Health Worker Migration Research Articles

Research Trends and Patterns on International Migration of Health Workers (1950–2022)

Research Trends and Patterns on International Migration of Health Workers (1950–2022)

The World Health OrganisationGlobal Code of Practice and migration of health workers from Zimbabwe.

The migration of health workers remains one of the most pressing challenges facing many countries in the global South. This short communication seeks to reignite debate on the effectiveness of the World Health Organisation (WHO) Code as a tool for managing the migration of health workers from the South. While the WHO Code was somewhat effective in reducing the migration of health workers from countries such as Zimbabwe during the first five years of its implementation, demand for health workers in the UK after Brexit and the COVID-19 pandemic has accelerated the rate of migration of health workers from countries facing critical shortages. Clearly, new solutions are needed that strike a balance between the right of health workers in the South to migrate and the right of citizens in the region to a stable supply of health workers.

Assessment of Urban ASHA workers: Unveiling Urban Dynamics

Background: The World Health Report highlighted the critical role of human resources in health systems, especially noting the human resource crisis in low-income countries due to various challenges such as migration and illness of health workers. The study aims to assess the performance of urban ASHA workers in Meerut and identify factors affecting their performance. Specific objectives include evaluating the delivery of essential services by ASHA workers and understanding the various individual, occupational, and environmental factors that influence their effectiveness. Methodology: The study was conducted with 40 ASHAs from the urban areas of Meerut. Data was collected through interviews using pretested schedules and performance assessments based on structured scales. Beneficiaries were also interviewed to gauge service delivery effectiveness. Chi-square and Fisher exact tests were used to analyze data and understand the association between various factors and ASHA performance. Results & Conclusion: The results were categorized into performance grades based on the ASHAs' scores, showing a distribution among different performance levels. Factors such as age, education, training frequency, occupation, and timely receipt of incentives were found to significantly affect the performance of ASHA workers. The study revealed that younger, better-educated, and regularly trained ASHAs with timely incentives showed better performance.

Decoding the impact of night/day shiftwork on well-being among healthcare workers

This study delved into the complex effects of work schedules on the well-being of healthcare professionals, spotlighting Nigeria’s medical landscape. A diverse cohort of 387 participants, spanning doctors, nurses, pharmacists, and laboratory technicians or scientists, formed the research base, with the majority being women (67.7%), with a mean age of 34.67 years. Professionals self-reported their predominant schedules to gauge work patterns, classifying them as day or night shifts. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) tool assessed the quality of life across the physical, psychological, social relationship, and environmental domains. Psychological distress was measured using the Depression, Anxiety, and Stress Scales (DASS), and perceived social support was evaluated via the Multidimensional Scale of Perceived Social Support (MSPSS). A cross-sectional design was adopted, and the study employed moderated mediation analysis using SmartPLS 4.0. The results underscored the significant ramifications of night shifts on environmental and physical well-being. Psychological health and social relationships were better among day shift than night shift workers. There was a pronounced correlation between night shifts and heightened levels of anxiety, stress, and depression. The mediating role of psychological distress and the moderating influence of social support in these relationships were evident. This study offers invaluable insights into the role of work schedules in shaping the well-being of healthcare professionals, emphasising the protective role of social support and the unique challenges faced by migrant health workers.

Multi-criteria decision analysis method for differential diagnosis of tropical febrile diseases.

This paper employs the Analytical Hierarchy Process (AHP) to enhance the accuracy of differential diagnosis for febrile diseases, particularly prevalent in tropical regions where misdiagnosis may have severe consequences. The migration of health workers from developing countries has resulted in frontline health workers (FHWs) using inadequate protocols for the diagnosis of complex health conditions. The study introduces an innovative AHP-based Medical Decision Support System (MDSS) incorporating disease risk factors derived from physicians' experiential knowledge to address this challenge. The system's aggregate diagnostic factor index determines the likelihood of febrile illnesses. Compared to existing literature, AHP models with risk factors demonstrate superior prediction accuracy, closely aligning with physicians' suspected diagnoses. The model's accuracy ranges from 85.4% to 96.9% for various diseases, surpassing physicians' predictions for Lassa, Dengue, and Yellow Fevers. The MDSS is recommended for use by FHWs in communities lacking medical experts, facilitating timely and precise diagnoses, efficient application of diagnostic test kits, and reducing overhead expenses for administrators.

