Emigration Of Health Workers Research Articles

Author’s Responses to Peer Reviews of “Medical Brain Drain From Southeastern Europe: Using Digital Demography to Forecast Health Worker Emigration”

Author’s Responses to Peer Reviews of “Medical Brain Drain From Southeastern Europe: Using Digital Demography to Forecast Health Worker Emigration”

Peer Review of “Medical Brain Drain from Southeastern Europe: Using Digital Demography to Forecast Health Worker Emigration”

Peer Review of “Medical Brain Drain from Southeastern Europe: Using Digital Demography to Forecast Health Worker Emigration”

How to Understand Limitations of the Right to Exit with Respect to Losses Associated with Health Worker Emigration: A Clarification

There is a recent interest in the ethics of high-skilled worker emigration through which the limitations of the right to exit are discussed. Insightful arguments have been made in favour of (or against) the emigration restrictions on skilled workers in order to tackle the deprivations in developing countries. However, there is still a need for clarification on how we can understand, discuss and implement limitations of a right from a normative perspective. Significantly, how we understand the limitation of a right might determine how we approach such limitations – both in terms of the process of assessing the limitations and in terms of their implications. In this paper, I identify two distinct ways to understand limitations of the right to exit with respect to losses associated with health worker emigration, while also pointing to their implications for restrictive policies: (i) as a matter of scope, and (ii) as a matter of weight or emergency, which requires a compensatory scheme for the individual right holders. While the emergency restrictions seem to be a point of convergence in the literature, what defines an emergency and the nature of the compensation still warrant exploration. To that end, I also discuss from a normative perspective what might constitute a public emergency that would give states a prima facie prerogative to regulate temporary limitations on the exercise of the right to exit. In addition, I briefly introduce the implications of emergency restrictions, with a particular focus on compensatory schemes for individual right holders.

Health Without Care? Vulnerability, Medical Brain Drain, and Health Worker Responsibilities in Underserved Contexts

There is a consensus that the effects of medical brain drain, especially in the Sub-Saharan African countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue—while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In the first step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves would hold responsibilities to assist with respect to vital needs of their compatriots. These are fair reciprocity, duty to support vital institutions, and attending to the unintended harmful consequences of one’s actions. While the first two are explained and also largely discussed in the literature, the third requires an explication on how and on which basis skilled workers would have a responsibility as such. In this article, I offer a vulnerability approach with its dependency aspect that may account for why the health workers in underserved contexts would have a responsibility to attend to the unintended side effects of their actions that may lead to a vital risk of harm for the population. I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility.

Determinants of health professionals’ migration in Africa: a WHO based assessment

Purpose – How do economic prosperity, health expenditure, savings, price-stability, demographic change, democracy, corruption control, press freedom, government effectiveness, human development, foreign aid, physical security, trade openness and financial liberalization play-out in the fight against health-worker crisis when existing emigration levels matter? Despite the acute concern of health-worker crisis in Africa owing to emigration, lack of relevant data has made the subject matter empirically void over the last decades. The paper aims to discuss these issues. Design/methodology/approach – A quantile regression approach is used to assess the determinants of health-worker emigration throughout the conditional distributions of health-worker emigration. This provides an assessment of the determinants when existing emigrations levels matter. Findings – Findings provide a broad range of tools for the fight against health-worker brain-drain. As a policy implication, blanket emigration-control policies are unlikely to succeed equally across countries with different levels of emigration. Thus to be effective, immigration policies should be contingent on the prevailing levels of the crisis and tailored differently across countries with the best and worst records on fighting health-worker emigration. Originality/value – This paper has examined the theoretical postulations of a World Health Organization report on determinants of health-worker migration.

Globalization and health worker crisis: what do wealth-effects tell us?

Purpose – Owing to lack of relevant data on health human resource (HHR) migration, the empirical dimension of the health-worker crisis debate has remained void despite abundant theoretical literature. A health worker crisis is growing in the world. Shortages in health professionals are reaching staggering levels in many parts of the globe. The paper aims to discuss these issues. Design/methodology/approach – A quantile regression approach is used to examine the determinants of health-worker emigration throughout the conditional distributions of health-worker emigration. This provides an investigation of the determinants when existing emigrations levels matter. The author assesses the determinants of emigration in the health sector through-out the conditional distribution of HHR emigration. Findings – The findings have been presented in two main strands: when existing emigration levels are low and when existing emigration levels are high. In the former case (when existing emigration levels are low), wealth-effects have the following implications. First, while economic prosperity is a good tool against nurse brain drain in middle income countries (MICs), health expenditure is a good instrument against physician brain drain in low income countries (LICs). Second, whereas positive demographic change fuels the problem in LICs, it mitigates the issue in their MIC counterparts. Third, savings, government-effectiveness, foreign-aid and inflationary pressures only accentuate the problem for both income groups. Fourth, corruption-control becomes a vital tool for emigration-control in both income-brackets. Fifth, while trade openness mitigates physician emigration in LICs, financial openness has the opposite effect on nurse emigration. In the latter case (when existing immigration levels are high), the following conclusions have been drawn. First, While economic prosperity fights nurse emigration only in LICs, savings is a tool against physician emigration only in their MIC counterparts. Second, health expenditure and inflationary pressures are relevant tools in the battle against physician resource flight. Third, whereas, government effectiveness is an important policy measure for mitigating emigration in LICs, human development plays a similar role in MICs. Fourth, democracy, press-freedom, foreign-aid and financial openness fuel emigration in either income strata. Fifth, population growth and trade openness are important tools in the fight against brain-drain. Sixth, the HIV infection rate is a deterrent only to nurse emigration. Originality/value – This paper complements existing literature by empirically investigating the World Health Organization hypothetical determinants of health-worker migration in the context of globalization when income-levels matter. In plainer terms, the work explores how the wealth of exporting countries play-out in the determinants of HHR emigration.

