No. 41: The Quality of Migration Services Delivery in South Africa

The South African Department of Home Affairs (DHA) is responsible for the implementation and management of migration policy and legislation, as well as the registration of births, marriages and deaths and the issuing of identity documents and passports. It is often criticised in the media and in private conversation for being administratively inefficient, cumbersome and unwieldy. South African and foreign customers reportedly regularly complain about the poor quality of services delivered by the Department. Such evidence and media reporting underpins the widelyheld belief that the Department is not easily accessible, is unresponsive to the needs of its customers, is riddled with corruption and, to the extent that systems are in place to provide efficient and quality services, is poorly managed. In recent years, the DHA has also been plagued by a number of incidents of corruption and mismanagement and a protracted and controversial process of drafting new immigration legislation. At the same time, several incidents were reported that suggested there was significant tension between former IFP Home Affairs Minister Buthelezi and the ANC Director-General of Home Affairs. These factors contributed to the general sense that the Department was in disarray, and had not made any progress in improving its ability to deliver services in a timely manner, or towards living up to the criteria set out in the Departmental Standards brochure published in 1997. The Southern African Migration Project (SAMP) therefore proposed to test current per ceptions of the Department through a study of the quality of services delivered: the Services Quality Survey (SQS) project. In SAMP’s view, the value of implementing such a project lies in assessing and comparing the views, preferences and expectations of service consumers with those of the service providers. By developing an understanding of the constraints that hinder performance and the factors that enhance performance, the results of the SQS are intended to be used as a baseline against which to assess and benchmark current performance and service standards, and to set realistic targets and objectives to improve service delivery in the future. In the SQS project, interviews were conducted with Departmental officials, citizens and non-citizens nationwide using structur ed questionnaires. The questionnaires administered to citizens and non-citizens were largely the same, though non-citizens were also asked about their country of origin, their reason for entering the country, and how frequently they visited South Africa. The questionnaire administered to officials included questions about length of service, job satisfaction, knowledge of policies and legislation administered by the Department, national ser vice standards principles such as Batho Pele, and internal Departmental regulations and procedures. Inter views with officials, citizens and non-citizens were conducted in and around the offices of the Department that had been pre-selected in each province. At the completion of the fieldwork component of the survey, 179 officials, 2 120 citizens and 968 non-citizens had been interviewed. The SQS first sought to establish the level of familiarity that officials have with key legislation, policies administered by the Department and their impact on service delivery, as well as knowledge of internal Departmental policies and regulations: Nearly 40% of officials indicated that they were “unfamiliar” with the Immigration Act of 2002. Of these, 66% had been employed by the DHA for six years or more. An even higher 60% of officials said they were unfamiliar with the Refugees Act of 1998. This included officials at offices where staff were most likely to come into contact with asylumseekers: 53% of officials at Border Posts and 55% at Airports. Officials are more familiar with the national Batho Pele Principles of 1998, perhaps due to widespread advertising and visibility in DHA Offices. Nearly 90% were familiar with the Batho Pele principles. However, when asked to list some of Batho Pele’s most important principles, many were unable to mention them directly. With regard to the Home Affairs Turnaround Strategy launched in October of 2003, only 40% of officials had heard of the Strategy. One of the central aims of the SQS was to compare customer perceptions about the DHA with those of officials working within the Department. Amongst the most frequent anecdotal complaints heard about the DHA is that office locations are inaccessible, infrastructur e and physical conditions are poor, and resources, in terms of facilities and available equipment, are limited. When asked about proximity to, and accessibility of, DHA offices, the majority of citizens (86%) reported that it took less than one hour of travel to arrive at the office where the interview took place. The majority of citizens either traveled by taxi (42%), drove in their own car (19%) or walked (19%) to the office. Amongst non-citizens, 94% of those visiting an office, as opposed to passing through a border post or airport, were able to reach the DHA in one hour or less. Some 83% of non-citizens interviewed at a Regional Office and 73% of those at District Offices were able to reach the DHA in one hour or less. A second common complaint about the DHA is a lack of good customer service, often linked to negative attitudes of officials at the front line of interactions with the public. As one of the main focuses of the Survey, officials and customers were asked about their perceptions and experiences of service delivery in the DHA. In answering a range of questions about customer service, the majority of respondents were surprisingly positive: they felt that they were treated fairly, there was little discrimination in terms of how different groups were treated, and officials were interested in hearing what they thought. Officials and customers sampled were asked a series of questions closely linked to the Batho Pele Principles, which address service delivery issues such as consultation on service quality and choice, information, access, courtesy in treatment, transparency, redress, and value for money. Here, while it was apparent that officials and customers were aware of the Batho Pele programme, familiarity with its principles, and the extent to which the Department was implementing these principles, was not as good. To further understand how DHA customers are treated, specific questions were asked about perceptions of the attitudes of Departmental staff. Official, citizen and non-citizen respondents were asked whether DHA staff within the office where the interview took place were: friendly or unfriendly, attentive or inattentive, cooperative or uncooperative, patient or impatient, helpful or unhelpful, considerate or inconsiderate, polite or impolite, at ease or anxious, honest or misleading, trusting or suspicious, knowledgeable or not knowledgeable, and interested or not interested in their jobs. Across the citizens and non-citizens sampled, the results of the survey show that customers felt the attitudes of DHA staff were extremely positive overall. Interestingly, officials themselves were somewhat less positive about the attitudes of DHA staff. Customers were asked a series of questions on their experiences with service delivery at the DHA on the day they were interviewed, as this was thought to have a likely impact on whether respondents viewed the Department positively or negatively overall. Rates of satisfaction with the customer service received were also consistently high, with 87% of citizens and 92% of non-citizens reporting that they were satisfied with the level of service they had received. Similarly, 85% of citizens and 92% of non-citizens responded that they were satisfied with their overall experience as a customer at the Department of Home Affairs on the day they were interviewed. In addition to examining satisfaction levels on the day they were interviewed, customers and officials were asked more generally about their opinions on the current performance of the DHA. Again, in terms of overall performance, efficiency, fair treatment and general satisfaction with service delivery, the majority of customers expressed positive views. Similarly, in terms of levels of corruption and trustworthiness, very few customers and officials believe that corruption is a widespread problem. At the same time, customers and officials expressed a low level of tolerance for practices that might constitute or lead to corruption, though non-citizens appear to have a slightly higher level of tolerance for such practices. Very few respondents reported actual experiences of corruption, either directly or indirectly. In overall terms, the survey results suggest that perhaps the DHA is not in such a crisis in terms of service delivery, customer relations, and attitudes of staff. The customers sampled were positively disposed towards the Department, and were optimistic regarding its ability to continue delivering quality services. It is not possible to explain exactly why these findings are so inconsistent with media depictions, anecdotal evidence of broader public opinion, and the negative assessment made by the Director-General himself. However, it is important to understand the contextual factors that may have contributed to shaping the opinions and perceptions of the respondents. Further, the positive results of the survey do not mean that there are no problems or issues to be addressed within Home Affairs. Although the results of the survey indicate a higher quality of service delivery than perhaps originally anticipated, the question to ask is whether there are measures that the DHA can take to further enhance the positive perceptions of its customers and officials and to improve service delivery. Finally, the results presented in this report provide baseline data and a benchmark against which to measure the future performance of the Department, particularly in terms of levels of customer satisfaction with service quality. One of the key recommendations made in this report is that consideration should be given to administering a similar survey at regular intervals as a means of continuous assessment and as a basis for ongoing efforts to improve performance and the quality of services

