Migration Of Healthcare Workers Research Articles

Global healthcare professional migration: a blessing or a curse?

Numerous studies have been conducted on global health worker migration since the 1960s. Various ideas have been put forward on how to control the migration, but no concrete steps have been finalised on how the developed recipient countries can compensate the developing donor countries. In this editorial, I will attempt to review some of the issues responsible for the inaction in addressing this continuing global phenomenon. The lack of a robust health workforce operating in stable delivery infrastructures undermines effective domestic health systems and global public health interventions. 1 The 2010 World Health Organization report on migration of healthcare workers reiterates the fact that there is generally a global shortage of qualified and highly skilled healthcare workers, and this is exacerbated by the disproportionate flow of emigration and immigration from poor to rich countries, which is threatening global health. 2 The report indicates that the consequences have been dire for resource-poor countries, including financial and human resource loss, health system weakening, and failure to provide essential public health interventions.

Human capital contracts for global health

Human capital contracts for global health

The “Brain Drain” of Health Care Workers: Causes, Solutions and the Example of Jamaica

Despite much media attention being given to the physician shortage in Canada in recent years, this shortage pales in comparison to that seen in many middle- and low-income countries. A major cause of the shortage in these countries is the migration of health care workers from developing to developed nations, a phenomenon known as the "brain drain". The loss of these workers is having devastating impacts globally, particularly in Sub-Saharan Africa and the Caribbean. Causes of the "brain drain" are numerous and include poor working conditions in poorer countries and active recruitment by richer countries. Jamaica has been one of the countries in the Caribbean hardest hit by mass migration of health care workers. The multiple dimensions of Jamaica's health worker "brain drain" illustrate both the complexity of the issues reviewed in this commentary, and the net loss for low- and middle-income countries. Creative and sustainable solutions to the problem are actively being sought globally, but will require commitment and support from all nations as well as from international funding bodies if meaningful impacts on health are to be realized.

The evolution of global health teaching in undergraduate medical curricula.

BackgroundSince the early 1990s there has been a burgeoning interest in global health teaching in undergraduate medical curricula. In this article we trace the evolution of this teaching and present recommendations for how the discipline might develop in future years.DiscussionUndergraduate global health teaching has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalization, cross-border movement of pathogens and international migration of health care workers. This teaching has many different strands and types in terms of topic focus, disciplinary background, the point in medical studies in which it is taught and whether it is compulsory or optional.We carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that this teaching is rising in prominence, particularly through global health elective/exchange programmes and increasing teaching of subjects such as globalization and health and international comparison of health systems. Our findings indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance.We suggest that there are three types of doctor who may wish to work in global health – the ‘globalised doctor’, ‘humanitarian doctor’ and ‘policy doctor’ – and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special overseas doctor track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study.SummaryWe argue that teaching of global health in undergraduate medical curricula must respond to changing understandings of the term global health. In particular it must be taught from the perspective of more disciplines than just biomedicine, in order to reflect the social, political and economic causes of ill health. In this way global health can provide valuable training for all doctors, whether they choose to remain in their countries of origin or work abroad.

Miniaturization and globalization of clinical laboratory activities

Clinical laboratories provide an invaluable service to millions of people around the world in the form of quality diagnostic care. Within the clinical laboratory industry the impetus for change has come from technological development (miniaturization, nanotechnology, and their collective effect on point-of-care testing; POCT) and the increasingly global nature of laboratory services. Potential technological gains in POCT include: the development of bio-sensors, microarrays, genetics and proteomics testing, and enhanced web connectivity. In globalization, prospective opportunities lie in: medical tourism, the migration of healthcare workers, cross-border delivery of testing, and the establishment of accredited laboratories in previously unexplored markets. Accompanying these impressive opportunities are equally imposing challenges. Difficulty transitioning from research to clinical use, poor infrastructure in developing countries, cultural differences and national barriers to global trade are only a few examples. Dealing with the issues presented by globalization and the impact of developing technology on POCT, and on the clinical laboratory services industry in general, will be a daunting task. Despite such concerns, with appropriate countermeasures it will be possible to address the challenges posed. Future laboratory success will be largely dependent on one's ability to adapt in this perpetually shifting landscape.

Urgent need for human resources to promote global cardiovascular health

The World Health Organization estimates the existence of a global shortage of over 4 million health-care workers. Given the growing global burden of cardiovascular disease (CVD), the shortfall in global human resources for health (HRH) is probably even greater than predicted. A critical challenge going forward is to determine how to integrate CVD-related human resource needs into the overall global HRH agenda. We describe the CVD implications of core HRH objectives, including coverage, motivation, and competence, in addition to issues such as health-care worker migration and the need for input from multiple stakeholders to successfully address the current problems. We emphasize gaps in knowledge regarding HRH for global CVD-related care and research opportunities. In light of the current global epidemiologic transition from communicable to noncommunicable diseases, now is the time for the global health community to focus on CVD-related human resource needs.

