Migration Of Healthcare Workers Research Articles

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.

BRAIN-DRAIN PHENOMENON AMONG HEALTHCARE WORKERS

Background: One of biggest challenge for health human resource is the brain-drain issue. Regardless of the push and pull factors, migration of health care workers from developing countries to developed ones, have done more harm than good on the health care deliveries in the various countries. The aim of this paper is to review and explore the factors, impacts and strategies to improve the brain-drain phenomenon among healthcare workers. Materials and Methods: A general review was conducted with the focus on the healthcare workers issues related to the brain-drain from various countries, guided by one research question; What are the brain-drain factors among the healthcare workers, its impacts and the strategies to improve the phenomenon? Relevant studies were identified. The literature searching was done based on the formulated research question from the electronic databases, PubMed, ScienceDirect and Google Scholar. Result: 14 articles were reviewed from high-, middle- and low-income countries. Focusing on the healthcare sectors, most low- to middle-income countries demonstrated the internal brain-drain issues as income-generating potential was commonly observed within the private service. However, external brain-drain was more common in high-income countries. The factors that causes brain-drain include financial rewards, continuing rewards, career development, continuing education, hospital infrastructure, resource availability, hospital management, political issues, family issues, training, education and development. Conclusion: The internal and external brain-drain phenomenon among healthcare workers were contributed by the pulling and pushing factors either from the donor countries or the receiving countries. The most common factors including income-generated potential, inadequate wages despite of poor working condition, no clear professional development and intellectual stimulation, and aggravated by the political and economic instability. A comprehensive approach needed by the policy maker and political actors to tackle these factors to improve the equity at all levels of healthcare service deliveries. Keywords: brain-drain phenomenon, brain-drain factors, brain-drain impacts, brain-drain strategies, brain-drain in healthcare.

Labour migration of doctors and nurses and the impact on the quality of health care in Eastern European countries: The case of Poland

The purpose of this commentary article is to explain the causes and effects of the economic migration of health care workers from Poland to Western countries, and to analyse the impact of the migration of doctors and nurses on the functioning of the public health system. We use data from the National Central Statistical Office, our own preliminary research, social surveys and the Watch Health Care database. Domestic data are analysed and compared with trends in Western Europe as described in Eurostat and Organisation for Economic Co-operation and Development reports. The decreasing number of active physicians remaining in the health care system results in long waits for specialist appointments. The demand for doctors from Central and Eastern Europe will continue to grow. Consequently, there will be a further outflow of medical staff from Poland and other countries in the region and the current problems with access to health care will continue. JEL Codes: I00, I11, J61

Work-related barriers and resources of migrant and autochthonous homecare nurses in Germany: A qualitative comparative study

BackgroundThere is substantial research about the occupational health of nurses worldwide. However, empirical evidence about the psychosocial health of migrant and minority nurses in outpatient settings in Germany in comparison to that of autochthonous nurses is lacking. ObjectivesThis study aims to identify work-related stressors, resources and the corresponding coping strategies of migrant and minority nurses in comparison to autochthonous nurses. Design24 migrant and 24 autochthonous nurses employed in the German homecare sector were interviewed in qualitative explorative manner while a distinction was made between non-commercial and private-commercial services. SettingsThe interviews took place in the nursing services' premises or in the nurses' private homes. ParticipantsServices were randomly chosen among all homecare providers in the second largest German federal city-state Hamburg. Nurses were invited for an interview, once their management agreed to participate in the study. Registered nurses and nursing assistants as well as those with a foreign certificate but validated or in process were eligible to participate. MethodsRelevant literature findings formed the base for the semi-structured interview guide. Key areas in the interview guide were barriers, resources and coping strategies in the collaboration with colleagues, superiors and clients as well as in the collaboration within a linguistically and culturally diverse team and clients. The conventional approach to qualitative content analysis by Hsieh and Shannon guided the analysis. ResultsRegardless of their origin or culture, nurses perceive time pressure, lifting patients, lack of appreciation or the client's personal fate as burdening. In the intercultural context, the divergent understanding of behavioral patterns as well as of nursing care and a non-functioning communication impede the collaboration within a diverse nursing workforce. Migrant and minority nurses suffer prejudices, verbal and sexual harassment proceeding from their clients. However they keep it to themselves and don't broach it to their supervisors or colleagues. The interaction with humans, the verbal exchange with colleagues and supervisors at eye level as well as the sensemaking of being a nurse helps nurses to cope with occupational stressors. ConclusionsDifferences in language is a main stressor which impedes a functioning team collaboration as well as a positive nurse-client relationship. Migrant and autochthonous nurses share similar coping strategies to master occupational burdens. A good collaboration within the team and having an appreciative supervisor are resources that support migrant and minority nurses as well as autochthonous nurses to face the stressors and to cope with those. Migrant nurses of different origin perceive their status as migrants as a sense of community by sharing commonalities. Contribution of the paperWhat is already known about the topic?•The growing demand for care due to the demographic change leads to an increasing trend to hire healthcare personnel such as nurses from abroad.•The nurses' workplace is characterized by physically and psychologically demanding tasks leading to musculoskeletal pain and job dissatisfaction.•Migrant healthcare workers experience additional stressors like discrimination practices as well acculturative stress.What this paper adds:•Migrant and Autochthonous nurses share similar coping strategies to master occupational burdens•Differences in language is a main stressor, which impedes a functioning team collaboration as well as a working nurse-client relationship. More autochthonous than migrant and minority nurses report these differences as stressful.•Migrant nurses of different origin perceive their status as migrants as a sense of community by sharing the same destiny – this appears as an important resource for migrant and minority nurses.

