Human Resources

This paper highlights and discusses changing patterns of outward migration of Zambian nurses in the light of policy developments in Zambia and in receiving countries. Prior to 2000, South Africa was the most important destination for Zambian registered nurses. In 2000, new destination countries, such as the United Kingdom, became available, resulting in a substantial increase in migration from Zambia. This was attributed to a policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering Voluntary Separation Packages: early retirement lump-sum payments promoted by the government, which nurses used towards migration costs. The dramatic decline in migration to the United Kingdom since 2004 was reported to be most likely due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses were also noted now to be leaving Zambia for other destination countries. This paper argues that the focus of any migration strategy should be on how to retain a motivated workforce through improving working conditions and policy initiatives to encourage nurses to stay within the public sector.

This policy brief notes that a significant share of health worker migration is occurring between Organization for Economic Co-operation and Development (OECD) countries, even though the bulk of migration flows is originating from developing and emerging countries. Countries with expatriation rates of doctors above 50% (which means that there are as many doctors born in these countries working in the OECD countries as there are working in their home country) include five African countries: Mozambique, Angola, Sierra Leone, Tanzania and Liberia. The brief found that the needs for health workers in developing countries, as estimated by the World Health Organization (WHO), largely outstrip the numbers of immigrant health workers from those countries working in OECD countries. In 2000, all African-born doctors and nurses working in the OECD represented no more than 12% of the total shortage for the region, as estimated by WHO. The brief argues that international migration is neither the main cause of healthcare shortages in developing countries, nor would its reduction be enough to address to the worldwide health human resources crisis. It recommends that receiving countries should expand education and training capacity to reduce dependency on foreign health personnel to fill domestic needs.

The WHO Secretariat has redrafted the code of practice in order to take into account, as requested, the views and comments expressed by members of the Board in January 2009 and the outcome of the subsequent sessions of the regional committees. Two core themes identified by the regional committees and incorporated in the revised draft code were that member states should strive to achieve a balance between the rights, obligations and expectations of source countries, destination countries and migrant health personnel, and that international health worker migration should have a net positive impact on the health system of developing countries and countries with economies in transition. The revised draft text emphasises that international health personnel should be recruited in a way that seeks to prevent a drain on valuable human resources for health. It also recommends that countries should abstain from active international recruitment of health personnel unless equitable bilateral, regional, or multilateral agreement(s) exist to support such recruitment activities.

The paper reports on a survey of recently arrived international nurses working in London, to assess their demographic profile, motivations, experiences and career plans. The Philippines, Nigeria and South Africa were the three most commonly reported countries of training (in total, more than 30 countries of training were reported). Sixty per cent of the nurses from sub-Saharan Africa and more than 40% from South Africa and India/Pakistan/Mauritius were aged 40 or older; the youngest age profile was reported by the Australia/New Zealand/USA nurses.