A great year for potato leafhopper

Frequent rains may have delayed alfalfa harvest but they haven\u27t slowed the buildup of potato leafhopper populations. Potato leafhopper is a small, bright green insect that can be seen hopping out of your way as you walk in an alfalfa field. This sap-sucking insect can cut alfalfa yields in half and even kill seedlings when populations are high and left unmanaged. The primary cause of yield loss is shorter or stunted stems; however, leaf yellowing or hopperburn is the telltale symptom of this pest

No. 47: The Haemorrhage of Health Professionals From South Africa: Medical Opinions

The health sector has been especially hard hit by the brain drain from South Africa. Unless the push factors are successfully addressed, intense interest in emigration will continue to translate into departure for as long as demand exists abroad (and there is little sign of this letting up.) Health professional decision-making about leaving, staying or returning is poorly-understood and primarily anecdotal. To understand how push and pull factors interact in decision- making (and the mediating role of variables such as profession, race, class, age, gender income and experience), the opinions of health professionals themselves need to be sought. This paper reports the results of a survey of health professionals in South Africa conducted in 2005-6 by SAMP. Since there is no single reliable database for all practicing health professionals, SAMP used the 29,000 strong database of MEDpages. All those on the list were invited by email to complete an online survey. About 5% of the professionals went to the website and completed the questionnaire; some requested hard copies or electronic copies of the questionnaire which they completed and returned. Although the sample is biased towards professionals who have internet access and those who were willing to complete an online questionnaire, the sample represents a good cross-section (though not necessarily statistically representative sample) of South African health professionals and offers insights into their attitudes and opinions about emigration and other topics. In partnership with the Democratic Nursing Organisation of South Africa (DENOSA), SAMP also distributed the survey manually to a sample of nurses and received an additional 178 responses. Data on 1,702 health professionals was collected. The largest category of respondents was doctors (44%), followed by nurses (15%), dieticians/therapists (12%), psychologists (10%), pharmacists (7%) and dentists (5%). The sample was almost evenly split between males and females. About 70% of the respondents were white, followed by blacks (10%), Indians (6%) and Coloureds (3%). The pre-dominance of whites is primarily a historical legacy of the apartheid system which was racially biased in its selection of health trainees. About 57% of the sample came from the private sector, 23% from the public sector and 17% had employment in both sectors. Half the respondents were under 42 years of age. Just over 20% were in their first five years of service while 26% had twenty or more years of service. There was more variation within professions but, in general, the sample provided an extremely good mix of professionals at different stages of their career. The survey asked questions relating to (a) living in South Africa, (b) employment conditions and (c) attitudes about moving to another country. Each answer was evaluated against the set of basic demographic characteristics to see if there were important differences in response e.g. did health sector make a difference or did gender make a difference? The seven demographic characteristics analyzed were: sex, race, health sector, health profession, domicile, household income and years of service. The survey revealed the extreme dissatisfaction of many South African health professionals, a sentiment that cut across profession, race and gender. The profession is characterized not by a groundswell of discontent but a tidal wave of unhappiness and dissatisfaction with both economic and social conditions in the country. For example: With regard to general conditions in the country, there were very high levels of dissatisfaction with the HIV/AIDS situation (84% dissatisfied), the upkeep of public amenities (83%), family security (78%), personal safety (74%), prospects for their children’s future (73%) and the cost of living (45%). In only three categories were there fewer dissatisfied than satisfied professionals: availability of schooling (29% dissatisfied versus 46% satisfied), housing (30% versus 45%) and (perhaps unsurprisingly) medical facilities (19% versus 57%). In terms of working conditions, the most important source of dissatisfaction was taxation levels (58% dissatisfied, 14% satisfied) followed by fringe benefits (56% and 17%), then remuneration (53% and 22%), the availability of medical supplies (50% and 28%), workplace infrastructure (50% and 31%). prospects for professional advancement (41% and 30%) and work load (44% and 31%). Consistent with widespread concerns about safety, as many as a third were dissatisfied with the level of personal security in the workplace. Around a third of the respondents were dissatisfied with the level of risk of contracting a life-threatening disease in their work (35% versus 28% for HIV/AIDS; 32% versus 30% for TB and 37% versus 26% for Hepatitis B), an extraordinarily high percentage which is indicative of the conditions under which many work. On only two measures was there general satisfaction among the health professionals: collegial relations (76% satisfied, 5% dissatisfied) and the appropriateness of their training for the job (71% versus 14%). Variables with the greatest impact on satisfaction levels included profession and sector (public or private). Other variables (e.g. age, gender, race and years of experience) were not significant. The highest dissatisfaction levels expressed were as follows: for Workload: public sector employees, nurses and pharmacists; for Workplace Security: public sector, nurses, dentists and pharmacists; for Relationship with Management: public sector and nurses; for Infrastructure: public sector, nurses and black professionals; for Medical Supplies: public sector and public/private employees; for Morale in the Workplace: public and public/private sectors and nurses; for Risk of contracting TB: public sector; for Risk of contracting HIV/AIDS: nurses, doctors and dentists; for Risk of contracting HEP B: nurses and dentists; for Personal Safety: black professionals. Overall, public sector employees and nurses tend to have the highest levels of dissatisfaction. Income levels do significantly influence satisfaction levels on some broad issues including schooling for children, finding a house, cost of living and availability of products. In general, the higher the income the greater the percentage that are satisfied. Black professionals are more dissatisfied than others regarding finding a house (61%), schooling for children (52%) and accessing medical services for family/children (39%). Younger professionals are the most dissatisfied when it comes to finding a house (51%) and nurses have the highest percentage dissatisfied with the cost of living (62%). Comparing life in South Africa today with the situation before 1994, respondents were divided almost equally with 35% feeling it had improved, 31% that it was the same and 35% that it had deteriorated. Not surprisingly, race had a significant impact with over 50% of black, Coloured and Indian respondents feeling that life was better now than before. In sum, it is alarming that South Africa’s health professionals find satisfaction in little except their interaction with colleagues. While their views of living and working in South Africa are very negative, they hold very positive opinions about other places: When asked whether life would be better in a number of potential destination countries overseas, responses were overwhelmingly positive. Topping the list of where life would be better were Australia and New Zealand (77% better, 6% worse), followed by North America (77% better, 7% worse) and Europe (72% better, 10% worse). The Middle East was also rated highly, particularly by dentists and nurses. As many as a half the sample felt that their lives would be better there. There was little evident enthusiasm for the Southern African region with 69% of respondents thinking it would be worse to live there, and only 9% thinking it would be better. However, as many as 30% of black respondents said they would do better in other Southern African countries than in South Africa. Asia was viewed in a more positive light than the rest of Southern Africa. When asked where they would likely go if they left South Africa (their personal MLD or Most Likely Destination), most selected developed countries or regions. The most popular choices were Australia/New Zealand (33%), the United Kingdom (25%), Europe (10%), the United States (10%) and Canada (9%). The results were generally consistent across the demographic variables although the UK is a more likely destination for dentists (38%) and Europe a more likely destination for psychologists (17%). Only black health professionals rated a move to a SADC country (14%) about as likely as a move to a developed country such as Canada (12%) or the United States (21%). Respondents were asked to compare employment conditions in South Africa with those in their MLD. Five features were identified by over 60% of respondents as better in the MLD: workplace security (69%), remuneration (65%), fringe benefits (63%), infrastructure (63%) and medical supplies (61%). Other issues rated by about half as better in the MLD included workload and