Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly in sub-Saharan Africa. As nurses form the backbone of healthcare systems in many of the affected countries, accelerating migration of nurses is most critical. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality.
Human Resources
The exodus of health professionals from sub-Saharan Africa: Balancing human rights and societal needs in the 21st century
Ogilvie L, Mill JE, Astle B, et al: Nursing Inquiry 14(2): 114–124, 2007
The exodus of health professionals from sub-Saharan Africa: balancing human rights and societal needs in the twenty-first century
Ogilvie L, Mill JE, Astle B, Fanning A, Opare M: Nursing Inquiry 14 (2): 114-124, June 2007
Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly those in sub-Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub-Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.
The experience of health workers in Tanzania’s primary healthcare services
Human Resources for Health ; Via Eldis
This article from Human Resources for Health outlines the findings of a report on motivation among primary healthcare workers in Tanzania. Despite widespread access to primary healthcare facilities in rural and urban Tanzania there is considerable bypassing of the service. This research looked at the experience of those working in this field to assess how their working conditions could be improved, which would in turn improve the quality of the service for users.
The financial cost of doctors emigrating from sub-Saharan Africa: Human capital analysis
Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M et al: British Medical Journal, 24 November 2011
The objective of this study was to estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Researchers calculated the financial cost of educating a doctor in nine source countries with a high HIV and AIDS burden (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), which ranged from US $21,000 in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn, with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). They conclude that destination countries should consider investing in measurable training for source countries and strengthening of their health systems.
The financial cost of doctors emigrating from sub-Saharan Africa: Human capital analysis
Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, Au-Yeung CG et al: British Medical Journal, 24 November 2011
The aim of this study was to estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Researchers included nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. In the nine source countries the estimated government subsidised cost of a doctor’s education ranged from US$21 000 in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn, with costs for each country ranging from $2.16m for Malawi to $1.41bn for South Africa. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Destination countries should consider investing in measurable training for source countries and strengthening of their health systems, the authors conclude.
The first world's ROLE IN THE THIRD WORLD BRAIN DRAIN
We in the third world are rarely willing to admit to our "third worldliness." We aspire to first world standards, and the things we want more than anything else are hotels of international standard, a well reputed university, and, in particular, good medical and nursing schools. We are greatly gratified by the recognition of our graduates as being of international standard - "Our doctors and nurses are as good as any others" - but there are difficulties with this. As soon as a country produces graduates of an acceptable international standard then it is "fishing in the same pond" as first world countries for their services. It is inevitable that doctors and nurses will be attracted to countries where salaries or working conditions are seen as better, says this article in the British Medical Journal.
The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts
Witter S; Namakula J; Wurie H; et al.: Health Policy and Planning 32(Suppl 5) v52–v62 2017
The authors examine the experiences of health workers through a gender lens, especially in fragile and post-conflict states. In these contexts, there may not only be opportunities to (re)shape occupational norms and responsibilities in the light of challenges in the health workforce, but also threats that put pressure on resources and undermine gender balance, diversity and gender responsive human resources for health (HRH). The authors used a mixed method for research in Sierra Leone, Zimbabwe, northern Uganda and Cambodia to understand how gender influences the health workforce. They applied a gender analysis framework to explore access to resources, occupations, values, and decision-making and draw largely on life histories with male and female health workers to explore their lived experiences, complemented by surveys, document reviews, key informant interviews, human resource data and stakeholder mapping. The findings shed light on patterns of employment: in all contexts women predominate in nursing and midwifery cadres, are under-represented in management positions and are clustered in lower paying positions. Gendered power relations shaped by caring responsibilities at the household level affect attitudes to rural deployment and women in all contexts face challenges in accessing both pre- and in-service training. Coping strategies within conflict emerged as a key theme, with experiences shaped by gender, poverty and household structure. Most health worker regulatory frameworks did not sufficiently address gender concerns. The authors argue that unless these are proactively addressed post-crisis, health workforces will remain too few, poorly distributed and unable to meet the health needs of vulnerable populations. Practical steps need to be taken to identify gender barriers proactively and engage staff and communities on best approaches for change.
The global migration of nurses: importing skills, exporting shortages
id21health
Research by the World Health Organisation explores the international migration of nurses and the implications for five countries: Australia, Ireland, Norway, the UK and the USA. The flow of nurses to these countries has risen during the 1990s, and, in some cases, recruitment is from developing countries. In this article the researchers propose a number of policy options to manage nurse migration and make a number of recommendations for improving workforce data systems.
The great brain drain discussion
Some possible solutions to the brain drain include a greater investment in more research and policy study about the causes of the drain, educating policy makers about the causes, and a rethink of the nursing profession in relation to compensation. This is according to notes that summarize a 41-message discussion on the brain drain of health professionals from developing to developed countries. The discussion took place on the listserv HIF-net at WHO.
Further details: /newsletter/id/30119
The health professions and the performance of future health systems in low-income countries: Support or obstacle?
Dussault G: Social Science and Medicine 66(10):2088-95, May 2008
This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources and responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. A ‘social contract’ - granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services - may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their roles.