Migration Of Healthcare Workers Research Articles

Feminist foreign policy and global (health) care work migration: Addressing the invisibility of colonial gaps in feminist policy making

ABSTRACT The state-sponsored recruitment of migrant healthcare workers from the global South into the global North is a contemporary practice that requires critical engagement. Germany, like many other like-minded countries, has developed its own recruitment program Triple Win which aims to sustainably and ethically secure its national health care system through the use of foreign labor. Absent from Triple Win is an awareness of the ongoing colonial power relations that reproduce the program as a practice in neocolonial care extractivism. This lack of awareness is set against the country’s promotion of a feminist foreign and development policy, which seeks to transform international politics through a gender centred approach. Locating Triple Win within the context of feminist foreign policy we analyse how Germany’s feminist foreign and development policy makes visible, addresses and changes the colonial power relations that sustain care work migration programs. In doing so, we seek to build on existing studies of care work migration as a gendered and racial phenomenon. To do this we adopt a postcolonial feminist approach that is grounded in an ethics of care in order to remap the local and the global through a critical analysis of care work migration as a neocolonial development practice.

Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID-19.

Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers' experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy. Romanian physicians working in Germany during the COVID-19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n=21) were collected from mid of September to early November 2022 and content analysis was performed. Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.

Migrant healthcare workers: exploring resilience and capacity for circular migration

Abstract Background This study focuses on migrant healthcare workers’ experiences and explores mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective equitable healthcare workforce policy. Methods Romanian physicians working in Germany served as an empirical case study. We applied a qualitative explorative approach; interviews (n = 21) were collected from mid of September to early November 2022 and content analysis was performed. Results Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Conclusions Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy. Key messages • Effective retention policy must consider mobility patterns of healthcare workers and motivational factors, calling for systematic data and research evidence. • Major push and pull factors reveal strong interconnectedness of healthcare systems and policy in sending and receiving countries, calling for more equitable health workforce policy.

Health Diplomacy as a Tool to Build Resilient Health Systems in Conflict Settings—A Case of Sudan

Attacks on health have become a significant concern for non-belligerents of war, including healthcare personnel and facilities, as witnessed in the ongoing Sudan conflict. About 1.5 billion people in fragile and conflict-affected settings (FCAS) have a heightened need for essential health services. Conflicts often lead to the disruption of the building blocks of health systems, a lack of access to health facilities, the failure of essential medical supply chains, the collapse of political, social and economic systems, the migration of health care workers, and upsurges in illness. While health indicators often decline in conflict, health can also bring peace and harmony among communities. An investment in building resilient health systems and health diplomacy is a neutral starting point for mitigating the repercussions of conflicts. The international commitment towards Sustainable Development Goals (SDGs) provides the impetus to emphasise the relationship between health and peace with the amalgamation of SDG 3, SDG 16, and SDG 17. The inspection of how health diplomacy should be used as a ‘tool for peace’ and not as leverage in conflict settings must be reiterated by the international community.

Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study.

Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study. An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics. Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers. COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved.

Maternal Practices of Korean Healthcare Workers in Germany

In the framework of the former West German government’s “guest worker” (Gastarbeiter) recruitment policy between 1955 and 1973, more than 11,000 South Korean nurses and nurse assistants moved to Germany to work in medical or nursing institutions to fill a gap in the provision of healthcare services as “guest workers.” Drawing on personal accounts, the current empirical study explores mothering practices primarily between the 1960s and 1990s in the families of Korean migrant healthcare workers who resided in Germany over the course of their working lives and/or returned to Korea. This study charts the manner in which these migrant mothers navigated and balanced competing social discourses around mothering that emerged from the different cultural and historical backgrounds in a new host society. The concepts around mothering consist of the ideology of “intensive mothering,” the Confucian ideal of “wise mother and good wife,” and the German notion of the “raven mother.” Special attention is paid to the way in which mothering is negotiated and experienced by migrant mothers in gendered family roles over the time—the period from childhood to adulthood—spent in the host country. Various practices and strategies for childcare arrangements and education in sustaining a migrant family in the host country are discussed. Another salient question to explore is the manner in which the migrants’ ethnic culture and values inform their ethno-specific mothering practices. In this respect, the demands and aspirations of cross-cultural mothering to raise children with dual-cultural competence in both the culture of origin and that of destination are explored

