Briefing of HRH experts in the WHO African Region, Ouidah, Bénin, 8-11 April 2003
Understanding and influencing
the international migration of
health workers
Outline
• The health care workforce in the global
context
• Why is the migration of health care
professionals a concern?
• Factors Driving Migration
• Policy Options to Manage Migration
• Moving Forward
Barbara Stilwell
World Health Organization
AcademyHealth Scientific Session
International Migration of Health Workers
San Diego June 66-8 2004
World Health Organization
Geneva
• Migration flows are likely to increase in the future
• Labour markets are becoming globalized
• FreeFree-trade agreements and GATS, for example, are
•
Total migration compared to physicians, nurses and all
professionals
removing barriers to labour flows between countries
Training programs in many developing countries are of
high quality and are similar to those in developed
countries
In the global labour market, some countries are large
importers, others are large exporters
1000
Total
Physician
All prof.
Nurses
100
10
1
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
•
Proportion of professionals
UK
Number (thousands)
The health care workforce in the global
context
Years
World Health Organization
Geneva
World Health Organization
Geneva
Proportion of professionals
US
Migration Flows 1
Immigrants to the United States 1992 to 2000
• Changing patterns – less
Annual Migration of Nurses out of the
Philippines to Various Countries
1000000
Number
100000
All Immigrants
Country
All Health
Professionals
Physicians
Saudi Arabia
All Occupations
10000
UAE
1992
1993
1994
1995
1996
1997
1998
1999
2000
2002
3,279
3,794
5,083
0
63
3,633
271
209
367
269
175
349
1,796
11
295
Kuwait
320
25
104
TOTAL
6,078
5,245
10,627
Libya
USA
1000
1997
(to October
UK
Nurses
1992
•
to US, more to Saudi
Arabia and UK
Only 22 nurses migrated
from Saudi Arabia to the
UK in 2002 – 'carousel'?
Year
Source: Statistical Yearbook of the Immigration and Naturalization
Service 2001; Bureau of Citizenship and Immigration Services
World Health Organization
Geneva
Pascal Zurn
World Health Organization, Geneva
Source: Department of Labour and Employment, Manila, Philippines
World Health Organization
Geneva
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Briefing of HRH experts in the WHO African Region, Ouidah, Bénin, 8-11 April 2003
Why is the migration of health care
professionals of concern?
Migration Flows 2
Source
Country
Number
Physicians
Number
Nurses
In Portugal In source In Portugal In source
country
country
Angola
820
961
Guinea
Bissau
358
197
Sao Tomé
Tomé
238
Cap Verdé
Verdé
231
383
• Developed countries are increasingly relying on
14288
253
1299
67
84
183
71
40
232
• However, most of the AngolaAngola-born and Cape VerdeVerde-born physicians in
Portugal completed medical school in Portugal
World Health Organization
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Impact in source countries
• Though actual numbers of migrants are
small, the problem is exacerbated by other
factors in developing countries:
– stocks and flows into the workforce are small
– weak health systems, with poor capacity to
expand
– the rising death toll among health professionals
– weak economies, so that the decision to migrate
comes sooner
•
•
•
migrant health care professionals to cope with
domestic shortages
Less developed countries are now the main
source of migrant health care professionals
Outflow of health care professionals is believed
to affect adversely the health care system in
several of these developing countries
Member countries are seeking solutions from
WHO
World Health Organization
Geneva
Factors Driving Migration
• How many health care professionals are
governments willing to accept into their country?
⇒ desire to accept migrants
• How many health care professionals are willing
to leave their home country and to move
abroad?
⇒
desire to migrate
World Health Organization
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Factors Driving Migration
• Desire to Accept Migrants
•
– Domestic shortages of health care professionals
– Insufficient training capacity to produce enough
health care professionals domestically
– High quality training programs in developed countries
Desire to Migrate
– Wages and working conditions better abroad
– Opportunities for career advancement
– Improved living conditions
– Send remittances back home - 'transnational
corporations of kin'
World Health Organization
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Pascal Zurn
World Health Organization, Geneva
World Health Organization
Geneva
Factors affecting the motivation of
health workers in five African countries
Better management of
health services
Continuing education,
training
Zimbabwe
Uganda
South africa
Ghana
Conducive w orking
environment
Cameroun
Better/realistic
remuneration
0
10
20
30
40
50
60
70
80
90
Percentage
Source: Awases M, Gbary A, Nyoni J. and Chatora R, Migration of health professionals in six
countries: Report, Brazzaville, WHO Regional Office For Africa, 2002.
World Health Organization
Geneva
Page 2
Briefing of HRH experts in the WHO African Region, Ouidah, Bénin, 8-11 April 2003
Remittances
Workers’ remittances received by developing
countries by region 1999 - 2002
Sub-Saharan Africa
South Asia
Middle East and North
Africa
2002
2001
2000
1999
Latin America and the
Caribbean
Policy Options to Manage Migration
• Migration can not be stopped
• It is often a symptom of much wider labour
market conditions that need to be taken into
consideration:
• working conditions may be poor in the health
sector
• there may be unemployment and therefore it is
Central Asia
difficult to find a job
East Asia and Pacific
0
10
20
30
Remittances (billions of dollars)
• part time work may not be available
• there may be a mismatch of skills
World Health Organization
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World Health Organization
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Policy Options to Manage Migration
Moving Forward
• To manage migration, countries might:
• Migration resolution requests WHO to:
– Encourage temporary stays
– Restrict immigration from atat-risk countries
• e.g.. Commonwealth Agreement on Ethical
Recruitment
– Facilitate return migration, harness the diaspora
– Use bilateral agreements to manage migration
– Encourage ethical recruitment practices
– Train new types of providers that meet local needs
– Bond new graduates
World Health Organization
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Pascal Zurn
World Health Organization, Geneva
• Monitor movement of health workforce through improved
information systems
• Research impact of trade agreements
• Support Member States in improving planning mechanisms
• Develop a Code of Practice
• Facilitate dialogue between countries to explore modalities
for source countries to offset lost investment
• Ensure that all programmes pay attention to HR
strengthening
• Declare World Health Day 2006 as Human Resources for
Health Development
• Include human resources as a top priority area in the POW
World Health Organization
Geneva
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