A pilot qualitative study of dementia perceptions of Nigerian migrant caregivers

IntroductionConcomitant with the rate at which the United Kingdom’s population is aging, the increased number of older adults with dementia, and the decrease in relatives who are available to care for these older adults, there has been an exponential rise in the need for healthcare assistants in the workforce. Since the workforce now comprises of a significant number of migrant healthcare workers, some of whom originate from developing countries like Nigeria, it is important to understand some sociocultural factors that may influence the quality of caregiving provided for older adults with dementia in the United Kingdom. ObjectiveTo gain an in-depth understanding of dementia perceptions and experiences of Nigerian migrant formal dementia caregivers. SettingNorth East England. ParticipantsSix Nigerian migrant healthcare workers employed in long-term care facilities (e.g., nursing homes) that have older adults with dementia. MethodsQualitative descriptive method embedded in symbolic interactionism, following a purposive sampling technique and recruitment to the study was used. Semi-structured interviews and thematic analysis were conducted for data collection and analysis respectively. ResultsCultural specificity, dementia awareness, and empathic witnessing were identified as the three major themes in the findings. The findings suggest that meanings given to dementia symptoms are influenced by sociocultural factors and they may ultimately affect the way people with dementia are cared for. DiscussionMinimal knowledge about dementia consequently results in minimal appreciation or regard for the seriousness and importance of dementia. When people from communities with different meanings of dementia and little knowledge of the condition become caregivers in developed countries, there may potentially be new psychological burdens that originate from the differing contextual significance of dementia and caregiving for persons with dementia.

Positive Employee Behaviors and Occupational Burnout in Healthcare Workers: Moderating Roles of Work Engagement

Positive employee behaviors (comprising organizational citizenship behavior & workplace commitment) may overstretch and lead to occupational burnout, which may compromise the functionality of health workers and their ability to provide quality service to their patients. Less research attention has focused the moderating roles of work engagement on the connections of organizational citizenship behavior and workplace commitment to occupational burnout, especially in Nigeria where manpower deficit created by the migration of healthcare workers is on the increase. This study, therefore, investigated the extent to which organizational citizenship behavior and workplace commitment are connected with occupational burnout, and how work engagement moderates such relationships in 191 healthcare workers (55 males; 136 females), sampled from 3 public hospitals in Ondo State, Nigeria. The ages of the participants averaged 34.56 years (SD = 8.52). Results of the hierarchical multiple regression indicated that organizational citizenship behavior was significantly related with increased level of occupational burnout. Work engagement was significantly related with reduced level of occupational burnout in healthcare workers. Workplace commitment was significantly connected with increased level of occupational burnout. Results of moderation test revealed that when interacted with work engagement, organizational citizenship behavior and workplace commitment were related with reduced level of occupational burnout. To sustain the efficiency and well-being of healthcare workers (especially those who engage in extra-role behaviors & are psychologically attached to the organization's goals), management of public hospitals should enhance the work engagement level of employees in order to effectively manage their level of occupational burnout.

