Managing health professional migration from sub-Saharan Africa to Canada: a stakeholder inquiry into policy options.

Ronald Labonté,Nathan Klassen,Corinne Packer

doi:10.1186/1478-4491-4-22

Abstract

BackgroundCanada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada?MethodsWe interviewed a small sample of émigré South African physicians (n = 7) and a larger purposive sample of representatives of Canadian federal, provincial, regional and health professional departments/organizations (n = 25); conducted a policy colloquium with stakeholder organizations (n = 21); and undertook new analyses of secondary data to determine recent trends in health human resource flows between sub-Saharan Africa and Canada.ResultsFlows from sub-Saharan Africa to Canada have increased since the early 1990s, although they may now have peaked for physicians from South Africa. Reasons given for this flow are consistent with other studies of push/pull factors. Of 8 different policy options presented to study participants, only one received unanimous strong support (increasing domestic self-sufficiency), one other received strong support (increased health system strengthening in source country), two others mixed support (voluntary codes on ethical recruitment, bilateral or multilateral agreements to manage flows) and four others little support or complete rejection (increased training of auxiliary health workers in Africa ineligible for licensing in Canada, bonding, reparation payments for training-cost losses and restrictions on immigration of health professionals from critically underserved countries).ConclusionReducing pull factors by improving domestic supply and reducing push factors by strengthening source country health systems have the greatest policy traction in Canada. The latter, however, is not perceived as presently high on Canadian stakeholder organizations' policy agendas, although support for it could grow if it is promoted. Canada is not seen as "actively' recruiting" ("poaching") health workers from developing countries. Recent changes in immigration policy, ongoing advertising in southern African journals and promotion of migration by private agencies, however, blurs the distinction between active and passive recruitment.

Highlights

Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries
The International Organization for Migration (IOM) estimates that about 20 000 Africans leave Africa every year to take up employment in industrialized countries
We first describe some of the dynamics in the recent flows of physicians and nurses from SSA to Canada, and turn to our findings on policy options

Summary

Introduction

Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. The International Organization for Migration (IOM) estimates that about 20 000 Africans leave Africa every year to take up employment in industrialized countries. While Canada is more dependent on foreign-trained health professionals than most other OECD nations, it places slightly lower than some other Englishspeaking OECD countries, such as the United Kingdom, the United States of America, Australia and New Zealand [5]. Canada has a comparatively higher proportion of foreign-trained physicians from sub-Saharan.

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Results

Conclusion