4 THE CARIBBEAN REGION AND MIGRATION Over the past 4 decades, the Caribbeanregion has lost more than 5 million people tomigrationThe net migration rate in the Caribbean region isone of the highest in the world with great variation within the regionJamaica, Guyana, St. Lucia and Suriname have shown the greatest losses to international migration.Data from United Nations Population Division, 2003
5 THE CARIBBEAN REGION AND MIGRATION Dynamics: WorkforceMigration is international, intraregional, and into the regionOther Dynamics:Human trafficking of women and childrenReturn of deportees
6 MIGRATION IN THE CARIBBEAN REGION International Migration: Workforce and Brain DrainMigration to the US, Canada and the UKSkilled migration rates from the Caribbean region are some of the highest in the world (IADB, 2006)
7 MIGRATION IN THE CARIBBEAN REGION International Migration: Workforce and Brain drainMore than 60% of highly-skilled or tertiary-educated migratingMore than 30% of secondary-educated migratingJamaica, Guyana, Grenada, Haiti, more than 80% of tertiary-educated skilled labour migrating with increased migration to the United States
8 MIGRATION IN THE CARIBBEAN REGION Reasons for migration to the United States: WorkforceProximity to the CaribbeanWages and increased earning capacityCommon language for English-speaking islandsSocial and family networks resident in the United StatesFavourable immigration policies for skilled labour such as nurses, physicians, teachers and other professionals
9 MIGRATION IN THE CARIBBEAN REGION There are positive impacts of international migrationand some of these include:Return or transfer of knowledge, for example the strengthening of health and education facilities through partnerships and contribute to country level developmentRemittances and economic investments although the data for the health professions is not known.
10 MIGRATION IN THE CARIBBEAN REGION Negative impacts of international migration include:Loss of human capitalReduced productivityLoss of financial investments borne by countriesThese are critical issues for some of the countries in theregion that are undergoing public sector and healthsector reforms.
11 MIGRATION IN THE CARIBBEAN REGION Intraregional migration in the Caribbean: WorkforceThe Caribbean Single Market and Economy (CSME)was established in 1989 by the Heads of Government ofCARICOM through the Grand Anse Declaration
12 MIGRATION IN THE CARIBBEAN REGION Intraregional migration in the Caribbean: WorkforceMajor goals of CSME are to deepen the integrationprocess and to strengthen the Caribbean community in all its dimensionsFacilitate the free movement of labour and abolish needs for work permits for workforce from CSME participating countries.This represents the move towards a common policy agenda for migration at the intra-regional level
13 MIGRATION IN THE CARIBBEAN REGION Migration and the Health Workforce
14 MIGRATION IN THE CARIBBEAN REGION Health today is complex and needs a public health and population approachCritical needs to address include the capacity to use trans-sectoral approaches to:-measure needs-manage, plan and evaluate-conduct research and development-strengthen information systems-develop health, education and social programs
15 MIGRATION AND BRAIN DRAIN IN THE CARIBBEAN REGION: DATA AND EVIDENCE Lack of data and evidence-base for country and regional level policy development for migration especially as this relates to the health workforceDifficult to move towards policy when the evidence base regarding the health workforce is questionable.
16 MIGRATION AND BRAIN DRAIN IN THE CARIBBEAN REGION: DATA AND EVIDENCE Trans-sectoral approaches needed to gather evidence that must involve the inclusion of labour, trade, education, health and social developmentImportant to share data because governments will find it easier to design, monitor and evaluate the impact of migration policiesNeed to have policies in place to protect personal information to balance the need to share information
17 MIGRATION IN THE CARIBBEAN REGION Migration in the Caribbean region is an important issue for the health sector since labour market needs for this sector are aligned to the skills of the secondary and tertiary educated workforce.