Determinants of Health Professionalss Migration in Africa: A WHO Based Assessment

Purpose – How do economic prosperity, health expenditure, savings, price-stability, demographic change, democracy, corruption-control, press-freedom, government effectiveness, human development, foreign-aid, physical security, trade openness and financial liberalization play-out in the fight against health-worker crisis when existing emigration levels matter? Despite the acute concern of health-worker crisis in Africa owing to emigration, lack of relevant data has made the subject matter empirically void over the last decades. Design/methodology/approach – A quantile regression approach is used to assess the determinants of health-worker emigration throughout the conditional distributions of health-worker emigration. This provides an assessment of the determinants when existing emigrations levels matter. Findings – Findings provide a broad range of tools for the fight against health-worker brain-drain. As a policy implication, blanket emigration-control policies are unlikely to succeed equally across countries with different levels of emigration. Thus to be effective, immigration policies should be contingent on the prevailing levels of the crisis and tailored differently across countries with the best and worst records on fighting health worker emigration.Originality/value – This paper has examined the theoretical postulations of a WHO report on determinants of health-worker migration.

Defending the active recruitment of health workers: a response to commentators

I am very grateful to the five commentators for taking the time to respond to my article ‘The Active Recruitment of Health Workers: A Defense’.1 I have learned a great...

The impact of health worker migration on development dynamics: evidence of wealth effects from Africa

This article examines three relevant hypotheses on the effect of health worker migration on human development and economic prosperity (at the macro- and micro-levels) in Africa. Owing to the lack of relevant data on health human resource (HHR) migration for the continent, the subject matter has remained empirically void over the last decades despite the acute concern about health professional emigration. Using quantile regression, the following findings have been established. (1) The effect of HHR emigration is positive (negative) at low (high) levels of economic growth. (2) HHR emigration improves (mitigates) human development (GDP per capita growth) in low (high) quantiles of the distribution. (3) Specific differences in effects are found in top quantiles of human development and low quantiles of GDP per capita growth where the physician (nurse) emigration elasticities of development are positive (negative) and negative (positive), respectively. As a policy implication, blanket health-worker emigration control policies are unlikely to succeed across countries with different levels of human development and economic prosperity. Hence, the policies should be contingent on the prevailing levels of development and tailored differently across the most and least developed African countries.

The active recruitment of health workers: a defence

Many organisations in rich countries actively recruit health workers from poor countries. Critics object to this recruitment on the grounds that it has harmful consequences and that it encourages health...

10 best resources on … health workers in developing countries

yet until recently researchers and policymakers paidrelatively little attention to their role in developing countries.This is due in part to the inherent complexities and limitedavailability of data—both of which have also held back researchin the world’s wealthier countries. But in low- and middle-income countries, these difficulties have been exacerbated bya tendency to focus on more visible issues.In recent years, however, this has changed. The need to addresshealth workers in public policy took on particular prominenceafter 2000 when increased foreign aid for health programmesconfronted limited capacity in many developing countries toapply those funds—often for a lack of skilled personnel.Research was also spurred by concerns that emigration ofhealth workers was exacerbating the scarcity of health workersin many low- and middle-income countries. Consequently, healthworkforce issues are now attracting a great deal of attentionfrom politicians, donors, practitioners, advocates and researchers(see, for example, Global Health Workforce Alliance 2006).As attention has increased, research has also improved. Untilrecently, most publications could be characterized as eitherplanning studies, using modelling and simulations, orpersonnel management studies, using interviews and observa-tion to assess health care delivery approaches to staffing. Whilethese studies have their uses, they also miss an important partof the picture because they tend to focus only on employmentwithin the public sector and miss many of the dynamicinteractions that occur between health workers and thelabour markets in which they move. By contrast, a newgeneration of research is explicitly addressing both the privatesector and the broader labour market with increasinglysophisticated data and research tools.Our goal in this essay is not so much to present the ‘10 best’resources on health workers, which would be presumptuousto say the least, but rather to introduce this new generationof research by highlighting a number of good research articlesthat demonstrate this trend. These articles share a growingawareness that the number and quality of health workersengaged in health care services is influenced by more thangovernment decisions about spending and deployment. Theyencompass the behaviour of private practitioners and non-governmental organizations; people who seek health care; andhealth workers themselves as they make choices about theirtraining, employment, location and work effort, all within acontext defined by the broader labour market, politics andculture. This is why recent research is often framed within theperspective of labour market analysis even if it emerges fromfields like political science, sociology, anthropology, publicadministration and business management. The better economicstudies are also enriched by contributions from these otherfields.KEY MESSAGES Until recently researchers and policymakers paid little attention to the role of health workers in developing countriesbut a new generation of studies are providing a fuller understanding of these issues using more sophisticated data andresearch tools. Recent research highlights the value of viewing health workers as active agents in dynamic labour markets who arefaced with many competing incentives and constraints. Newer studies have provided greater insights into human resource requirements in health, the motivations andbehaviours of health workers, and health worker migration. We are encouraged by the progress but believe there is aneed for even more, and higher quality, research on this topic.