career and professional advancement. Only training preparation was rated as better in South Africa. Hence, there is a very general perception that most aspects of the work environment are better in the MLD than in South Africa. Many also listed existing push factors that would prompt them to seek employment overseas. Some 72% cited inadequate remuneration as a reason to emigrate. Next came workplace infrastructure (cited by 27%), educational opportunity (25%), professional advancement (23%), job security (22%) and workload (19%). How serious are South African health professionals about actually leaving the country? Almost half of the respondents have given it a great deal of consideration and only 14% have given it no consideration at all. Male health professionals have given emigration more serious consideration than females (53% v 41%); white professionals have given it marginally more serious consideration than black (45% v 41%), while both groups have given it less consideration than Indians and Coloured professionals. Professionals in the private sector have actually given it more consideration than those in the public sector (48% v 44%). And professionals under 30 have given it more consideration than their older counterparts (indeed, this measure of emigration potential declines with age). Type of profession is a clear differentiating variable: pharmacists (at 68%) have given emigration a great deal of consideration, followed by dentists (58%), physicians (48%) and nurses (46%). Place of residence and level of income make little difference. Indeed it would appear that rampant dissatisfaction is translating directly into a serious consideration of leaving for a large percentage of health professionals. Around half of the respondents (52%) said there was a high likelihood they would leave South Africa within the next five years. This includes 25% likely to move within two years and 8% within six months. About 14% of the respondents had already applied for work permits in other countries. Six percent had applied for permanent residence, 5% for citizenship and as many as 30% for professional registration overseas. Recruiters are often identified as the guilty party in the “poaching” of health professionals from developing countries and are clearly very active in South Africa. The survey showed that health professionals get most of their information about foreign job opportunities from recruiter advertisements in professional journals and newsletters. Health professional publications such as the South African Medical Journal and Nursing Update carry copious job advertisements, primarily from the UK, Australia and Canada. Many of these advertisements are placed by both local and international health recruitment agencies. Agencies also make direct contact with health professionals about employment opportunities in other countries. Nearly two in five (38%) had been personally approached, with greater than half of all doctors (53%) having been contacted. However, survey respondents minimized the role of recruitment agencies, saying their influence was marginal. Less than a quarter of respondents had actually attended recruitment meetings. Despite this, the role of such agencies should not be discounted as having an impact on emigration. The survey also provided insights into the phenomenon of return migration. A third of the sample had already worked in a foreign country and returned to South Africa. Are South African health professionals who have international experience more or less satisfied with their life and job than those who have no overseas experience? This is an important issue given the growing attention being paid internationally to encouraging “return migration.” Those who have lived and worked in foreign countries might have found that conditions are not as attractive as once imagined. Certainly, there is anecdotal evidence that some émigrés return to South Africa because their expectations are not met. On the other hand, returnees may be influenced to return by nostalgic images of South Africa that fail to reflect current realities. In such a case, those who return to the country may be even more dissatisfied with conditions and choose to emigrate once again. The main conclusions are as follows: The vast majority of return migrants were doctors (63% of the total and 50% of doctors in the sample). Very few nurses had worked outside the country (only 5% of the total and 11% of nurse respondents). While living and working conditions are a major driving force in emigration; they do not attract people back. People return for a variety of less tangible reasons including family, a desire to return “home”, missing the South African lifestyle, patriotism, wanting to make a difference, and the fact that the ‘grass is not as green’ as anticipated on the other side. Returnees are generally more satisfied with living and working conditions than those who have never worked in a foreign country. With regard to employment and working conditions, return migrants are less dissatisfied on virtually every measure. The difference is particularly marked with regard to prospects for professional advancement (35% of return migrants dissatisfied versus 58% of non-migrants), income levels (34% versus 59%) and taxation (32% versus 60%). When it comes to living conditions in South Africa, return migrants are more positive about some issues, especially the cost of living, finding suitable accommodation and schools, and medical services. But they are equally as negative about certain others, especially the HIV/AIDS situation in the country, personal and family safety, public amenities and their children’s future prospects. In other words, while experience overseas has softened some attitudes about many determinants of emigration, it has done little to affect opinions related to safety or perceived health risks, especially as it relates to HIV/AIDS. Return migrants are primed for re-emigration. Those who have returned to South Africa are just as likely to leave again as those who have never left. For example, 1 2% of return migrants said they would probably leave within 6 months (compared to 6% of non-migrants). About a quarter of each (27% and 25%) said they would probably leave within two years. And around half (53% and 51%) said they would probably leave within five years. Finally, the survey provided insights into the attitudes of health professionals towards government policy. The South African government has moved recently towards more proactive retention policies for the health sector. Despite this, there is considerable scepticism among health professionals that conditions will improve. The overwhelming majority (94%) disapproved of the way the government has performed its job in the health sector over the last year. The survey results reported in this paper demonstrate the intense dissatisfaction of health professionals with working and living conditions in the sector and the country. Emigration is set to continue and even accelerate. The possibility that the health professional shortfall will be met by health professionals currently being trained in South Africa is disproved by a recent SAMP survey which showed that the emigration potential of health sector students is greater than students in the non-health sector; 65% indicated they would emigrate within five years. The level of dissatisfaction in the sector is such that it may seem difficult for government to know where to begin. Certainly it could begin with itself. There can be few professions where practitioners are as unhappy with their government department. The reasons for this need to be addressed and confidence built or restored. The health department, in concert with its provincial counterparts, also needs to address workplace conditions identified by respondents as needing change. When it comes to other factors, family and personal safety and security are rated as reasons to leave. Unless and until the level of personal security improves, health professionals will continue to be attracted by countries that are perceived to be safer. The other policy option facing South Africa would be for the country to become a recruiter and net importer of health professionals itself. Here there is a very real dilemma. To date, the Department of Health has adopted a policy of not recruiting health professionals from developing, particularly other African, countries. The problem, as some critics have pointed out, is that if South Africa does not recruit them, someone else will. At least this way, it is argued, health professionals are not lost to the region or continent. The only way this would benefit other countries is if they had greater access to South African health care facilities in return. There are compelling reasons for South Africa to adopt a more open immigration policy towards the immigration of health professionals from parts of the world that are being actively recruited by developed countries. In May 2007, under its new quota system for immigrants, the government announced the availability of 34,825 work permits in 53 occupations experiencing labour shortages. Significantly, not a single health professional category is on the designated list. This is clearly not in the country’s best interests. There is a decided and growing shortage of health professionals. Morality may suggest that a no-immigration policy is the best one to pursue but no country uses morality as a basis for making immigration decisions and South Africa certainly is not applying such criteria to other sectors. A twin-pronged strategy is urgently needed: address the conditions at home that are prompting people to leave and adopt a more open immigration policy to those who would like to come