Labour market regulation as global social policy: The case of nursing labour markets in Oman

This article examines global social policy formation in the area of skilled migration, with a focus on the Gulf Arab region. Across the globe, migration governance presents challenges to multiple levels of authority; its complexity crosses many scales and involves a multitude of actors with diverse interests. Despite this jurisdictional complexity, migration remains one of the most staunchly defended realms of sovereign policy control. Building on global social policy literature, this article examines how ‘domestic’ labour migration policies reflect the entanglement of multiple states’ and agencies’ interests. Such entanglements result in what we characterize as a ‘multiplex system’, where skilled-migration policies are formed within, and shaped by, globalized policy spaces. To illustrate, we examine policies that shape the nursing labour market in Oman during a period when the state aims to transition from dependence on an expatriate to an increasingly nationalized labour force. Engaging a case-study methodology including a survey of migrant healthcare workers, semi-structured interviews and data analysis, we find that nursing labour markets in Oman represent an example of global policy formation due to the interaction of domestic and expatriate labour policies and provisioning systems. The transnational structuring of policy making that emerges reflects a contingent process marked by conflicting outcomes. We contend that Oman’s nursing labour market is an example of new spaces where global social policies emerge from the tension of competing national state and market interests.

The intersection of culture in the provision of dementia care: A systematic review.

To understand the intersection of healthcare professionals' and care workers' culture and their provision of person-centred care for people with dementia. Due to the nature of global immigration and recruitment strategies, health care is provided by a culturally diverse workforce. Consequently, there is a need to understand healthcare professionals' and care workers' cultural values of illness, disease and dementia. Cultural values and beliefs regarding dementia and care of the older person differ, and currently, there is a lack of clarity regarding the intersection of culture in the provision of person-centred dementia care. A search of the following databases was completed: Medline, CINAHL, Psychology and Behavioural Sciences, PsycINFO and PubMed for papers published from 1st January 2006 to 31st July 2016. A total of seven qualitative studies met the inclusion and exclusion criteria, all explored the impact of healthcare professionals' and care workers' culture in relation to their provision of person-centred dementia care. A meta-synthesis of the data from these studies identified four themes: cultural perceptions of dementia, illness and older people; impact of cultural perceptions on service use; acculturation of the workforce; and cross-cultural communication. Limited evidence was found on the impact of healthcare professionals' and care workers' culture on their provision of person-centred dementia care. The intersection of culture and dementia included the understanding of dementia, care and family roles. Acculturation of migrant healthcare workers to the culture of the host country, workplace, and support with the communication was identified as necessary for the provision of person-centred dementia care. Open access education and training to support communication is required, alongside the development of robust interventions to support the process of acculturation of migrant healthcare professionals and care workers to provide culturally competent person-centred dementia care.

Migrant caregiving for family members with mild cognitive impairment: an ethnographic study

Background: Migrant families caring for family members with mild cognitive impairment (MCI) face considerable socioeconomic burden and isolation. Aim: To examine the cultural needs, beliefs and health seeking behaviours of migrant Turkish family member caregivers. Design: An ethnographic approach was used employing in depth interviews. Methods: Turkish caregivers residing in Melbourne, Australia were purposively sampled. Ten participants undertook face-to-face interviews in Turkish and English, followed by coding, transcription and thematic analysis. Results: Common themes were: (i) characteristics of MCI; (ii) care complicates our lives; (iii) beneficial coping strategies; (iv) adherence to cultural beliefs; (v) an uncertain future; (vi) interfacing with community health providers: need to understand Turkish culture (vii) need for long-term support. Migrant caregivers voiced undergoing considerable stress exacerbated by their cultural obligations. Conclusions: Establishing ethnically appropriate community support groups and advocating for a health workforce tier of representative migrant health care workers is recommended as a new role for community nurses.

New Form of National Language Policy? The Case of the Economic Partnership Agreement (EPA) in Japan

Language policies in Japan have been mainly discussed in the context of national provisions and regulations regarding the Japanese language, or foreign language education. This paper examines the possible emergence of a new national language policy, embedded in a bilateral economic partnership agreement (EPA) signed between Japan and Southeast Asian countries. Besides its economic orientation, the EPA encourages and regulates the movement of people, in particular migrant healthcare workers from the signatory countries. Under the EPA, the migrants are required to take one year of Japanese language training before they start working in Japan and are expected to pass the national licensure examinations in the Japanese language if they wish to continue to work. In order to address the EPA as a newly emerging form of language policy, I firstly identify three unique features of the EPA: its international outlook, the number of policy actors involved, and its close relationship to Japan’s immigration scheme. Second, I analyse EPA policy documents, demonstrating another distinctive feature of the EPA—the representation of language on the ‘policy-paper’ level, with a focus on preemployment Japanese language training. Third, I examine how language training under the EPA is interpreted and appropriated as a language policy and the potential influence of language ideologies in those processes. This paper concludes with a call for more investigations from the perspective of language policy and planning on implicit language policies in Japan and beyond, in particular those embedded in immigration policies.

