1. The Nurse Labor and Education Markets of the English Speaking CARICOM No ‘Business as Usual’ Christoph Kurowski May 2009

2. 2 CK 090527  What is the ES-CARICOM’s potential to serve as a medical tourism hub?  How would staff/nurse shortages compounded by migratory outflows impact the development of such an industry?  How would the development of such an industry impact the availability of staff/nurses and consequently service provision to the general population? Motivation and objectives  Establish the information base for HRH policy decision making through a comprehensive review of the regional nurse and education labor markets.

3. 3 CK 090527 StatesPopulation CARICOM / CSME 1515.2 M English- Speaking (ES) CARICOM 136.2 M Guyana (GY) Jamaica (JM) Saint Lucia (SL) Saint Vincent & the Grenadines (SVG) Trinidad & Tobago (TT) The ES-CARICOM

4. 4 CK 090527  Multi-Year Programmatic AAA (with several deliverables) … Not leading immediately to a lending operation  Partnership with HNP hub  Partnership with PAHO  Funding from various sources (BB, Gates (through hub), PHRD)  Early engagement with key countries  Local consultants The approach

5. 5 CK 090527 Methods Country case studies ES CARICOM Active supply including distribution, vacancies, salaries, attrition by source, increments including potential applicants, applicants, intake, output, in-migration, costs of training, policies, reforms. Country case studies – OECD Stock of ES-CARICOM nurses, inflows of ES-CARICOM trained nurses, pass rates, costs of training, Jamaica nurse survey Individual characteristics, reasons for entering nurse profession, financing of nurse education, willingness-to-pay, continuing education, job satisfaction, income, employment history, intent to migrate, migration, reasons for migration, diaspora effect, remittences, intent to return. Projections Demand taking demographic and epidemiological shifts into account, supply, scenario analyses Costs and benefits Cost of training, scenario analysis, salaries, VAT trough remittances.

6. 6 CK 090527 Nurse Education In-Migration NLM Death & Disability Retirement Out-Migration Increments: 10.5% annually Attrition: 8% annually A fragile supply equilibrium

7. 7 CK 090527 with attrition driven by out-migration

8. 8 CK 090527 … out-migration determined by OECD country immigration policy 81% of non-migrants have considered migrating 75% of non-migrants dissatisfied with work environment US nurse shortage of over 800,000 by 2020

9. 9 CK 090527 … the stock abroad greater than in the region

10. 10 CK 090527 … and the possibility for growing intra-regional migration

11. 11 CK 090527 Employment StatusNumber Full-time, nurse152 Part-time, nurse3 Retired2 Studying1 Full-time, alternative occupation1 Not working, studying or retired0 Total159 Negligible inactive supply

12. 12 CK 090527 … but potential to boost training capacity

13. 13 CK 090527 NCLEX pass rate by country … yet the quality of training is doubtful.

14. 14 CK 090527 Regional approach Focus on both increasing nurse training and managing migration Improve monitoring systems Expand survey and establish baseline of panel data set Alternative financing models for nurse education Framework convention Looking forward

15. 15 CK 090527 Ana Deroche Audrey Corry Elizabeth Ward Luke Shors Marko Vujicic Mary Dowling Oscar Ocho Pauline Reid Tomoko Ono Veronica Jarrin Yuki Murakami MoH Barbados MoH Guyana MoH Jamaica MoH St. Lucia MoH St. Vincent & the Grenadines MoH Trinidad & Tobago PAHO World Bank Team and Collaborating Agencies