Migration of nurses and doctors: pull factors to work in Saudi Arabia

BackgroundAlthough Saudi Arabia is a common destination to which nurses and doctors migrate, few studies have explored the pull factors attracting them to work in the Middle East and Saudi Arabia. This qualitative study explores the pull factors drawing nurses and doctors to work in Saudi Arabian hospitals.MethodsThe study utilized a qualitative approach with focus groups. The participants included 83 doctors and nurses at two government hospitals.ResultsFive themes (rewards, job entry requirements, religion, influence of family and friends, and changing work environments) were identified based on the 10 focus group sessions.ConclusionMoving forward, health managers should proactively plan the state of healthcare as the need for migrant healthcare workers changes.

Migration Intent of Health Care Workers during the COVID-19 Pandemic in Kosovo.

The migration of healthcare workers from developing countries to more economically developed countries is a long-standing and ongoing trend. Loss of qualified staff due to migration can negatively impact healthcare systems. Understanding factors that drive migration is essential to identifying and managing health system needs. Our study explored factors related to the migration intent of healthcare staff in Kosovo, particularly after the COVID-19 pandemic. We carried out a cross-sectional survey of healthcare workers from public and private institutions. The survey analysed the prevalence of willingness to migrate and whether willingness was affected by the pandemic, and calculated crude and adjusted odds ratios for variables which may influence migration willingness. 14.43% of healthcare workers reported aspiration to migrate, and 23.68% reported an increased chance of migrating after the pandemic. Dissatisfaction with wages and working conditions, higher education and private sector engagement were associated with increased odds of migration willingness. After the pandemic, factors related to interpersonal relationships and state response gave lower odds of migration intent. These findings point to potential factors associated with the migration of healthcare workers, which can help policymakers address gaps in national health system strategy.

Medical Brain Drain From Southeastern Europe: Using Digital Demography to Forecast Health Worker Emigration.

This paper shows that the tools of digital demography, such as Google Trends, can be used for determining, estimating, and predicting the migration of health care workers (HWs), in this case, from Croatia and the Western Balkans (WB) to Germany and Austria. This study aims to test the usefulness of Google Trends indexes to forecast HW migration from Croatia and the WB to Germany and Austria. The paper analyzes recent trends in HW mobility in Europe and focuses specifically on mobility patterns among medical doctors and nurses using digital demography. Without increased emigration in the last 10 years, Croatia and the WB would have 50% more HWs today, and this staff is now crucial in the fight against a pandemic. Furthermore, the COVID-19 pandemic contributed to the increase in emigration. A particular problem in analyzing the emigration of HCWs from Croatia and the WB is that there is no system for monitoring this process. Official data is up to 3 years late and exists only for persons deregistered from the state system. Furthermore, during the pandemic, the "normal" ways of data collection are simply too slow. The primary methodological concept of our approach is to monitor the digital trace of language searches with the Google Trends analytical tool. To standardize the data, we requested the data from January 2010 to December 2020 and divided the keyword frequency for each migration-related query. We compared this search frequency index with official statistics to prove the significance of the results and correlations, and test the model's predictive potential. All tested migration-related search queries, which indicate HCWs' emigration planning, showed a positive linear association between Google index and data from official statistics (Organisation for Economic Co-operation and Development: Serbia R2=0.3381, Bosnia and Herzegovina [B&H] R2=0.2722, Croatia R2=0.4515). Migration-related search activities such as "job application + nurses" from Croatia correlate strongly with official German data for emigrated HWs from Croatia, Serbia, and B&H. Decreases in Google searches were correlated with the decrease in the emigration of HWs. Thus, this method allows reliable forecasts for the future. This paper highlights that the World Health Organization's list of countries with HWs shortages should be updated to include Croatia and the countries from the WB. The issue of the European Union drawing HWs from the EU periphery (Croatia) and nearby countries (B&H, Serbia) clearly shows a clash between the EU freedom of movement and the right to health care and a need to ensure a health care workforce in all European regions. Understanding why HWs emigrate from Croatia and the WB, and the consequences of this process are crucial to enabling state agencies and governments to develop optimal intervention strategies to retain medical staff. The benefit of this method is reliable estimates that can enable a better response to a possible shortage of HWs and protect the functioning of the health system. The freedom of movement of workers in the EU must be supplemented with a common pension and health care system in the EU.