The impact of brain drain in underserved countries: implementing a global ethical leadership approach

Purpose – Health care worker migration from underserved nations to developed nations, also known as the “brain drain” effect, is a leading cause of worldwide health inequalities. The purpose of this paper is to identify the factors which have and continue to contribute to “brain drain,” investigate the human consequences of health care worker migration, and explore the ways in which a global ethical leadership approach could be used to help address the issue of “brain drain” and its resulting deleterious effects on global health equality. Design/methodology/approach – An argument is made supporting the need for a global leadership approach that is centered on the enforcement of ethical international health care worker recruitment policies and collaborative endeavors between wealthy and underserved nations to help improve the working conditions of health care workers worldwide. Findings – The successful use of ethical leadership approaches in addressing and reversing the “brain drain” effect has been documented in Thailand and Ireland. These case examples could be used as templates for future legislative action on a global scale. Originality/value – This piece highlights the urgent need for a global ethical leadership approach to help address the issue of “brain drain” in underserved nations and provides concrete strategies to help guide legislative decision making.

Causes that Effect the Mobility of Albanian Healthcare Personnel

The healthcare system is affected by massive migration of personnel, hence one third of the Albanian population leave abroad. The migration of healthcare personnel in Albania is becoming a phenomenon that might risk the stability of the healthcare system with it’s upgrading intensity. It also contributes to lowering the quality of services rendered and at the same time reduces the necessary transfer of knowledge to the younger generations. According to the Order of Physicians of Albania, 170 Medical doctors from 2009 until 2014 have asked for certificate of “Good standing” in order to apply for a job abroad. Qualitative research performed during last year, outlines and frames the problems and causes for the migration in five basic categories: economic, professional, political, personal and social factors for migration, including questions concerning the index of satisfaction for the profession. In order to respond to the objective of the study, a qualitative approach through focus groups with experienced and young professional was considered. The aim of this paper is to understand the “push” factors which affect the mobility of Albanian healthcare personnel. The need for higher income and professional development are the main causes of migration of healthcare workers in Albania in the past several years. Doctors are exposed to threats, verbal and physical attacks and generally do not feel safe at their workplace as consequence job satisfaction is reduced. DOI: 10.5901/ajis.2015.v4n2s2p160

Challenging stereotyping and misconceptions about international HCA education

The healthcare workforce is estimated to be strategically underpinned by the contribution of a vast number of HCAs who provide front line care to patients and their families and carers. Published statistics reveal that migrant workers constitute a considerable percentage of the HCA workforce. Because of this, the need to support their capacity to provide effective and high-quality care is of paramount importance to workforce development. Alongside this, within the context of educational provision, is the need to promote the avoidance of stereotyping how people from certain international and cultural backgrounds learn. This avoids homogenising international students indiscriminately in the context of learning and teaching where the individuality they bring to healthcare provision is neither acknowledged nor valued. The capacity for the vast majority of international students to develop professionally and personally is at present largely understated in the proposals to develop healthcare assistant education. By supporting international colleagues in their roles, their commitment and sense of belonging will increase, thus impacting on the capacity of the healthcare workforce to recruit and retain valuable people with valuable skills and the personal capacity to provide compassionate care. This paper provides an overview of the issues for consideration in supporting migrant healthcare workers and the benefits this can bring to the whole HCA workforce in practice.

Ethical recruitment and employment of internationally educated paramedics

A shortage of skilled paramedics in the UK has led the London Ambulance Service NHS Trust to look overseas to help fill vacant posts. Ian Peate considers the ethical issues associated with the migration of healthcare workers and whether alternative solutions should be explored.