Navigating Exodus: Understanding the Migration Dynamics of Health Care Professionals from Turkey

Objectives: We aimed to determine the reasons for the emigration of health workers who left Turkey and the difficulties experienced before and after the migration.Methods: This is an exploratory qualitative study of open-text fields focusing on migrant health workers from Turkey. Answers given to five open-ended questions directed to the participants in our survey, with 513 participants between April and June 2022, were used. Data were analyzed following content analysis.Results: A total of 506 responses were analyzed. The mean age of the participants was 39.9 ± 8.8 years (54.2% men, 77.5% medical doctors). Almost all participants reported that the political atmosphere in Turkey forced them to migrate. Some participants were unable to do their jobs due to the increasing violence in the health system in recent years. Most participants saw migration as the only way out, as they did not feel free and safe. Comparatively, they were in a better economic situation in Turkey and had a higher standard of living.Conclusion: Migration creates a sense of security while at the same time accepting a lower standard of living. To organize the sustainable migration of professionals, it is beneficial to ask what framework conditions need to be created and to access the labor market in particular.

The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan.

To address domestic shortages, high-income countries are increasingly recruiting health workers from low- and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not substantially aggravating existing health workforce availability challenges. This is due to the fact that all three countries are faced with health worker unemployment grounded in unwillingness to work in rural areas and/or overproduction of certain cadres. Respondents, however, pleaded against targeting very experienced and specialised individuals. While observing little harm of health worker migration at present, stakeholders also noted few benefits such as brain gain, describing how various barriers to skill enhancement, return, and reintegration into the health system hamper in practice what may be possible in theory. Improved availability of data on health worker migration, including their potential return and reintegration into their country of origin's health system, is urgently necessary to understand and continuously monitor costs and benefits in dynamic national and international health labour markets. Our results imply that potential benefits of migration do not come into being automatically, but need in-country supportive policy and programming, such as favourable reintegration policies or programs targeting engagement of the diaspora.

From humanitarian crisis to employment crisis: The lives and livelihoods of South Sudanese refugee health workers in Uganda.

Despite the many benefits of refugee health workers for health systems, they commonly face challenges integrating into host country workforces. The Global Code of Practice on International Recruitment of Health Personnel, which should monitor and protect migrant health workers, offers little guidance for refugees and research is needed to inform strategy. Based on interviews with 34 refugee health workers and 10 leaders across two settlements supporting populations fleeing the humanitarian crisis in South Sudan since 2013, we describe the governance and social dynamics affecting South Sudanese refugee health worker employment in Uganda. Refugees in Uganda legally have the right to work but face an employment crisis. Refugee health workers report that systemic discrimination, competition from underemployed domestic workers, unclear work permit rules and expensive credentialling processes exclude them from meaningful work in public health facilities and good jobs in the humanitarian response. This pushes them into unchallenging roles in private clinics, poorly remunerated positions on village health teams or out of the health sector altogether. Health system strengthening initiatives in Uganda to integrate humanitarian and government services and to deter the domestic workforce from emigration have overlooked the potential contributions of refugee health workers and the employment crisis they face. More effort is needed to increase fairness in public sector recruitment practices for refugee health workers, support credentialling, training opportunities for professional and non-professional cadres, job placements, and to draw attention to the public benefits of refugee health worker employment alongside higher spending on human resources for health.

Why Do Hungarian Health Workers Migrate? A Micro-Level Analysis

The sustainability of healthcare systems is challenged by the international migration of health workers in many countries. Like other Central and Eastern European (CEE) countries, a great number of health professionals from Hungary have emigrated recently, increasing the shortage of health workers in the country. The aim of this study is to explore the migration attitudes of Hungarian health workers, applying a micro-level approach of push–pull factors. For this purpose, semi-structured interviews have been conducted with practicing and inactive Hungarian health professionals living in Hungary and abroad. The interviews were subjected to a thematic analysis, and the following groups of factors were revealed and discussed: wealth and income, workplace, human capital, quality of life, family, personal network, and personality. In addition, geography and life stage (life course) as two overarching, integrative categories are also discussed. The results point to the role of income, work environment, and family in migration decisions. As a new factor, the importance of geographical characteristics (local context, distance) is also explored, which has received less attention in previous studies. A novelty of our study is the CEE post-socialist point of view, mirrored by the life-path elements of the interviews. Another novelty is the qualitative and micro-level approach, forming the basis of policy recommendations presented at the end of our study.