DISEASE-PREVENTION CLAIMS AND THE FIRST AMENDMENT: "WHO WILL PROTECT US FROM OUR PROTECTORS?"

The area of disease-prevention claims ("health claims") for food poses a broad spectrum of dilemmas that often arise in the food and drug law area and in other regulatory situations. These recurring questions include: How does an agency balance the public's right to information with the agency's desire to prevent consumer deception? Given an agency's broad mandate to protect public health, what type of consumer should it aim to protect with its limited resources? What should an agency do in the face of uncertainty? To what extent, and under what conditions, is informed choice desirable? How much of an agency's role is or should be educational? How should an agency balance consumers' need for information with the problem of information overload

No. 46: Voices from the Margins: Migrant Women’s Experiences in Southern Africa

The concept of the feminization of migration traditionally refers to the growth in numbers and relative importance of women’s migration, particularly from and within developing countries. In Africa, for example, the proportion of female migrants rose from 42% of the total in 1 960 to almost 50% at the present time. This process is a result, first, of the continued impoverishment and marginalization of many women in developing countries; and second, of the increasing demand for female labour in the service industries of industrial and industrializing countries. The United Nations suggests that the full implications of migration and mobility for women are difficult to assess, due to a dearth of data on women and migration. What also eludes official statistics is the extent to which women migrants are independent actors in migration decision- making. There remains a lack of understanding of women’s motives and experiences in the migration process, which is linked historically to the invisibility and marginalization of women as migrants. In Southern Africa, there is still a serious lack of gendered analysis of contemporary cross-border migration, and limited understanding of women’s experiences as migrants. Migration to South Africa in the twentieth century consisted of two main types: Immigrants, exclusively white until the mid-1980s, came primarily as “family class” migrants from Europe, with women accompanying their working spouses. Migrants, primarily black and male, were allowed temporary entry to South Africa under bilateral agreements with sending states (such as Botswana, Lesotho, Malawi, Mozambique and Swaziland). Although temporary migration was male-dominated, some women did accompany their spouses or left on their own for South Africa. Since 1990, the number of women migrants to South Africa has increased dramatically, although a recent SAMP survey shows that with the exception of Zimbabwe, temporary migration in the SADC is still male-dominated. Women have become far more mobile but may not be moving primarily as economic migrants who work or are looking for work. Gender roles tend to produce a more varied set of reasons for circular movements among women. Overall, female migrants are generally older and more educated than male migrants, and more likely to be married. Women migrants are motivated by a range of social, economic and reproductive factors, but are less likely to seek formal employment than males. They are more likely to travel for purposes of cross-border trade and are likely to stay for shorter periods and engage less with the formal economy or social networks. SAMP’s Migration and Gender Conference in 2002 determined that there was a need for more in-depth research with a specific focus on women’s migration experiences to complement statistical data. SAMP developed the Migrant Voices Project (MVP) in 2004 and, in 2005, conducted an in-depth, qualitative study with women migrants both temporarily and permanently living in South Africa, as well as with South African women who had returned to the country after migrating. Through these interviews, the MVP gathered qualitative information from women migrants on a range of issues including: migration decision- making, travel preparations, experiences while migrating, resulting in household and lifestyle changes, experiences of living in a foreign country, and treatment from family and community when returning to countries of origin. Beyond personal experiences, the MVP also explored women’s perceptions of the importance of migration in the Southern African Development Community (SADC) region, reasons for women’s migration in particular, awareness of policy, and gender-specific challenges encountered. Finally, SAMP aimed to glean policy recommendations from women migrants themselves, against a backdrop of the redrafting of immigration regulations in South Africa, and renewed uptake of the SADC Facilitation of Movement Protocol. The findings of the MVP are presented in considerable depth in this paper. They confirm some aspects of our previous understanding of why women migrate: for many, migration is a survival strategy driven primarily by household need. Migration also allows women the opportunity to work, to earn their own money and to exercise greater decision-making power in their daily lives. However, the MVP also challenged current understanding in a number of respects. Many of the migrant women interviewed are independent agents in migration decision-making, rather than deferring to male partners or parents, and have defied resistance from families and communities. Some challenge the idea that migration is motivated purely by economic and livelihood needs, instead valuing the fundamental experience of travel in itself, and the personal benefit of exposure to other cultures, languages and ideas. In terms of gendered migration experiences, many women feel male migrants are as vulnerable, if not more so than women, for a number of complex reasons. Although many travel to South Africa through irregular means, they place high value on the right of governments to control and manage migration, and wish to regularize their own status. And, though knowledge of migration policy and regulations differs, women articulated a number of key migration policy recommendations for the region. This publication, as well as drawing conclusions from women’s descriptions of their experiences as migrants, also provides a forum for the voices of women themselves to be heard. Providing a means for those voices to be heard by policy-makers and others in positions of power is always a challenge. SAMP’s Migration Policy Series is widely consulted by those who make the rules. By providing space for women to speak (through copious verbatim reproduction of their comments), SAMP anticipates that these voices will be heard and will affect the current policy debate. Migration conferences, workshops and forums are notable in Southern Africa for the absence of migrants themselves. SAMP hopes that this publication will prompt greater policy attention to the voices, needs and experiences of ordinary women

Alfalfa resistance to the potato leafhopper: deciphering the resistance mechanism and updating management guidelines

