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Session I: Push and Pull Factors for Source Countries and Destination Countries

David Wright. A More Congenial Mileu": Immigration Reform and the Transnational Migration of Health Care Workers in the 1960s and 1970s
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doctorsmallDuring the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed to be national doctor and nursing shortages in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will provide an historical overview of this fundamental shift in public policy, which opened the floodgates to the widespread transnational migration of health workers.

Lisa Eckenwiler. Thinking Ecologically (and Ethically) about the Global Migraiton of Health Workers
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I will discuss the idea that an ecological approach has the richest conceptual resources for understanding the transnational flow of health personnel and its implications, and, therefore, formulating more ethical and effective remedies. I note four merits of ecological thinking: (1) it enables us to trace the multiple and complex relationships among policies-economic, trade, labor, health, and immigration-promulgated by governments, the for-profit sector, and international lending bodies-and people, that shape the lives of health workers and those in need of care; (2) it can identify patterned mobilities of the care workforce and in turn, highlight the fragile parts of the ecosystem (here, particular health systems and populations); (3) it captures the way in which the transnational organization of care work reflects and perpetuates structural injustice and allows for the assignment of obligations to remedy it; (4) it encourages a focus on the need for sustainability in health systems and populations.

Philomina Thomas. Push and Pull Factors that have led to the migration of health professionals from India
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Migrating health Professionals can be divided into the following three categories: (a)Physicians, (b)Nurses, and (c) Paramedical Staff. Each of these can be further sub-categorised according to their widely different socio-economic backgrounds. It would be quite unlikely that the same set of factors operate in the case of each of these categories and sub-categories. At most we can advance the following tentative propositions:

  1. The migrating health professionals generally come from the Indian middle classes which have shown a very high level of desire to migrate for a multitude of reasons.
  2. Physicians probably migrate for Economic Reasons and for reasons such as Professional Development and Career Advancement. Physicians are generally very highly regarded and they wield great influence in Indian society. It is likely that anger or frustration over the existing health system in India does not play such an important part in the migration decision of Physicians.
  3. The push factors that induce nurses to migrate include high levels of dissatisfaction over the way they are treated in Indian society and within the health system. Feelings of anger, frustration and powerlessness play a key part in their decision to migrate. Higher salaries abroad and the prospect of migration of the entire family to a developed, more women-friendly country induce a large number of nurses to migrate.
  4. In the case of paramedical staff nothing much is known about their migration behaviour. It is possibly the case that economic factors play the most important part in persuading paramedical staff to migrate.

Elzbieta Gozdziak. Health Care Workers from Poland: Emigration or Pendulum Migration

This presentation is based on an exploratory qualitative study of international job mobility of health care and social care workers from Poznan and vicinity. The findings indicate that the scale of health and social care workers’ "emigration" reported in the media does not correspond with the reality reported in interviews. The perception is that a much larger numbers of health care personnel emigrate than can be documented. Emigration seems to be a misnomer. There is quite a lot of job mobility among health care workers, but it amounts to short-term (3-6 months) circular/pendulum migration. Language, particularly written communication, is the number one barrier to employment outside of Poland, especially for nurses.  Language is less of a barrier for doctors. Some nurses work as social care workers in private homes on a rotational basis.  Social care workers without health care background follow a similar pattern. Because of the proximity of Poznań to Berlin, there are a number of social care workers who care for elderly patients in their homes 3-4 days a week and return to Poznań on Thursday or Friday night. The shortages of health care workers in Poland stem not from emigration but from aging of the health care personnel.

Session II: Transnational Relationships Affecting Migration of Health Professionals

Janet Hatcher Roberts. Strengthening Health Systems with Human Resources: The Case of Guyana

Objectives

Examine how the work in Guyana strengthened the human resources responsible for delivering preventive health services and treatment in targeted communities

  1. Highlight what was being done to strengthen the human resources within the overall framework of health systems strengthening and in the broader social and political environment in which we worked in Guyana; and,
  2. Discuss and illustrate how we ensured that the human resources for health were stronger as a result of the work in Guyana.