Health workforce protection and preparedness during the COVID-19 pandemic: a tool for the rapid assessment of EU health systems.

This article is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. The study aims to strengthen health workforce preparedness, protection and ultimately resilience during a pandemic. We argue for a health system approach and introduce a tool for rapid comparative assessment based on integrated multi-level governance. We draw on secondary sources and expert information, including material from Denmark, Germany, Portugal and Romania. The results reveal similar developments across countries: action has been taken to improve physical protection, digitalization and prioritization of healthcare worker vaccination, whereas social and mental health support programmes were weak or missing. Developments were more diverse in relation to occupational and organizational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strongest in Demark and weak in Portugal and Romania. Major governance gaps exist in relation to education and health integration, surveillance, social and mental health support programmes, gendered issues of health workforce capacity and integration of migrant healthcare workers (HCW). There is a need to step up efforts and make health systems more accountable to the needs of HCW during global public health emergencies.

Mobility and migration of health care workers

IntroductionThe estimated shortage of about 15 million health and social care professionals, including over 6 million nurses, together with the significant phenomenon of international migration of such professionals, emerged, during COVID-19, with even more evidence. During the pandemic the danger of a collapse of health systems in many areas due to a shortage of staff was manifest. In addition to this, low-income countries are witnessing a decrease in their health and social care workforce resulting in further inability to ensure essential levels of professional coverage to deal with populations' needs.MethodsAn integrative review analysis, in 4 languages (English, Italian, Spanish, French) of trend in terms of legislation and policy documents were conducted using health and social database and gray literature. 29 different document were include in this review.ResultsA number of initiatives have been developed in order to establish international and/or bilateral obligations among countries; however, this showed to be insufficient. There is therefore the need to set up a joint effort/actions among different stakeholders such as Government, Higher Education institution, International Labor health market actors, and NGOs in the field of migration, labor and training of health and social care professionals in order to better meet health and social care needs worldwide.ConclusionsIt is timely to develop specific actions aimed at setting up a passport for health and social care professionals which allows to guarantee prior certification and accreditation of skills by independent agencies; countries should work together to improve retention of health care professionals in their job. Moreover, every effort should be done to enhance younger generation interest in health and social carrier, as opportunity to really makes difference in other lives and to play an active role in the development of society.Key messages Without health and social care professionals, there is no health.Migration is a serious issues and opportunity.

Health workforce protection and preparedness during COVID-19: a rapid assessment of EU countries

Abstract Background Healthcare workers face high pressures and new threats during the COVID-19 pandemic, and health systems and governance are key to improve preparedness and protection. This study aims to introduce a tool for rapid assessment based on an integrated multi-level governance approach and to empirically explore preparedness and protection. Methods The study is explorative in nature and applies a comparative approach. The assessment tool comprises four major dimensions of governance: system, sector, occupational and sociocultural issues (focus on gender issues and migrant healthcare workers) of protection and preparedness. Secondary sources and expert information serve the empirical exercise, using material from Denmark, Germany, Portugal and Romania. Results We revealed similar developments across countries: action has been taken to improve physical protection, vaccination of healthcare workers and digitalisation, while social and mental health support programmes were poor or lacking. Developments were more diverse in relation to occupational/ organisational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strong in Demark and weak in Portugal and Romania. We are able to identify major governance gaps in relation to integration of education and health systems, social and mental health support programmes, gendered issues of health workforce capacity, integration of migrant healthcare workers, and comprehensive surveillance and monitoring. Conclusions There is a need to step up efforts and make health systems more accountable to the needs of healthcare workers during global public health emergencies.