In 1997 several seed companies released alfalfa products that were marketed as resistant to the potato leafhopper, (Empoasca fabae Harris), the key pest of this crop in the Midwest and northeastern United States. The objectives of this research were to investigate the mechanism of insect resistance in leafhopper-resistant alfalfa and to determine if potato leafhopper-resistant alfalfa would require updated pest-management guidelines. It was determined that an antixenotic mechanism functioned at a plant or stem level, and without a choice, leafhoppers could feed as much on resistant alfalfa compared with susceptible alfalfa. Antixenosis was largely a function of insect behavior. The antixenotic mechanism detected in lab studies was not detected at the field-plot scale. The densities of potato leafhopper adults and nymphs were similar among plots of one susceptible alfalfa and four leafhopper-resistant alfalfas during three years of sampling. Cage studies were used to compare the potential for loss from potato leafhopper and leafhopper population growth potential on resistant and susceptible alfalfas. Resistant alfalfas had a lower potential for loss, compared with susceptible alfalfa, beginning with the second cutting of the seeding year. Moreover, similar numbers of potato leafhopper nymphs were produced on susceptible and resistant alfalfas. We used a stand tolerance concept to describe why these new alfalfas have a greater yield potential compared with susceptible alfalfa when the leafhopper number is high; the leafhopper population-damage-potential might be reduced if leafhoppers aggregate on a fraction of the stand. Stand tolerance implies the interplay of more than one resistance mechanism, but emphasizes the impact this tactic will have on pest management by raising the economic injury level. We calculated economic thresholds for both alfalfa types and found that the threshold was similar for both alfalfa types when the alfalfa was young. The threshold in susceptible alfalfa went from 8 adult leafhoppers, per 10 seeps during the seeding year up to 33 leafhoppers per 10 sweeps in subsequent years. The threshold in tolerant alfalfa went from 8 per 10 sweeps during the first cutting of the seeding year up to 80 per 10 sweeps in subsequent cuttings and years

The Implementation and Impact of the Teacher Evaluation Process On Special Educator Professional Growth in a Public Middle School

This mixed methods program evaluation examined teacher and administrator perceptions regarding fidelity of implementation of components of the teacher evaluation program with middle school special education teachers. These components include pre-conferences, observations, and post-conferences; summary evaluations; and professional development plans. Incorporating evidence from qualitative interviews with school-based administrators, qualitative focus groups with special education teachers, and a quantitative survey with special education teachers, this study found that fidelity of implementation of the components of teacher evaluation is impacted by evaluator capacity. Capacity is defined as both, time to engage in the components of teacher evaluation and professional knowledge of special education. The study found that school administrators want to engage fully in the evaluation process with fidelity but often believed they lack the time to do so. The study found that increased evaluator knowledge of teaching special education was warranted to enable evaluators to provide specific actionable feedback to special education teachers. Quality feedback is necessary as part of the evaluation process to facilitate professional growth. The findings of this study suggested actions school administrators can take at the school-based level, such as improving time management, increasing their own professional knowledge, and effective utilization of other professionals to assist with teacher feedback and professional development. This study suggested that improving the fidelity of implementation of the components that comprise teacher evaluation could result in professional growth of special education teachers, increased competence, and improved self-efficacy

No. 47: The Haemorrhage of Health Professionals From South Africa: Medical Opinions