Gendered perceptions of migration among skilled female Ghanaian nurses

Within current research on African health worker emigration, relatively few studies have explored how health workers themselves see international migration and its impact on their lives, and how gender norms influence these perceptions. This article draws on research aiming to examine these issues, conducted between June and August 2008. Ghanaian nurses’ views of migration are highly influenced by gendered notions of women prioritising family responsibilities over personal desires. However, these ideas are being called into question by the growing numbers of women who may consider migrating as skilled professionals, and attach considerable importance to their professional interests.

Human Resources for Treating HIV/AIDS: Needs, Capacities, and Gaps

Despite recent international efforts to scale-up antiretroviral treatment (ART), more than 5 million people needing ART in low- and middle-income countries (LMIC) do not receive it. Limited human resources to treat HIV/AIDS (HRHA) are one of the main constraints to achieving universal ART coverage. We model the gap between needed and available HRHA to quantify the challenge of achieving and sustaining universal ART coverage by 2017. We estimate the HRHA gap in LMIC using recently published estimates of ART coverage, HIV incidence, health-worker emigration rates, mortality rates of people needing ART, and numbers of HRHA needed to treat 1000 ART patients (based on review studies, 2006). We project the HRHA gap in 10 years (2017) using a simple discrete-time model with a health worker pool replenished through education and depleted through emigration/death; a population needing ART replenished with a given HIV incidence rate; and higher survival rates for treated populations. We analyze the effects of varying assumptions about HRHA inflows and outflows and the evolution of the HIV pandemic in three different regional base cases (sub-Saharan Africa, non-sub-Saharan African LMIC, and South Africa). Current ART coverage for LMIC is around 28%-32% and, other things equal, will drop to 16%-19% by 2017 with constant current HRHA production rates. A naive model, ignoring the increased survival probability resulting from ART, suggests that approximately the current number of HRHA in ART services needs to be added every year for the next ten years to achieve universal coverage by 2017. In a model accounting for increased survival of treated patients, outcomes vary by region; sub-Saharan Africa requires two times, non-sub-Saharan African LMIC require 1.5 times and South Africa requires more than three times their respective current HRHA population to be added every year for the next 10 years to achieve universal coverage by 2017. Even if achieved by 2017, sustaining universal coverage requires further HRHA increases until the system reaches steady state. ART coverage is sensitive to HRHA inflow and emigration. Our model quantifies the challenge of closing the HRHA gap in LMIC. It shows that strategies to achieve universal ART coverage must account for feedback due to higher survival probabilities of people receiving ART. It suggests that universal ART coverage is unlikely to be achieved and sustained with increased HRHA inflows alone, but will require decreased HRHA outflows, substantially reduced HIV incidence, or changes in the nature or organization of care. Means to decrease HRHA emigration outflows include scholarships for healthcare education that are conditional on the recipient delivering ART in a country with high ART need for a number of years, training health workers who are not internationally mobile, or changing recruitment policies in countries receiving health workers from the developing world. Effective organizational changes include those that reduce the number of HRHA required to treat a fixed number of patients. Given the large number of health workers that even optimistic assumptions suggest will be needed in ART services in the coming decades, policymakers must ensure that the flow of workers into ART programs does not jeopardize the provision of other important health services.

Health Worker Emigration from Poland

The International Herald Tribune recently covered the problem of worker emigration from Poland in Judy Dempsey's piece "Poland faces shortage as workers go west." She pointed out that since joining the European Union (EU), the outflow from Poland may be nearing 8oo,ooo people more than z per cent of the population (i). Workforce shortages in construction and manufacturing were described, but in the healthcare system as well shortages are noticeable and are starting to paralyze the system in some regions. Medical workforce emigration must be considered in the context of aging populations. Lower birth rates and improved life expectancy generate greater a need for healthcare services, particularly geriatric care. "Skill importation" is a common response. In the United Kingdom, for example, two-thirds of doctors are emigrants (z). The problem is compounded by the "double aging" of providers. In the United States, an increasing fraction of nurses is over 45, as the number of younger women working in nursing is not increasing (2). For physicians and nurses from post-communist Europe, these developments in wealthier countries generate an opportunity to find new employment at much higher salaries and with better working conditions. Surveys show that as many as 40 per cent of physicians in Poland have considered emigration for work and about 3-4 per cent have already moved or have definite plans to do so. Results are similar for nurses (data provided by the Polish Chamber of Physicians and Polish Chamber of Nurses and Midwifes).