workers?
6 What are the challenges that patients are experiencing due to health workers brain drain
in Zengeza?
7 How is the impact of brain drain of health workers in Zengeza?
8 Can brain drain be mitigated?
9 Propose what you think can be measures to mitigate brain drain of health workers in
Zimbabwe?