18 THE CONTEXT: THE MIGRATION DISCUSSION IS OCCURING IN PARALLEL WITH HIGHLY VISIBLE EVENTS “These examples illustrate theenormous richness and diversityof the workforce needed to tacklespecific health problems”World Health Report, 2006
19 MIGRATION IN THE CARIBBEAN REGION Migration and the Health WorkforceHistorical regional migration and a shared sense of regional integrationCSME has enhanced the migration or free movement of qualified professionals and skills within the region by liberalizing conditions of access to markets and skills within the regionJuly 2006: Extension of the free movement agreement to include nurses among other professionals
20 Health Workforce in the Caribbean NursesPhysicianDentistAnguilla31.391.3Antigua and Barbuda184.108.40.206Bahamas23.816.72.5Barbados220.127.116.11Belize12.310.2Cayman5321.53.9Dominica18.104.22.168Grenada22.214.171.124Guyana126.96.36.199Jamaica188.8.131.52Montserrat184.108.40.206St. Kitts and Nevis49.811.72St. Lucia22.65.8St. Vincent & Grenadines220.127.116.11Suriname22.85Trinidad & Tobago28.77.5Turks and Caicos18.104.22.168Virgin Islands ( British)3311.5Health Workforce in the Caribbean Region per 10,000 Population (PAHO 2004)
21 MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION: THE EXAMPLE OF NURSING New Challenges for Nursing:Large numbers of nurses leaving the regionLoss of more experienced nursesLoss of nursing educatorsLimited educational capacity to replace lost nurses
22 MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION New Challenges for Nursing:Inability to assimilate ‘returnees’Image and work conditions for nursesAggressive recruitment of nurses by companies representing employers from countries with shortages
23 MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION The wage differential is the major pull factor for Caribbean health professionals, especially physicians and nurses.A comparison of average monthly wages show that Caribbean nurses working in the US are paid $3,056, in Canada $2,812, and in the United Kingdom $2,578. In Trinidad and Tobago nurses are paid an average monthly salary of $913.
24 MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION 42% of nursing positions were vacant in 2005 (CARICOM/PAHO 2005)PAHO estimates that the departure of 300 nurses from the Caribbean represented losses of $15 to $16.5 million US dollars in training costs
25 MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION Most common reported reasons for resignation were:Poor remunerationLimited opportunities for professional development and career mobilityNon-involvement in the decision-making processPoor working environmentLack of support from supervisors
26 Number of Registered Nurses, Vacancies and Vacancy Rates by Country (Hewitt, 2004) # of VacanciesVacancy RateAntigua3205617.5Barbados93019220.6Dominica177116.2Jamaica2256131758.4St Kitts5026St. Lucia409184.4St Vincent2163415.7Trinidad2125113253.3Total6625281042.4
27 Registered Nurses' Resignations with Declared Intentions to Migrate to the UK, USA, or Canada, by Year and Country (Hewitt 2004)CountryYear19981999200020012002TotalAntigua9312Barbados1622613145175Dominica2413Jamaica90135159152109645St. Kitts18St- Lucia1118171066St. Vincent30574129185279218178993
28 MIGRATION OF THE HEALTH WORKFORCE OF THE CARIBBEAN REGION Development concerns:A highly skilled health workforce plays a major role in a country’s sustainable developmentCountries are experiencing severe limitations in their capacity to provide affordable, quality, health and social services to their nationals.The lack of skilled workforce in the health sectors slows the steps or progress in improvements in economic and social sectors in the regionCaribbean Commission on Health and Development Report, 2005
29 THE FUTURE: POLICY IMPLICATIONS The issue of migration does not belong to any one organization, thus faces challenges relating to:FundingCoordinationInfrastructureDifficult to put into place appropriate evaluation, measurement and dissemination mechanismsIn the Caribbean region there is the need for a coordinated approach to the issue of migration.
30 THE FUTURE: POLICY IMPLICATIONS Necessary to consider the multilateral approach to managing migrationUse the experience in bilateral agreements as building blocks to wider market accessGovernments may experience increased pressure to ensure that conditions of work and pay are satisfactory
31 THE FUTURE: POLICY IMPLICATIONS Evolution from individual and country specific work to efforts relating to major regional health, social and economic policy.Changed nature of collaboration and partnerships in ways that reflect movement from program and evidence to policy.
32 “At the heart of each and every health system the workforce is central to advancing health.” World Health Report, 2006