| Summary: | South Africa is facing a severe shortage of medical doctors and has a government that is sceptical of reliance of foreign skills known as skilled immigration. The government and the national Department of Health (DoH) have implemented a variety of intervention measures in order to alleviate the negative impact of this shortage caused by medical skills shortage in the sector. However, the DoH's reluctance to recruit foreign medical doctors, and particularly its prohibition on the recruitment of doctors from South Africa's neighbouring countries, undermines the government's effort to increase the number of doctors in the health system. Skilled immigration, the importation of scarce skills from outside the country, made little progress with the enactment of the Immigration Act 13 of 2002. The priority of South Africa's immigration policy is still focused on controlling skilled immigration, as is underlined by its protectionism and restrictiveness. The Department of Home Affairs' (DHA) immigration policy and its counterproductive approach to attracting skilled foreign labour has drawn criticism from a wide range of people including academics, politicians and businesspeople. The DHA itself has in its white papers of 1999 and of 2017 admitted that its inflexible approach to immigration has resulted in the country's failure to attract skilled foreign workers. In this study, I use archived parliamentary meeting minutes and parliamentary documents as the primary data source to understand the deliberations of stakeholders on skilled immigration which resulted in the Immigration Act 13 of 2002. The Act had a direct effect on the DoH's approach to the recruitment of foreign medical doctors. More specifically, this dissertation aims to explore how stakeholders who were involved in the drafting process of the Immigration Act 13 of 2002 deliberated on the existing cultural and structural conditions that resulted in the Immigration Bill which preceded the Act. By exploring the changes in the immigration policy, the dissertation aims to understand the impact of the immigration policy and institutional xenophobia on the recruitment of foreign doctors. Margaret Archer's (1995) morphogenetic/morphostatic cycle is used to understand the development of South Africa's immigration policy from 2000 to 2006 as this was the period in which the discussion of the Immigration Bill started. I argue that institutional xenophobia which is manifested in South Africans' antagonism towards foreign nationals, the deeply-entrenched employment equity policy that promotes national workers, the weakened state of the civil society, and the consolidated power of the government in decision-making all contributed to the DoH's decision to restrict the recruitment of foreign medical doctors. In the absence of government's support, it is unlikely that there will be a conducive environment to put in place a skilled immigration policy that can harness skilled foreigners' skills and facilitate skilled foreigners' entry. This dissertation suggests that the government critically review its immigration policy which is deepening South Africa's skills gap in the medical field. This dissertation further recommends the government to consider the option of allowing foreign doctors to work in the private sector. This would not only increase the overall number of doctors in the health sector, it would also dispel the public's concern that the employment of foreign doctors would cost a hefty amount at the expense of the public.
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