Brain-drain and health care delivery in developing countries.

Migration of health workers ‘Brain drain’ is defined as the movement of health personnel in search of a better standard of living and life quality, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. The debate about migration of health workers from the developing to the developed world has remained pertinent for decades now. 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 developing countries. This article reviews the literature on the effects of cross-border migration of health care professionals.

A vision and compass for healthcare leadership: Lessons from the migrant nurse resolution for recurrent nursing shortages

A vision and compass for healthcare leadership: Lessons from the migrant nurse resolution for recurrent nursing shortages Deleise S Wilson, Richard W Redman, Kathleen M PotempaSchool of Nursing, University of Michigan, Ann Arbor, MI, USAAbstract: The ways migrant health care workers have been used internationally over the past decades demonstrates, in part, the global factors and effects of institutional leadership decisions. This example is especially illustrative in nursing given decades of the recruitment and exportation of nurses. The lessons for leadership in nursing may inform leaders in other health professions.Keywords: health care leadership, leadership decisions

From boutique to basic: a call for standardised medical education in global health

From boutique to basic: a call for standardised medical education in global health

Agency and Responsibility in Health Care Worker Migration

Snyder (2009) correctly identifies the most important ways in which the term ‘poaching’ is misleading when it is used to characterize social responsibilities in the context of health care worker (H...

The Impact of Global Inequities on Health Professional Migration

Health determinants and how they are distributed have an important impact on health systems around the world. Nurses can play a significant role in mediating the effects of many of these determinants both inside the health care system and outside. Yet the areas that have the greatest health inequities and heaviest disease burdens have the fewest health workers. A number of efforts are underway to understand and manage health care worker migration. Intersectoral collaboration is key, as are other factors necessary to build strong health systems, including research for development, capacity-building, integrated health systems, evidence-based decision-making, a strong and vibrant civil society and accountability and transparency in the public and private sectors.

Anal fistula: an unusual presentation of tuberculosis in a migrant health care professional

We present a case of a young health care professional from the Indian subcontinent, who presented with a low anal fistula and underwent exploration, debridement and fistulotomy twice. The initial working diagnosis was Crohn's disease. However, Mycobacterium tuberculosis, fully sensitive to all first-line drugs was cultured from the specimens sent from the second surgical procedure. On initiation of anti-tubercular therapy the symptoms improved within 5 weeks. The origin of the patient, high index of suspicion for non-infectious reactivation of tuberculosis in migrant health care workers, importance of a proper history taking including previous exposure and diagnostic workup is stressed.

The impact of the migration of health care workers on the countries involved: the Romanian situation

The impact of the migration of health care workers on the countries involved: the Romanian situation

Restrictions on health worker migration proving problematic

Everybody's working on it, but it's a complex problem and much more needs to be done. ![Figure][1]</img> Restricting migration of health care workers from the developing to the industrialized world is perceived by many human rights experts as a violation of an individual's right to migrate to a

An overview of the world's medical schools

Background: In the past several years, there has been a rapid expansion in the number of medical schools. Presently, there are over 1,900 operating medical schools in the world, located on six of the seven continents. Regrettably, other than for select countries and regions, relatively little is known about the characteristics or the quality of these institutions.Description: The International Medical Education Directory (IMED) provides an accurate and up-to-date resource of information about medical schools. Based on current listings in IMED, the geographical distribution of medical schools does not mirror the regional population. The Caribbean, with a total population of less than 40 million, has 54 operating medical schools. In contrast, of the 57 African nations, 16 did not have a single medical school.Conclusions: Given the physician's role in the healthcare team, the challenges presented by migration of healthcare workers, and questions concerning the adequacy of existing institutions to meet healthcare needs, developing and maintaining accurate and detailed information on the world's medical schools and their graduates is paramount.

Data on the migration of health-care workers: sources, uses, and challenges.

The migration of health workers within and between countries is a growing concern worldwide because of its impact on health systems in developing and developed countries alike. Policy decisions need to be made at the national, regional and international levels to manage more effectively this phenomenon, but those decisions will be effective and correctly implemented and evaluated only if they are based on adequate statistical data. Most statistics on the migration of health-care workers are neither complete nor fully comparable, and they are often underused, limited (because they often give only a broad description of the phenomena) and not as timely as required. There is also a conflict between the wide range of potential sources of data and the poor statistical evidence on the migration of health personnel. There are two major problems facing researchers who wish to provide evidence on this migration: the problems commonly faced when studying migration in general, such as definitional and comparability problems of "worker migrations" and those related to the specific movements of the health workforce. This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources, and other challenges that need to be met to obtain good evidence on the migration of health workers. This paper also proposes methods to improve the collection, analysis, sharing, and use of statistics on the migration of health workers.