Culturally-tailored Peer Support for Doctors and Nurses of Indian Origin

The mental health and well-being needs of healthcare workers have risen sharply, fuelled by the current COVID-19 pandemic. Migrant healthcare workers are affected not only by events in the country where they work but also by events in countries where their family and friends reside. Despite, increase in psychological distress, migrant HCWs don’t use the existing resources to support their needs.
 
 This paper summarises discussions from the workshop focusing on reasons/barriers in uptake of mental health and well-being resources in the UK, the scope of peer support initiatives and its boundaries in supporting colleagues in the UK and India. Finally, it makes recommendations on the governance structure and checklist when organising peer support for healthcare workers.

Migration of Healthcare Professionals in Post-Brexit Britain

What is the experience of migrant healthcare workers? How might this change following Brexit?
 This editorial explores the vital contributions of the migrant healthcare workers as the Architects of the NHS and recommends that it is critical to acknowledge their contribution and enhance their experience in post-Brexit Britain, for the survival of NHS as an exemplar healthcare service.

An evaluation of migration of nurses and other health care workers from Middle East to the West amidst the pandemic

This study can provide all essential information about the maintenance of migration of health care workers from the Middle East to the West. There are two effective dimensions in the diagnoses of migration of health care workers. These two dimensions are permanent and temporary, which are covered in this study. The migration of health care workers is accurately justified by their better living standards. Permanent migration of the health workers is maintained as they are high-skilled professionals. Economic development and career development aspects also justify permanent migration. Moreover, improper salary structure is treated as the primary cause behind the migration of health professionals from the Middle East to the West.

Factors influencing the migration intention of health professionals in low and middle income countries: Critical review with a theoretical model

Objective
 Migration of healthcare workers could result in shortage of human resources and rising inequalities in service provision in resource poor countries. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from low- and middle-income countries as well as introducing a practical model for health professional’s migration.
 Methods
 Google Scholar and PubMed were searched together with relevant journals for English studies from January 2005 to January 2020. The original studies which evaluated the motivational factors of dental and medical graduates migrating from low or middle income countries were included. The migration model was developed by investigating the factors and frameworks of selected studies.
 Results
 Twenty-five articles were met the inclusion criteria. Push and pull theory was the most popular way to describe the driving factors of migration. These factors were classified into three macro-, meso- and micro-level with eight key domains. Poor income, unfavorable socio-economic situation, political instability, lack of professional and educational opportunities together with family and personal concerns found as strong common reasons perpetuating migration.
 Conclusion
 Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their home countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for better quality of life improvement after migration. Once individuals could overpass their national identity and barriers of migration, the final decision toward migration would be more feasible.

How Do Migrant Nursing Home Staff Relate to Religion in Their Work With Patients Who Are Approaching Death?

AimTo investigate how migrant nursing home staff relate to religion in their care for patients who are approaching death.Method and TheoryIndividual in-depth interviews were conducted with 16 migrant health care workers from five nursing homes in Norway. The overall analytic approach was hermeneutical. The parts and the whole were interpreted in light of each other to gain a “thick description” of the data material in order to show the ways in which experiential meaning-making draws on cultural webs of sign ificance.FindingsReligion held various meanings for the migrant health care workers interviewed. Religious and cultural competence and knowledge of migrant nursing home staff was neither asked for by the management nor discussed in the staff group. The way our participants related to religion at work was therefore based on individual preferences and internalized practices.Conclusion and Implication for PracticeOrganized reflection groups among staff are needed in order to integrate and develop religious literacy in the multicultural nursing home setting. Such reflection groups can help the individual staff member to perform holistic nursing, that is, to be attentive of the interconnectedness of biological, social, psychosocial, and spiritual aspects in a human being.