The health sector has been especially hard hit by the brain drain from South Africa. Unless the push factors are successfully addressed, intense interest in emigration will continue to translate into departure for as long as demand exists abroad (and there is little sign of this letting up.) Health professional decision-making about leaving, staying or returning is poorly-understood and primarily anecdotal. To understand how push and pull factors interact in decision- making (and the mediating role of variables such as profession, race, class, age, gender income and experience), the opinions of health professionals themselves need to be sought. This paper reports the results of a survey of health professionals in South Africa conducted in 2005-6 by SAMP. Since there is no single reliable database for all practicing health professionals, SAMP used the 29,000 strong database of MEDpages. All those on the list were invited by email to complete an online survey. About 5% of the professionals went to the website and completed the questionnaire; some requested hard copies or electronic copies of the questionnaire which they completed and returned. Although the sample is biased towards professionals who have internet access and those who were willing to complete an online questionnaire, the sample represents a good cross-section (though not necessarily statistically representative sample) of South African health professionals and offers insights into their attitudes and opinions about emigration and other topics. In partnership with the Democratic Nursing Organisation of South Africa (DENOSA), SAMP also distributed the survey manually to a sample of nurses and received an additional 178 responses. Data on 1,702 health professionals was collected. The largest category of respondents was doctors (44%), followed by nurses (15%), dieticians/therapists (12%), psychologists (10%), pharmacists (7%) and dentists (5%). The sample was almost evenly split between males and females. About 70% of the respondents were white, followed by blacks (10%), Indians (6%) and Coloureds (3%). The pre-dominance of whites is primarily a historical legacy of the apartheid system which was racially biased in its selection of health trainees. About 57% of the sample came from the private sector, 23% from the public sector and 17% had employment in both sectors. Half the respondents were under 42 years of age. Just over 20% were in their first five years of service while 26% had twenty or more years of service. There was more variation within professions but, in general, the sample provided an extremely good mix of professionals at different stages of their career. The survey asked questions relating to (a) living in South Africa, (b) employment conditions and (c) attitudes about moving to another country. Each answer was evaluated against the set of basic demographic characteristics to see if there were important differences in response e.g. did health sector make a difference or did gender make a difference? The seven demographic characteristics analyzed were: sex, race, health sector, health profession, domicile, household income and years of service. The survey revealed the extreme dissatisfaction of many South African health professionals, a sentiment that cut across profession, race and gender. The profession is characterized not by a groundswell of discontent but a tidal wave of unhappiness and dissatisfaction with both economic and social conditions in the country. For example: With regard to general conditions in the country, there were very high levels of dissatisfaction with the HIV/AIDS situation (84% dissatisfied), the upkeep of public amenities (83%), family security (78%), personal safety (74%), prospects for their children’s future (73%) and the cost of living (45%). In only three categories were there fewer dissatisfied than satisfied professionals: availability of schooling (29% dissatisfied versus 46% satisfied), housing (30% versus 45%) and (perhaps unsurprisingly) medical facilities (19% versus 57%). In terms of working conditions, the most important source of dissatisfaction was taxation levels (58% dissatisfied, 14% satisfied) followed by fringe benefits (56% and 17%), then remuneration (53% and 22%), the availability of medical supplies (50% and 28%), workplace infrastructure (50% and 31%). prospects for professional advancement (41% and 30%) and work load (44% and 31%). Consistent with widespread concerns about safety, as many as a third were dissatisfied with the level of personal security in the workplace. Around a third of the respondents were dissatisfied with the level of risk of contracting a life-threatening disease in their work (35% versus 28% for HIV/AIDS; 32% versus 30% for TB and 37% versus 26% for Hepatitis B), an extraordinarily high percentage which is indicative of the conditions under which many work. On only two measures was there general satisfaction among the health professionals: collegial relations (76% satisfied, 5% dissatisfied) and the appropriateness of their training for the job (71% versus 14%). Variables with the greatest impact on satisfaction levels included profession and sector (public or private). Other variables (e.g. age, gender, race and years of experience) were not significant. The highest dissatisfaction levels expressed were as follows: for Workload: public sector employees, nurses and pharmacists; for Workplace Security: public sector, nurses, dentists and pharmacists; for Relationship with Management: public sector and nurses; for Infrastructure: public sector, nurses and black professionals; for Medical Supplies: public sector and public/private employees; for Morale in the Workplace: public and public/private sectors and nurses; for Risk of contracting TB: public sector; for Risk of contracting HIV/AIDS: nurses, doctors and dentists; for Risk of contracting HEP B: nurses and dentists; for Personal Safety: black professionals. Overall, public sector employees and nurses tend to have the highest levels of dissatisfaction. Income levels do significantly influence satisfaction levels on some broad issues including schooling for children, finding a house, cost of living and availability of products. In general, the higher the income the greater the percentage that are satisfied. Black professionals are more dissatisfied than others regarding finding a house (61%), schooling for children (52%) and accessing medical services for family/children (39%). Younger professionals are the most dissatisfied when it comes to finding a house (51%) and nurses have