International medical migration: A critical conceptual review of the global movements of doctors and nurses

Abstract

Background A critical appraisal of the discourse describing international medical migration around the turn of the 21 st century. Method A critical narrative review of a range of sources including grey literature, books, commentary and research reports, to trace the development and spread of specific causative models. English-language literature focussed on the Anglophone world. Findings The attribution of causative relations between the density of skilled medical workers (assumed to be linked with their migration), the provision of healthcare and population health outcomes illustrates how the global reach of biomedicine has to be understood in the context of local conditions. The need to understand migration as an aspect of uneven global development rather than a delimited issue of manpower services management is illustrated with reference to debates about 'brain-drain' of sub-Saharan Africa's healthcare professionals, task-shifting and the crisis in healthcare human resources. The widespread presumed cause of shortages of skilled healthcare staff in sub-Saharan Africa were over-determined by a compelling narrative of rich countries stealing poor countries' trained healthcare professionals. This narrative promotes medical professional interests and ignores historical patterns of underinvestment in healthcare systems and structures. Sociological theories of medicalization suggest that the international marketization of medical recruitment is a key site where the uneven global development of capital is at work. A radical reconfiguration of medical staffing along the lines of 'task-shifting' in rich and poor countries' healthcare systems alike offers one means of thinking about global equity in access to quality care.

Recursos Humanos Para a Economia Do Conhecimento Na Ótica Da Teoria Do Capital Humano

“…Esse fato está inserido nas melhores condições que os países desenvolvidos podem oferecer (BRADBY, 2014), o que estimula países em desenvolvimento a estabelecer políticas de retenção de seus profissionais qualificados (AISA; CABEZA; LARRAMONA, 2014).…”

Stemming the Medical Brain Drain: A Personal Perspective on a Global Problem

“…In addition, receiving countries have also attempted to implement ethical recruitment policies, for example, by sending compensatory payments to countries that have trained a significant portion of the destination country's healthcare staff (Bradby, 2014). But these policy changes have largely been ineffective.…”

“…But even with all the discussion of policy and politics, a more fundamental point was emerging from our discussion-in order for developing countries to advance, they need to import ideas from the outside, because "alongside the amplification of migration is the mobility of capital, ideas and technology" (Bradby, 2014). And my mother firmly believes that volunteer efforts, born out of a sense of loyalty to the country of one's birth, will provide the vehicle for healthcare in Bangladesh to move forward, little by little.…”

“…Although such concrete issues are often blamed when examining the issue of brain drain, conceptualizing the problem on an individual level is an important step in addressing it. For example, Hannah Bradby notes that (Bradby, 2014).…”

Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel – Ethical and Systems Perspectives

“…An ethical perspective or lens, pointing to the need for an ethical response to the global inequities in health personnel distribution, was central to the WHO 2006 World Report 8,10 ; and is found in sociological analyses that suggest that recruitment and migration demonstrate that "the uneven global development of capital is at work. " 19 Aluttis et al, 6 discussing the consequences of market approaches, reported that there was an increase from approximately 40 to 270 companies engaged in international nurse recruitment in the United States between the late 1990s and mid-2000s. This and Zubaran's paper 9 contrast the ethical principle of autonomy -reflected in Article 3.4 of the Code: "Nothing in this Code should be interpreted as limiting the freedom of personnel … to migrate" 1 -with the principle of distributive justice (promoting equity) and social accountability.…”