The writing that nurses do: Investigating changes to standards over time

Abstract Unlike general language tests, specific-purpose tests have a greater need for updating should there be changes to context-specific language use. With near continuous inflow of migrant healthcare workers and long-standing language testing practices, the healthcare domain represents a good context for investigating the relationship between changes in the English language assessment standards and changes in the workplace. Focusing on the Occupational English Test (OET), this paper explores evidence from within the healthcare profession, and from nursing in particular, which shows that in some English-speaking jurisdictions (UK, Ireland, Australia), existing English language proficiency requirements for writing had been set at higher levels than necessary for safe and effective practice. Against this background, standard setting studies involving the OET are presented to further clarify the reasons for the recent lowering of the English writing proficiency standards. The study suggests that these changes were brought about by a combination of the original standard being too high, and, more interestingly, differences in the amount and nature of writing required of nurses in the workplace as a result of technology. The paper concludes with a discussion of the outstanding research in relation to the appropriate writing construct given the technological advances in the healthcare workplace.

Provider perspectives on contraceptive service delivery: findings from a qualitative study in Johannesburg, South Africa

BackgroundHealthcare providers’ skills and attitudes are both barriers and facilitators of contraceptive uptake. In South Africa, migration of healthcare workers and the demands of the HIV epidemic have also contributed to inequitable access to sexual and reproductive health (SRH) care. Yet, the country has committed to achieving universal access to SRH services. We explored healthcare provider’s opinions and attitudes on provision of contraceptive services in public facilities, their personal use of methods, and their thoughts on the recent integration of new contraceptive methods in their facilities.MethodsWe conducted a phenomenological, qualitative study in 2017 at an outpatient, public HIV treatment clinic and two primary healthcare clinics (PHCs) in Johannesburg, South Africa. We purposively selected providers who had worked at the facilities for at least six months and were seeing patients for HIV or SRH services. Trained study staff conducted semi-structured interviews. We conducted descriptive analyses for quantitative data, and used an iterative, thematic analysis approach for open-ended responses.ResultsWe interviewed 14 healthcare providers (HIV clinic - 5; PHCs - 9). One respondent was a man; all were nurses. All respondents reported having ever personally used a contraceptive method; half (7/14) were currently using a method. Responses on service provision were conflicting. Respondents felt that their clinics currently met the contraceptive needs of their female patients through on-site services or referrals. However, they noted that staff shortages, lack of training, and a limited contraceptive offering meant that women did not always get the counselling or method they wanted. Respondents noted that the ‘best’ contraceptive methods for women were those that fit with a woman’s lifestyle and medical needs; however, providers also felt strongly that injectables were best for all women. Recent introduction of the implant at one PHC and injectable contraceptives at the HIV clinic was not overly challenging, though there were concerns about staffing and demand creation for the new methods.ConclusionsRespondents’ conflicting responses revealed challenges with current service delivery, particularly contraceptive counselling. Addressing staff workloads and providing refresher training on contraception would contribute to increased contraceptive service capacity and quality in this setting.

Healthcare, language and a free-trade agreement: Institutional logics of on-the-job Japanese language training for migrant healthcare workers

Abstract Faced with a pressing demand for eldercare workers, Japan signed Economic Partnership Agreements (EPAs) to recruit workers from Southeast Asian countries. The EPA limits the employment period for migrant workers, unless they successfully pass the healthcare licensure examination in Japanese. Therefore, they receive on-the-job training and prepare for the examination, making their host institutions partly responsible for assisting the training and exam preparation. In this system, migrants’ Japanese ability, tested against a strict standard, is the key to their being successfully accepted as good workers. Migrant workers and their employers are thus important actors in a neoliberal logic in which mastering a specific language practice and demonstrating it on standardized tests is deemed important for one’s social mobility. To analyse how this logic is realised in a healthcare workplace, this paper draws on fieldwork data in an eldercare home employing EPA workers. The operation scheme of the EPA and institutional policy will be highlighted as underlying mechanisms for the creation of neoliberal subjects. I argue these measures primarily support the hierarchical relationships between Japanese and non-Japanese, and between employer and employee. I also discuss consequential ways in which on-the-job training has differentially impacted employment trajectories of the migrant workers.