the highest percentage dissatisfied with the cost of living (62%). Comparing life in South Africa today with the situation before 1994, respondents were divided almost equally with 35% feeling it had improved, 31% that it was the same and 35% that it had deteriorated. Not surprisingly, race had a significant impact with over 50% of black, Coloured and Indian respondents feeling that life was better now than before. In sum, it is alarming that South Africa’s health professionals find satisfaction in little except their interaction with colleagues. While their views of living and working in South Africa are very negative, they hold very positive opinions about other places: When asked whether life would be better in a number of potential destination countries overseas, responses were overwhelmingly positive. Topping the list of where life would be better were Australia and New Zealand (77% better, 6% worse), followed by North America (77% better, 7% worse) and Europe (72% better, 10% worse). The Middle East was also rated highly, particularly by dentists and nurses. As many as a half the sample felt that their lives would be better there. There was little evident enthusiasm for the Southern African region with 69% of respondents thinking it would be worse to live there, and only 9% thinking it would be better. However, as many as 30% of black respondents said they would do better in other Southern African countries than in South Africa. Asia was viewed in a more positive light than the rest of Southern Africa. When asked where they would likely go if they left South Africa (their personal MLD or Most Likely Destination), most selected developed countries or regions. The most popular choices were Australia/New Zealand (33%), the United Kingdom (25%), Europe (10%), the United States (10%) and Canada (9%). The results were generally consistent across the demographic variables although the UK is a more likely destination for dentists (38%) and Europe a more likely destination for psychologists (17%). Only black health professionals rated a move to a SADC country (14%) about as likely as a move to a developed country such as Canada (12%) or the United States (21%). Respondents were asked to compare employment conditions in South Africa with those in their MLD. Five features were identified by over 60% of respondents as better in the MLD: workplace security (69%), remuneration (65%), fringe benefits (63%), infrastructure (63%) and medical supplies (61%). Other issues rated by about half as better in the MLD included workload and career and professional advancement. Only training preparation was rated as better in South Africa. Hence, there is a very general perception that most aspects of the work environment are better in the MLD than in South Africa. Many also listed existing push factors that would prompt them to seek employment overseas. Some 72% cited inadequate remuneration as a reason to emigrate. Next came workplace infrastructure (cited by 27%), educational opportunity (25%), professional advancement (23%), job security (22%) and workload (19%). How serious are South African health professionals about actually leaving the country? Almost half of the respondents have given it a great deal of consideration and only 14% have given it no consideration at all. Male health professionals have given emigration more serious consideration than females (53% v 41%); white professionals have given it marginally more serious consideration than black (45% v 41%), while both groups have given it less consideration than Indians and Coloured professionals. Professionals in the private sector have actually given it more consideration than those in the public sector (48% v 44%). And professionals under 30 have given it more consideration than their older counterparts (indeed, this measure of emigration potential declines with age). Type of profession is a clear differentiating variable: pharmacists (at 68%) have given emigration a great deal of consideration, followed by dentists (58%), physicians (48%) and nurses (46%). Place of residence and level of income make little difference. Indeed it would appear that rampant dissatisfaction is translating directly into a serious consideration of leaving for a large percentage of health professionals. Around half of the respondents (52%) said there was a high likelihood they would leave South Africa within the next five years. This includes 25% likely to move within two years and 8% within six months. About 14% of the respondents had already applied for work permits in other countries. Six percent had applied for permanent residence, 5% for citizenship and as many as 30% for professional registration overseas. Recruiters are often identified as the guilty party in the “poaching” of health professionals from developing countries and are clearly very active in South Africa. The survey showed that health professionals get most of their information about foreign job opportunities from recruiter advertisements in professional journals and newsletters. Health professional publications such as the South African Medical Journal and Nursing Update carry copious job advertisements, primarily from the UK, Australia and Canada. Many of these advertisements are placed by both local and international health recruitment agencies. Agencies also make direct contact with health professionals about employment opportunities in other countries. Nearly two in five (38%) had been personally approached, with greater than half of all doctors (53%) having been contacted. However, survey respondents minimized the role of recruitment agencies, saying their influence was marginal. Less than a quarter of respondents had actually attended recruitment meetings. Despite this, the role of such agencies should not be discounted as having an impact on emigration. The survey also provided insights into the phenomenon of return migration. A third of the sample had already worked in a foreign country and returned to South Africa. Are South African health professionals who have international experience more or less satisfied with their life and job than those who have no overseas experience? This is an important issue given the growing attention being paid internationally to encouraging “return migration.” Those who have lived and worked in foreign countries might have found that conditions are not as attractive as once imagined. Certainly, there is anecdotal evidence that some émigrés return to South Africa because their expectations are not met. On the other hand, returnees may be influenced