Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges

Abstract

It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills.The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed.The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.

The national and international implications of a decade of doctor migration in the Irish context

“…Neither registration nor immigration data are collated primarily for medical workforce planning purposes. However, as in other countries, these have been used here as the principal sources of migration data [44] in the absence of data that track workforce movements within and outside of the jurisdiction. This is not uncommon and it has been noted that 'no European country can provide an accurate, complete and up-to-date information on all international stocks and flows of health professionals' [1].…”

“…This is not uncommon and it has been noted that 'no European country can provide an accurate, complete and up-to-date information on all international stocks and flows of health professionals' [1]. The principal sources of migration data include professional registers and immigration data [44]. Although each data source has limitations, it is possible by combining data sources to provide somewhat stronger evidence of doctor migration to Ireland.…”

Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges

“…For example, nearly 500 doctors and more than 1,000 nurses from South Africa register annually with the United Kingdom General Medical Council. 34 Kenya has lost 4,000 nurses to the UK and US; in Zimbabwe, only 360 of 1,200 doctors trained during the 1990s were still practising in their country in 2000, 25 and so on. While the traditional flow out of countries has been of doctors, the recruitment of nurses has now overtaken that of doctors.…”

“…While the traditional flow out of countries has been of doctors, the recruitment of nurses has now overtaken that of doctors. 34 Vacancy rates in some countries, despite inadequate staff establishments, are extremely high, of the order of 30-40% of public sector posts for professional staff. 25,29 Even Botswana, a middleincome country able to attract professionals from other countries, is only able to fill 78% of doctor posts and 81% of nursing posts.…”

Globalization and Health

“…Nonetheless, the opportunity to secure better working conditions, salaries, and quality of life has been important. (Stilwell, Diallo, Zurn, Dal Poz, Adams, & Buchan, 2003). Similarly, more than 500 nurses left Ghana in 2000-more than twice the number graduating from nursing programs that year .…”