Migration of health-care workers from developing countries: strategic approaches to its management.

Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries. Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration.

Nurse migration: let's tackle the real issues.

Migration of health care workers is on everyone's mind these days. This is especially so after the 2004 World Health Assembly resolution citing the severity of the problem, particularly for developing countries, and setting out a series of actions for the World Health Organization (WHO) and countries to take in addressing the problem. These actions include better information and information management, effective retention strategies, and stronger planning processes. The Assembly agreed that the theme for World Health Day in 2006 would be Human Resources for Health Development and that WHO would consult within the United Nations on the possibility of declaring a year or a decade of Human Resources for Health Development. The resolution, which follows work that ICN, WHO and a number of other agencies have been doing – and continue to do – is expected to generate an enhanced WHO program of work on migration. It offers new platforms for all of us to draw attention to the migration issues important to nurses and nursing. As ICN pointed out in its intervention during the Assembly, migration is a major factor contributing to the global nurse shortage. It is a symptom of dysfunctional health systems and not the primary disease. No matter how desirable the ‘pull’ factors attracting nurses to other countries, there must be strong ‘push’ factors in their home countries. We believe emphasis must be given to retention measures in both developed and developing countries. In too many countries today there is a critical shortage of nurses willing to work under the present pay and working conditions offered. And this shortage is not limited to clinical practice. It also includes the nursing faculty needed to prepare future generations of nurses. There is in fact a paradox in industrial and developing countries alike. Today nursing shortages exist side-by-side with the unemployment of thousands of nurses. As well, there are large pools of locally trained registered nurses who choose not to work in the health sector. Creating viable work practices, supportive infrastructures and targeted incentives in these countries would encourage inactive nurses to return to health care facilities and decrease the demand for professionals from other countries. In some developing countries nurses may have to wait nine months before being paid. In countries offering special allowances for scarce skills or placement in rural areas, nurses not only receive relatively poor salaries when compared with other health sector professionals, but they also receive lower percentages of salary for these allowances. The message that their contribution to the health sector is not equally valued is demoralizing and insulting. It is not surprising that nurses consider migrating, either temporarily or permanently. ICN is clear that any strategy must incorporate the benefits of temporary mobility as well as the potential threats of permanent migration. The very nature and magnitude of migration is unclear because there has been no systematic attempt to collect the relevant data. There is a real need for comprehensive information systems. ICN also believes that innovative retention approaches must be found. This includes providing free HIV/AIDS care to nurses, other health care workers and their families. Mechanisms should be considered to direct donor aid to financing salaried positions within health systems in crisis and for expanding training facilities. Ethical recruitment principles are the same in international and intranational contexts. Decent working conditions, safe work environments and equal pay for work of equal value are nurses’ minimum expectations. Condemning nurses to work in substandard conditions and attempting to ban the emigration of nurses are unacceptable options. Retaining nurses in active practice is key to resolving the present nursing crisis, both in the industrialized world and in developing countries. Equally importantly, the retention of nurses encourages and facilitates the recruitment of future nurse professionals. We need to make the workplace safe, just and attractive to current and future nurse professionals.

GATS and the Education Service Industry: The Politics of Scale and Global Reterritorialization

One consequence of the hype around globalization and education and debates on global political actors such as the World Bank, IMF and WTO—is that there has not been sufficient attention paid by education theorists to the development of a rigorous set of analytic categories that might enable us to make sense of the profound changes which now characterize education in the new millennium. 1 This is not a problema confined to education. Writing in the New Left Review, Fredric Jameson observes that debates on globalization have tended to be shaped by “…ideological appropriations— discussions not of the process itself, but of its effects, good or bad: judgements, in other words, totalizing in nature; while functional descriptions tend to isolate particular elements without relating them to each other.” In this paper we start from the position that little or nothing can be explained in terms of the causal powers of globalization; rather we shall be suggesting that globalization is the outcome of processes that involve real actors—economic and political—with real interests. Following Martin Shaw, we also take the view that globalization does not undermine the state but includes the transformation of state forms; “…it is both predicated on and produces such transformations.”3 Examining how these processes of transformation work, however, requires systematic investigation into the organization and strategies of particular actors whose horizons or effects might be described as global.

Time-capsule thinking: the health care workforce, past and future.

The size and shape of the U.S. health care workforce are in constant evolution. Using the metaphorical device of a time capsule, this essay examines the past and future of the workforce. It traces the growth, specialization, and diversification of health care workers during the twentieth century, emphasizing the particular expansion of the nonmedical aspects of the workforce. Looking ahead, the paper examines technology, informatics, nursing, provider distribution, and the global migration of health care workers as pivotal issues for the future of the workforce.