A mixed-methods study of health worker migration from Jamaica.

Gail Tomblin Murphy,Rowena Palmer,Ronald Labonté,Adrian Mackenzie,Joan Guy-Walker,Benjamin Waysome,Janet Rigby,Ivy Lynn Bourgeault,Annette Elliott Rose

doi:10.1186/s12960-016-0125-8

Gail Tomblin Murphy, Rowena Palmer + Show 7 more

Open Access

https://doi.org/10.1186/s12960-016-0125-8

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Abstract

BackgroundThis study sought to better understand the drivers of migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been ‘sources’ of health workers migrating to other countries. The aim of this paper is to present the findings from the Jamaica portion of the study.MethodsData were collected using surveys of Jamaica’s generalist and specialist physicians, nurses, midwives, and dental auxiliaries, as well as structured interviews with key informants representing government ministries, professional associations, regional health authorities, healthcare facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Multiple stakeholder engagement workshops were held across Jamaica to share and validate the study findings and discuss implications for the country.ResultsMigration of health workers from Jamaica continues to be prevalent. Its causes are numerous, long-standing, and systemic, and are largely based around differences in living and working conditions between Jamaica and ‘destination’ countries. There is minimal formal tracking of health worker migration from Jamaica, making scientific analysis of its consequences difficult. Although there is evidence of numerous national and international efforts to manage and mitigate the negative impacts of migration, there is little evidence of the implementation or effectiveness of such efforts. Potential additional strategies for better managing the migration of Jamaica’s health workers include the use of information systems to formally monitor migration, updating the national cadre system for employment of health personnel, ensuring existing personnel management policies, such as bonding, are both clearly understood and equitably enforced, and providing greater formal and informal recognition of health personnel.ConclusionAlthough historically common, migration of Jamaica’s health workers is poorly monitored and understood. Improved management of the migration of Jamaica’s health workers requires collaboration from stakeholders across multiple sectors. Indeed, participating stakeholders identified a wide range of potential strategies to better manage migration of Jamaica’s health workers, the implementation and testing of which will have potential benefits to Jamaica as well as other ‘source’ countries.

Highlights

This study sought to better understand the drivers of migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts
Who is migrating? Neither Jamaica’s government nor its health professional associations or regulatory bodies formally track the migration of health workers from the country, making a comprehensive analysis of this phenomenon problematic
The most recent estimates found during the scoping review suggested that 50 % of all physicians trained in Jamaica since 1991 have emigrated [16], while two thirds of nurses ever trained in Jamaica have emigrated [17, 18]

Summary

Introduction

This study sought to better understand the drivers of migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. Jamaica is one of the largest countries in the Caribbean, with an estimated population of 2.7 million [1]. Jamaica’s GDP is roughly US$ 14 billion, of which public expenditure on healthcare is approximately 5 % [4]. According to WHO, in 2003 (the most recent year for which data were available), Jamaica’s physician density per 1,000 population was 0.85, while its nursing/midwifery and its dentist density were 1.67 and 0.08, respectively [3]. Jamaica has two medical schools offering a 4-year medical program and eight nursing schools offering training at the certificate, diploma, and baccalaureate levels [5, 6]. Jamaica’s healthcare system is funded from public and private sources in roughly equal measure [4]. The public healthcare system is administered by the Ministry of Health (MoH) and four regional health authorities (RHAs)

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