1. Understanding and influencing the international migration of health workers Barbara Stilwell World Health Organization AcademyHealth Scientific Session International Migration of Health Workers International Migration of Health Workers San Diego June 6-8 2004

2. World Health Organization Geneva Outline The health care workforce in the global context The health care workforce in the global context Why is the migration of health care professionals a concern? Why is the migration of health care professionals a concern? Factors Driving Migration Factors Driving Migration Policy Options to Manage Migration Policy Options to Manage Migration Moving Forward Moving Forward

3. World Health Organization Geneva The health care workforce in the global context Migration flows are likely to increase in the future Migration flows are likely to increase in the future Labour markets are becoming globalized Labour markets are becoming globalized Free-trade agreements and GATS, for example, are removing barriers to labour flows between countries Free-trade agreements and GATS, for example, are 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 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 In the global labour market, some countries are large importers, others are large exporters

4. World Health Organization Geneva Proportion of professionals UK

5. World Health Organization Geneva Proportion of professionals US Source: Statistical Yearbook of the Immigration and Naturalization Service 2001; Bureau of Citizenship and Immigration Services

6. World Health Organization Geneva Migration Flows 1 Annual Migration of Nurses out of the Philippines to Various Countries Changing patterns – less to US, more to Saudi Arabia and UK Changing patterns – less to US, more to Saudi Arabia and UK Only 22 nurses migrated from Saudi Arabia to the UK in 2002 – 'carousel'? Only 22 nurses migrated from Saudi Arabia to the UK in 2002 – 'carousel'? Source: Department of Labour and Employment, Manila, Philippines

7. World Health Organization Geneva Migration Flows 2 However, most of the Angola-born and Cape Verde-born physicians in Portugal completed medical school in Portugal However, most of the Angola-born and Cape Verde-born physicians in Portugal completed medical school in Portugal Source Country Source Country Number Physicians Number Nurses In Portugal In source country In Portugal In source country Angola 820 820 961 961 383 383 14288 14288 Guinea Bissau 358 358 197 197 253 253 1299 1299 Sao Tomé 238 238 67 67 84 84 183 183 Cap Verdé 231 231 71 71 40 40 232 232

8. World Health Organization Geneva Why is the migration of health care professionals of concern? Developed countries are increasingly relying on migrant health care professionals to cope with domestic shortages Developed countries are increasingly relying on migrant health care professionals to cope with domestic shortages Less developed countries are now the main source of migrant health care professionals 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 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 Member countries are seeking solutions from WHO

9. World Health Organization Geneva Impact in source countries Though actual numbers of migrants are small, the problem is exacerbated by other factors in developing 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

10. World Health Organization Geneva Factors Driving Migration How many health care professionals are governments willing to accept into their country? How many health care professionals are governments willing to accept into their country?  desire to accept migrants  desire to accept migrants How many health care professionals are willing to leave their home country and to move abroad? How many health care professionals are willing to leave their home country and to move abroad?  desire to migrate

11. World Health Organization Geneva Factors Driving Migration Desire to Accept Migrants 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 Desire to Migrate –Wages and working conditions better abroad –Opportunities for career advancement –Improved living conditions –Send remittances back home - 'transnational corporations of kin'

12. World Health Organization Geneva Factors affecting the motivation of health workers in five African countries 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.

13. World Health Organization GenevaRemittances Workers’ remittances received by developing countries by region 1999 - 2002

14. World Health Organization Geneva Policy Options to Manage Migration Migration can not be stopped Migration can not be stopped It is often a symptom of much wider labour market conditions that need to be taken into consideration: 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 working conditions may be poor in the health sector there may be unemployment and therefore it is difficult to find a job there may be unemployment and therefore it is difficult to find a job part time work may not be available part time work may not be available there may be a mismatch of skills there may be a mismatch of skills

15. World Health Organization Geneva Policy Options to Manage Migration To manage migration, countries might: To manage migration, countries might: –Encourage temporary stays –Restrict immigration from at-risk countries e.g.. Commonwealth Agreement on Ethical Recruitment 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

16. World Health Organization Geneva Moving Forward Migration resolution requests WHO to: Migration resolution requests WHO to: Monitor movement of health workforce through improved information systems Monitor movement of health workforce through improved information systems Research impact of trade agreements Research impact of trade agreements Support Member States in improving planning mechanisms Support Member States in improving planning mechanisms Develop a Code of Practice Develop a Code of Practice Facilitate dialogue between countries to explore modalities for source countries to offset lost investment Facilitate dialogue between countries to explore modalities for source countries to offset lost investment Ensure that all programmes pay attention to HR strengthening Ensure that all programmes pay attention to HR strengthening Declare World Health Day 2006 as Human Resources for Health Development Declare World Health Day 2006 as Human Resources for Health Development Include human resources as a top priority area in the POW Include human resources as a top priority area in the POW