Health workforce data needed to minimize inequities associated with health-worker migration.

A persistent challenge with health-worker migration is the inequities it creates. To minimize these inequities, systems of global governance of health-worker migration have arisen which include various global codes of practice, agreements and reporting requirements. Reporting that is rigorous, open and transparent, and subject to scrutiny from the public, researchers, civil society organizations and other interested stakeholders, is important. One element of these codes and agreements with perhaps the greatest potential to deal with the impact of health-worker migration is more robust planning of the health workforce to address the goal of self-sufficiency. Open platforms for data sharing enable engagement of the public and stakeholders with data on the distribution and national origin of health workers, and reveal policy strengths and weaknesses related to health-workforce planning. We explore recent policies directed at reducing the inequities from health-worker migration. While many of the examples used focus on nurses and doctors, the issues discussed are relevant to all cadres of internationally trained health workers.

Market making and the production of nurses for export: a case study of India–UK health worker migration

BackgroundHigh-income countries increasingly look to the international recruitment of health workers to address domestic shortages, especially from low-income and middle-income countries. We adapt conceptual frameworks from migration studies to examine...

Mechanisms and Support Policies of Urban Integration on the Health of Migrant Workers in China

Mechanisms and Support Policies of Urban Integration on the Health of Migrant Workers in China

Workforce migration and brain drain – A nationwide cross-sectional survey of early career psychiatrists in Nigeria

Abstract Background Nigeria’s shortage of psychiatrists is exacerbated due to health worker migration. Aim This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria. Methods We conducted a cross-sectional survey covering Nigeria’s six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29. Results Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had ‘ever’ considered migration, 69.2% were planning to leave ‘now’, and 52.9% had taken ‘practical migration steps’. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05–4.88) predicted planning to leave ‘now’, while being in a relationship (OR = 3.46, 95%CI = 1.06–11.30) predicted taking ‘practical migration steps’. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested. Conclusions Systemic changes to address psychiatrists’ migration from Nigeria are needed.

Rural to Urban Transition: A Case of Health Worker Migration Dynamics Post-COVID-19 in Jakarta

Tenaga kesehatan dari daerah melakukan migrasi ke Jakarta untuk mendapatkan pekerjaan yang lebih baik. Terutama selama wabah Covid-19 merebak, banyak rumah sakit di Jakarta membutuhkan tambahan staf untuk menangani peningkatan permintaan layanan kesehatan. Dengan adanya kesempatan untuk menjadi sukarelawan, petugas kesehatan dari daerah menyadari adanya peluang untuk menyumbangkan keterampilan mereka serta meningkatkan peluang kerja. Artikel ini bertujuan untuk mengeksplorasi tantangan dan dampak yang mereka hadapi di daerah asal mereka. Dengan menggunakan metode kualitatif melalui wawancara mendalam terhadap empat mantan relawan di Rumah Sakit Islam Jakarta Sukapura, penulis menemukan bahwa pandemi Covid-19 berdampak signifikan terhadap perpindahan tenaga kesehatan dari daerah ke Jakarta. Data dianalisis menggunakan teknik Miles dan Huberman, yang melibatkan proses sistematis reduksi data dan penarikan kesimpulan untuk menghasilkan teori yang membumi. Hasil yang didapatkan dari analisis proses migrasi ini disebabkan oleh masalah-masalah seperti pembayaran yang kurang, gaji yang tertunda, dan kurangnya prospek karir di daerah asal mereka. Kondisi ini telah tertuang dalam peraturan undang-undang kesehatan saat ini, Undang-Undang Nomor 17 Tahun 2023, khususnya pada Pasal 235 dan 229, dengan tujuan untuk meningkatkan kesetaraan sistem pelayanan kesehatan di seluruh Indonesia.Abstract: Health workers from rural areas were eager to migrate to Jakarta for better employment. After the Covid-19 outbreak, many hospitals in Jakarta needed additional staff to handle the increased demand for health services. With the call for volunteers, health workers from rural areas recognized an opportunity to contribute their skills as well as improve employment opportunities. This article aims to explore the challenges and the implications that they encountered in their former regions. By employing a qualitative method using in-depth interviews with four former volunteers at Jakarta Islamic Hospital Sukapura, the authors discovered that the Covid-19 pandemic significantly impacted the movement of health workers from rural areas to Jakarta. The data were analyzed using Miles and Huberman’s techniques, involving systematic processes of data reduction and conclusion drawing to generate grounded theories. Results from the analysis of this migration process include underpayment, delayed salaries, and a lack of career prospects in their previous regions. This condition is also stated in the recent health law regulations, as outlined in Law Number 17 of 2023, specifically in Articles 235 and 229, with the aim of enhancing health system equality across Indonesia.