Cosmopolitan beginnings? Transnational healthcare workers and the politics of carework in Singapore

In recent times, the increasing scholarly interest in the contested place of the migrant in the cities of the North and South has drawn mainly on frameworks of integration, multiculturalism and cosmopolitanism. Much of the literature pays little heed to gender dynamics and accords little value in particular to the roles that female migrants play in actively shaping the urban contexts in which they live. We contend that by shifting attention to the more feminised spheres oriented towards the private sphere away from public display (including that of ‘carework’ which is increasingly performed by female migrant workers), we may be able to better glimpse cosmopolitanism at work. This is because the social relations of care provide more fertile ground for developing what Glick Schiller et al. (2011, Ethnic and Racial Studies 34 399–418) call ‘cosmopolitan sociability’. This is not to negate the findings of feminist analyses that suggest that carework, particularly in globalising cities restructured by neoliberal agendas, reproduces and extends forms of social inequalities. Indeed, even as the locus of carework shifts from local to foreign women from less developed countries, patriarchal norms and unequal gender relations are reinforced, and in fact intersect with other power geometries based on race, nationality and class. As illustration of the politics of carework, this paper discusses the place of migrant healthcare workers (primarily Chinese, Indian, Filipino and Burmese women) in institutionalised settings in the rapidly globalising city of Singapore. While their presence in the global city raises moral anxieties not only about the shift of carework from the family to outside the home, they also alert us to the possibilities and limits of a cosmopolitan approach to care transcending boundaries of race, culture, language and nationality.

"Brain drain" and "brain waste": experiences of international medical graduates in Ontario.

Background“Brain drain” is a colloquial term used to describe the migration of health care workers from low-income and middle-income countries to higher-income countries. The consequences of this migration can be significant for donor countries where physician densities are already low. In addition, a significant number of migrating physicians fall victim to “brain waste” upon arrival in higher-income countries, with their skills either underutilized or not utilized at all. In order to better understand the phenomena of brain drain and brain waste, we conducted an anonymous online survey of international medical graduates (IMGs) from low-income and middle-income countries who were actively pursuing a medical residency position in Ontario, Canada.MethodsApproximately 6,000 physicians were contacted by email and asked to fill out an online survey consisting of closed-ended and open-ended questions. The data collected were analyzed using both descriptive statistics and a thematic analysis approach.ResultsA total of 483 IMGs responded to our survey and 462 were eligible for participation. Many were older physicians who had spent a considerable amount of time and money trying to obtain a medical residency position. The top five reasons for respondents choosing to emigrate from their home country were: socioeconomic or political situations in their home countries; better education for children; concerns about where to raise children; quality of facilities and equipment; and opportunities for professional advancement. These same reasons were the top five reasons given for choosing to immigrate to Canada. Themes that emerged from the qualitative responses pertaining to brain waste included feelings of anger, shame, desperation, and regret.ConclusionRespondents overwhelmingly held the view that there are not enough residency positions available in Ontario and that this information is not clearly communicated to incoming IMGs. Brain waste appears common among IMGs who immigrate to Canada and should be made a priority for Canadian policy-makers.

Exploring the migration decisions of health workers and trainees from Africa: A meta-ethnographic synthesis

The migration of healthcare workers from Africa depletes countries already suffering from substantial staffing shortages and considerable disease burdens. The recruitment of such individuals by high income countries has been condemned by the World Health Organisation. However, understanding the reasons why healthcare workers migrate is essential, in order to attempt to alter migration decisions. We aimed to systematically analyse factors influencing healthcare workers' decisions to migrate from Africa. We systematically searched CINAHL (1980–Nov 2010), Embase (1980–Nov 2010), Global Health (1973–Nov 2010) and Medline (1950–Nov 2010) for qualitative studies of healthcare workers from Africa which specifically explored views about migration. Two reviewers identified articles, extracted data and assessed quality of included studies. Meta-ethnography was used to synthesise new lines of understanding and meaning from the data. The search identified 1203 articles from which we included six studies of healthcare workers trained in seven African countries, namely doctors or medical students (two studies), nurses (three), and pharmacy students (one study). Using meta-ethnographic synthesis we produced six lines of argument relating to the migration decisions of healthcare workers: 1) Struggle to realise unmet material expectations of self, family and society, 2) Strain and emotion, interpersonal discord, and insecurity in workplace, 3) Fear from threats to personal or family safety, in and out of workplace, 4) Absence of adequate professional support and development, 5) Desire for professional prestige and respect, 6) Conviction that hopes and goals for the future will be fulfilled overseas. We conclude that a complex interaction of factors contribute to the migration decisions of healthcare workers from Africa. Some of the factors identified are more amenable to change than others, and addressing these may significantly affect migration decisions of African healthcare workers in the future.

Reply to Hidalgo's ‘The active recruitment of health workers: a defence’ article

Hidalgo offers a novel and interesting defence of the active recruitment of health workers by organisations based in the developed world.1 His conclusions are highly controversial and run directly counter...