Migration has become a global phenomenon, touching nearly all corners of the world [1]. Yet, the effects of migration are increasingly becoming multifaceted, both at places of origin and at destinations [2]. Migration itself is a product of factors that help keep a migrant in their home area (push factors) and those that drive a migrant from the home area (pull factors) [3, 4]. Push factors include non-availability of economic and social opportunities, poverty, insecurity, overpopulation, poor living conditions, desertification, famines/droughts, fear of persecution, poor health care, loss of wealth, and natural disasters [5]. Pull factors include better job prospects, better living conditions, political freedom, better education facilities and assisted welfare systems, better commuting networks and communication facilities, better health care systems, better security and equality before the justice system [5].
The impact of emigration (out-migration) appears to be framed by two extremes. In some sending areas, migration has set in motion a development force, as remittances facilitate various kinds of investment. This includes direct and indirect investment in health and health care activities, including better access to essential treatment. In some cases, emigration has, however, drained local economies and societies of their human and financial capital [6]. Yet, studies on the relationship between emigration and health at the place of origin have been limited to the attrition of skilled health professionals through migration [7, 8].
Studies elsewhere, have noted migration, remittances in particular, to have favourable impacts on health outcomes [9,10,11,12]. This is because the additional income coming from remittances increases the ability to access health services, buy expensive medicine, and eat better-quality food [9, 10]. Adhikari et al. observed that elderly persons with migrant children were more likely than those whose children had not migrated to seek treatment, after controlling for socio-demographic and economic variables [10]. Remittances have also been associated with improved housing and water and refrigeration of food [13], among other determinants of health. For instance, adults in emigrants’ households were noted to be significantly less susceptible to being underweight than those in non-migrants’ households, yet they did not have an increased risk of being overweight [11]. However, migration was associated with increased chances of having symptoms of poor mental health among elderly persons residing in the emigrants’ households [10]. Given that remittances increased from US$ 36.9 billion in 2014 to US$ 39.8 billion in 2015, representing 2.16% and 2.59% of GDP for the respective years [9, 14], their relationship with health and health outcomes requires more attention.
Zimbabwe endures a very high migrant stock, with UNDP estimating 3.5 million of the population to be living in the diaspora [15]. Ratha et al. place the net migration for Zimbabwe at 11.1 migrants per 1000 population, translating to a migrant stock of over 4 million [16]. This means about a quarter of the Zimbabwean population is in the diaspora. The high level of emigration is associated with crippling, sometimes permanent, skills losses in the health and other sectors. This notion, however, overlooks the role of remittances as a determinant of health at the place of origin. Skeldon contends that remittances have a positive impact on the place of origin [17]. Recruitment and Returns are other key dimensions of migration, with an impact on health, that is worth considering. Recruitment deals with the employment status (employed, unemployed or underemployed) of migrants on departure and at destination. Returns refers to migrants who come back to their countries of origin. The Government of Zimbabwe thus recognises the importance of remittances as an economic driver. However, whilst diaspora remittances to the country have increased from 294 million (US$) in 2009 to 935 million in 2015, they have since been on the decline, reaching 635.43 million in 2019 [18].
The current economic situation in Zimbabwe is forcing people to emigrate in the hope of securing employment in countries with better economies such as South Africa, Botswana, UK and Australia [19]. The economic challenges are characterised by high unemployment rates, inflation and low productivity [20]. Those who migrate, however, may not get a job in their destination countries as soon as they would have anticipated. They may also find it difficult to have their qualifications recognised in the countries of destination. As a result, they end up in a worse economic situation than they were before they migrated. Considering that those with a high tendency to migrate tend to be breadwinners in their families, the situation may be worse for those they leave behind. When this happens, the health and general socio-economic situation of the families left behind is also affected.
During the 1980s and most of the 1990s, the government of Zimbabwe invested in primary and preventive health care and rolled out primary health care services to within 10 kms of at least 80% of the population [21]. However, the health delivery system has deteriorated with shortages of skilled professionals and health care staff, a lack of functional equipment, and a lack of essential medicines and commodities becoming persistent [22]. Disruptions and strikes by health care professionals over wages and working conditions and rampant corruption have also become a major problem [23]. Zeng et al. further notes that this deterioration coincided with a fall in demand for services, following the introduction of user fees in public health facilities, which are often applied in an ad hoc way and have been noted to drive households into poverty [21]. Consequently, demand for private health care in Zimbabwe has surged [24], despite the costs involved. This is within a context where universal health insurance is non-existent and only 10% of the population has medical aid cover [24].
It is also important to note that Zimbabwean suburbs (urban districts) are highly structured and homogenous [25]. This is a legacy of the colonial history of the nation, which saw neighbourhoods being organised around race, colour, social standing and employment/economic status [25]. Hatcliffe District—a low socio-economic status community—is therefore expected to host households with similar social status and economic standing, with minimum deviations.
This study explores the economic impact of emigration on health by comparing access to health and health care among emigrants' households and non-emigrants' households in urban Zimbabwe. It also explores the contribution of emigration in shaping other social determinants of health such as education and household nutrition security.