to return by nostalgic images of South Africa that fail to reflect current realities. In such a case, those who return to the country may be even more dissatisfied with conditions and choose to emigrate once again. The main conclusions are as follows: The vast majority of return migrants were doctors (63% of the total and 50% of doctors in the sample). Very few nurses had worked outside the country (only 5% of the total and 11% of nurse respondents). While living and working conditions are a major driving force in emigration; they do not attract people back. People return for a variety of less tangible reasons including family, a desire to return “home”, missing the South African lifestyle, patriotism, wanting to make a difference, and the fact that the ‘grass is not as green’ as anticipated on the other side. Returnees are generally more satisfied with living and working conditions than those who have never worked in a foreign country. With regard to employment and working conditions, return migrants are less dissatisfied on virtually every measure. The difference is particularly marked with regard to prospects for professional advancement (35% of return migrants dissatisfied versus 58% of non-migrants), income levels (34% versus 59%) and taxation (32% versus 60%). When it comes to living conditions in South Africa, return migrants are more positive about some issues, especially the cost of living, finding suitable accommodation and schools, and medical services. But they are equally as negative about certain others, especially the HIV/AIDS situation in the country, personal and family safety, public amenities and their children’s future prospects. In other words, while experience overseas has softened some attitudes about many determinants of emigration, it has done little to affect opinions related to safety or perceived health risks, especially as it relates to HIV/AIDS. Return migrants are primed for re-emigration. Those who have returned to South Africa are just as likely to leave again as those who have never left. For example, 1 2% of return migrants said they would probably leave within 6 months (compared to 6% of non-migrants). About a quarter of each (27% and 25%) said they would probably leave within two years. And around half (53% and 51%) said they would probably leave within five years. Finally, the survey provided insights into the attitudes of health professionals towards government policy. The South African government has moved recently towards more proactive retention policies for the health sector. Despite this, there is considerable scepticism among health professionals that conditions will improve. The overwhelming majority (94%) disapproved of the way the government has performed its job in the health sector over the last year. The survey results reported in this paper demonstrate the intense dissatisfaction of health professionals with working and living conditions in the sector and the country. Emigration is set to continue and even accelerate. The possibility that the health professional shortfall will be met by health professionals currently being trained in South Africa is disproved by a recent SAMP survey which showed that the emigration potential of health sector students is greater than students in the non-health sector; 65% indicated they would emigrate within five years. The level of dissatisfaction in the sector is such that it may seem difficult for government to know where to begin. Certainly it could begin with itself. There can be few professions where practitioners are as unhappy with their government department. The reasons for this need to be addressed and confidence built or restored. The health department, in concert with its provincial counterparts, also needs to address workplace conditions identified by respondents as needing change. When it comes to other factors, family and personal safety and security are rated as reasons to leave. Unless and until the level of personal security improves, health professionals will continue to be attracted by countries that are perceived to be safer. The other policy option facing South Africa would be for the country to become a recruiter and net importer of health professionals itself. Here there is a very real dilemma. To date, the Department of Health has adopted a policy of not recruiting health professionals from developing, particularly other African, countries. The problem, as some critics have pointed out, is that if South Africa does not recruit them, someone else will. At least this way, it is argued, health professionals are not lost to the region or continent. The only way this would benefit other countries is if they had greater access to South African health care facilities in return. There are compelling reasons for South Africa to adopt a more open immigration policy towards the immigration of health professionals from parts of the world that are being actively recruited by developed countries. In May 2007, under its new quota system for immigrants, the government announced the availability of 34,825 work permits in 53 occupations experiencing labour shortages. Significantly, not a single health professional category is on the designated list. This is clearly not in the country’s best interests. There is a decided and growing shortage of health professionals. Morality may suggest that a no-immigration policy is the best one to pursue but no country uses morality as a basis for making immigration decisions and South Africa certainly is not applying such criteria to other sectors. A twin-pronged strategy is urgently needed: address the conditions at home that are prompting people to leave and adopt a more open immigration policy to those who would like to come

Engaging Students with Disabilities in Virtual Learning

This professional learning module was designed to help teachers of students with disabilities (SWDs) who are navigating the issues related to virtual learning. The authors have experience in being teachers of SWDs, administrators, and lead teachers. We witnessed the struggles teachers had during the pandemic in engaging SWDs and their parents in virtual learning. This module was designed to help teachers alleviate some of those struggles. Districts might find it beneficial to use this PLM in training all teachers about engaging SWDs virtually as the world of education is leaning in the direction of blended learning, virtual academies, and traditional face to face learning. View professional learning module.https://digitalcommons.gardner-webb.edu/improve/1027/thumbnail.jp