The Effect of Migration of Health Workers in Labor Markets a Literature Review

This systematic review examines the effect of migration of health workers on the labor market. With an increasing global movement of healthcare professionals, it is essential to understand the implications of this phenomenon on both sending and receiving countries. Our review synthesizes existing research and analyzes factors such as recruitment patterns, skill gaps, policy implications, and the impact on healthcare systems. Through a comprehensive search of academic databases, we identified a range of studies that shed light on this complex issue. Findings suggest that health worker migration can have both positive and negative consequences. While it may alleviate shortages in receiving countries and boost remittances for sending countries, it can also exacerbate healthcare workforce imbalances and strain resource-poor regions. The systematic review underscores the need for evidence-based policies that balance the benefits and challenges of health worker migration. By understanding the dynamics at play, policymakers can make informed decisions to ensure the sustainability and equity of healthcare systems in an increasingly interconnected world.
 
 Received: 20 September 2023 / Accepted: 3 November 2023 / Published: 23 November 2023

Psychological morbidities among Nepalese migrant workers to Gulf and Malaysia.

One of the important aftereffects of rapid global development is international mobility, which has placed the health of migrant workers as a key public health issue. A less-developed country, Nepal, with political instability and a significant lack of employment, could not remain untouched by this phenomenon of migration. Our goal was to identify and determine the predictors of anxiety, depression, and psychological wellbeing among Nepalese migrant workers in Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia. A descriptive cross-sectional study was used to collect information from 502 Nepalese migrant workers in the arrival section of Tribhuvan International Airport from May to June 2019 using purposive sampling. Workers with a minimum work experience of 6 months and above were included in the study. A structured questionnaire with socio-demographic items was used along with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and WHO (five) wellbeing scale for measuring the subjective psychological wellbeing and screening for depression. The mean age of the respondents was 32.97 years. Majority (41.8%) of the respondents had work experience in Qatar and 63.7% had work experience of 1-5 years. The results suggested that 14.4% had mild to severe depression while 4.4% had a moderate level of anxiety. The WHO5 wellbeing index score suggested that 14.1% of the respondents had a score below 13, which is suggestive of poor psychological wellbeing. Further, the country of work (p = 0.043), sleeping hours (p = 0.001), occupation (p = 0.044), working hours (p = 0.000), water intake (p = 0.010) and anxiety level (p = 0.000) were found to be significantly associated with depression score. Similarly, sleeping hours (p = 0.022), occupation (p = 0.016), working hours (p = 0.000), water intake (p = 0.010), and anxiety level (0.000) were significantly associated with the WHO5 wellbeing score. Nepalese migrant workers in the Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia bear an important burden of psychological morbidities. This highlights the need to prioritize the migrant worker's mental health by Nepal as well as Gulf countries and Malaysia.

The negative impact of global health worker migration, and how it can be addressed

International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.

Promoting equitable health workforce distribution through improved migration governance: A mixed methods study of African health professionals' perceptions in Australia.

This study examined skilled health worker (SHW) migration governance in African countries and Australia, with an emphasis on areas of influence for achieving an equitable global health workforce distribution. We used a mixed-methods research design with African SHW migrants in Australia. An institutional and rights-based framing of governance guided thematic analysis of the interviews, which was mapped to survey findings from a Bayesian Exploratory Factor Analysis. The findings imply that Australian state actors enforce laws that attract SHW migrants and promote safe clinical practice, but do not adequately address their integration concerns or role in health system strengthening. Non-state actors in Australia make donations to African health institutions but rarely promote health workforce equity. African state actors respond to increased SHW migration trends by increasing health worker training and limiting migration, but they lack a comprehensive governance framework for involving citizens and engaging foreign governments. There is limited evidence of a shared community definition of SHW migration governance in many African countries. When stakeholders in both sending and receiving countries recognise the indivisibility of the rights at stake (for example, SHW rights as migrants and the right to health), support for an equity-focused SHW migration governance system may increase. Promoting these rights can result in policies that enhance health system strengthening in destination and source countries. Similarly, growing adoption of these rights in sending countries should help inspire a coordinated plan for strengthening health system and SHW migration governance.

