Migration of Health Workers in the Pacific Islands

Abstract

Human resources for health (HRH) are a crucial component of a well-functioning health system. Problems in the global HRH supply and distribution are an obstacle to achieving the health-related Millennium Development Goals and other health outcomes. The Pacific Island region, covering 20,000 to 30,000 islands in the South Pacific Ocean, is suffering a serious HRH crisis. Yet updated evidence and data are not available for the 22 Pacific Island Countries and Territories. The objective of this study was thus to explore the current HRH situation in the Pacific Island region, focusing particularly on the issue of health workforce migration. HRH trends and gaps differ by country, with some showing increases in HRH density over the past 20 years whereas others have made negligible progress. Currently, three Pacific Island countries are facing critical HRH shortages, a worsening of the situation from 2006, when HRH issues were first brought to widespread global attention. In this region, skilled personnel migration is a major issue contributing to the limited availability of HRH. Political commitment from source and destination countries to strengthen HRH would be a key factor toward increasing efforts to train new health personnel and to implement effective retention strategies.

Barriers to Adequate Prenatal Care Utilization in American Samoa

“…American Samoa, like many other developing populations, particularly island populations, experiences issues with its healthcare infrastructure: interruptions in service based on supply of medications or power [21], a lack of qualified healthcare professionals, which is a particular issue in the Pacific Islands [21,9], and problems with central location of their main healthcare facilities when large proportions of the population live in remote areas [22]. A common theme relating to this among the qualitative interviews was lack of car ownership and the need to rely on buses: “I couldn’t come because of the transportation, you know the buses.…”

“…Fifty-eight percent of families have incomes below the U.S. poverty level [7]. American Samoa faces very similar issues with provision of healthcare as other low-middle income island populations, particularly other Pacific island nations, who face unique issues of healthcare supply and demand, consistency of service provision and outward migration of healthcare professionals [8,9]. As such, American Samoa is considered both a medically underserved area and a healthcare professional shortage area [10].…”

Wave Upon Wave

“…14 However, emigration of health professionals following the 1987 and 2000 coups hampered efforts to create a pool of skilled health managers to support the decentralized health structure. 19…”

“…14 However, emigration of health professionals following the 1987 and 2000 coups hampered efforts to create a pool of skilled health managers to support the decentralized health structure. 19 Despite the setbacks, the reforms succeeded in consolidating clinical services under one umbrella, allowing for standardization of health services across the divisions. Within divisions, strengthening of clinical services resulted in subdivisional hospitals being equipped with resources to handle higher levels of clinical services before needing to refer to divisional hospitals.…”

Progress in Island Health in the Asia-Pacific Region

“…Health workers often migrate to larger centers leaving gaps in the provision of services. 4 As noted by Prof Patrick above, it is the smaller Pacific island states that will face the greatest challenges in delivering public health and medical services to modern standards.…”