An Assessment of the Prevalence, Pattern and Determinant of Brain - Drain Among Health Workers in Ovia - North East, Edo State Nigeria

The quality of performance in the health sector to a large extent depends on the availability and willingness of healthcare workers to work. The prevalence of brain drain among health workers has not been given adequate attention in Nigeria, as the migration of skilled health workers has negatively affected the quality of health care in the country. The aim of this study is to assess the prevalence, pattern and determinants of brain drain among health workers in Ovia North East, Edo state, Nigeria with the aim of addressing the factors of brain drain thereby encouraging health workers to stay back. A descriptive crosssectional study design was adopted and a cluster sampling technique was however used to select respondents for this study. A sample size of 320 was adopted. A well- structured questionnaire was used. It was reviewed that the predominant age group of respondents was 26-35 years with 145 (48.3%) with the mean age of 33; while the age group with the lowest response was greater than 36 years with 65 (21.3%) respondents. A higher proportion of the respondents were female with 170 (56.7%). This suggests relatively younger population of healthcare worker in Ovia North East, Edo State participated in the study. Majority of the respondents, 210(70%) had good knowledge, compared to those with poor knowledge 90(30%).The most identified push factor of brain drain was limited education opportunity with 295 (98.3%).The least identified push factor was social and retirement benefits with 175 (58.3%). The most identified pull factor of brain drain was recognition of professional expertise with 295 (98.3%). The least identified pull factor was social and retirement benefits with 230 (76.7%). Lastly, 265( 83.3% ) agreed that financial remuneration was a major reason for migration of health workers to developed countries. There is a statistically significant relationship between socioeconomic or political situations in the home country of respondents and the prevalence of brain drain among health care workers. (p=0.001). This study revealed that a high level of brain drain among health professionals, is greatly owed to recognition of professional expertise and financial remunerations. Owing to this, there is urgent need by the Government to take full responsibility to curtail the current brain drain in the country because sooner or later the increasing levels of brain drain in the country would pose a great threat to the quality of health services of the country.

Levelling the playing field for the international migration of nurses: the India English Language Programme

BackgroundThis article presents evaluation findings of the India English Language Programme, an innovative programme aimed at providing Indian nurses with an opportunity to participate in an ethical and mutually beneficial learning programme aimed at supporting migration into the United Kingdom’s National Health Service (NHS). The programme provided 249 Indian nurses wishing to migrate to the NHS on an ‘earn, learn, and return’ basis with funding to support English language learning and accreditation sufficient to apply for Nursing and Midwifery Council (NMC) registration. The Programme provided English language training and pastoral support to candidates, in addition to the availability of remedial training and examination entry for those not meeting NMC proficiency requirements on their first attempt.MethodsDescriptive statistical analysis of programme examination results and cost-effectiveness analysis is presented to demonstrate programme outputs and outcomes. Descriptive economic analysis of programme costings is presented alongside programme results to investigate the value-for-money provided by this programme.ResultsA total of 89 nurses were successful in meeting NMC proficiency requirements, representing a pass rate of 40%. Those undertaking OET training and examination(s) were more successful, compared to those undertaking British Council provision, with over half of candidates passing at the required level. This equates to an overall programme cost-per-pass of £4139 and represents a model to support health worker migration, in line with WHO guidelines, delivering individual learning and development, mutual health system gain, and value-for-money.ConclusionsTaking place during the coronavirus pandemic, the programme evidences the effective delivery of online English language training to support health worker migration during a highly disruptive period for global health. This programme demonstrates an ethical and mutually beneficial pathway for English language improvement amongst internationally educated nurses to facilitate migration to and global health learning in the NHS. It provides a template through which healthcare leaders and nurse educators, working in policy and practice environments in the NHS and other English-speaking countries, can design future ethical health worker migration and training programmes to strengthen the global healthcare workforce.