This project funded by the Canadian International Development Agency of Canada strengthened the public health system of Guyana with a particular focus on HIV and AIDS, Sexually Transmitted Diseases, Tuberculosis and Health Information Systems. A framework for approaching health and human resource sustainability within a health systems strengthening framework will be presented with discussion based on the project and country based examples.

Rick Cameron. Bridge Over Troubled Waters: Strategic Investment in the Long-Term Sustainability of Health Human Resources
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While significant strides have been made over the past decade to respond to emerging health human resources issues, a global shortage of health care workers currently exists. Seventy countries require over twenty-five million health care workers to meet the minimum health service requirements identified by the World Health Organization. The situation is expected to significantly worsen over the next decade, exacerbated by a global economic downturn. Canada and other developed nations have traditionally been dependent upon migrant health care workers from both developed and developing nations as a demand buffer to help meet their burgeoning health care needs. The US, for example, is expected to require an additional 200,000 physicians and 800,000 nurses by the year 2020. Given the expected exponential growth in demand and the diminished capacity of many nations to respond appropriately, the stability of the global health workforce will be further undermined and the competition for scare health human resources will increase significantly.

While developing countries will be hit hardest, Canada too may be caught in the crossfire. A multi-national approach is required to ameliorate the situation. As a first step, Canada and other developed nations must clarify their own roles and responsibilities at local, national and international levels. Strategic, coordinated investments in health human resources at provincial levels to help achieve and maintain an optimal stable health workforce will be required. Innovative new health human resource strategies will need to be developed to balance competing interests and to better coordinate program development and implementation that targets self-sufficiency in health human resources as the "policy of first response". Increasing professional training program enrolments to meet identified domestic needs and improving workforce retention by improving working conditions, incentives and deployment is an important place to begin. Additional research and program evaluation is required, however, to more clearly identify the necessary and sufficient conditions to achieve program success.

Alessio Cangiano. The Measurement of Health Workforce Migration: Data Availability, Quality and Use
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Data quality issues have been recognised as central to respond to the challenges of managing and planning human resources for health in developing countries. Nevertheless, statistics on migration of health professionals are often incomplete, not fully comparable, of limited use (i.e. they give only a broad description of the phenomena) and not as timely as required.

This presentation reviews the information on the availability of statistics on the international movements of health professionals, pointing to the strength, limitations and possible use of the main data sources. It consists of three main parts. First, an overview is provided of the data available from the major international statistical sources - OECD, WHO, the World Bank - as well as from datasets produced by academic studies - for instance Docquier and Bhargava (2006) and Clemens and Pettersson (2008). Second, we review and discuss the existing literature aiming to measure the impact of health professionals' migration on source countries' health systems using statistical analyses of aggregate data. Finally, a brief account of different health workforce projection approaches is provided.

Robert Huish. From Vulnerable Communities For Vulnerable Communities:Cuba's Latin American School of Medicine.

This paper demonstrates a working alternative to the accepted ethics of physician migration. Cuba's Escuela Latinoamericana de Medicina (ELAM) challenges the accepted global ethics of physician migration as its institutional ethics furnish its graduates with appropriate skills, knowledge and service ethics to deliver quality care in marginalized areas. This paper provides an analysis of how ELAM trains physicians in community-oriented service for marginalized areas in the global South. The principle finding of this analysis is that ELAM exhibits a working alternative to the accepted ethics of physician migration, as it encourages graduates to practice in marginalized communities rather than feed the migration pipeline into the North. Arguably, ELAM serves as an important case study in how a medical school's ethics can work to bring graduates closer to the communities that are in desperate need of their skills and of their compassion.


Session III: Consequences of Migration for Source and Destination Countries

DoctorsFrameSheba George. Consequences of Migration for nations and workers: A "ground-up" Approach using the case of Indian Immigrant Nurses to the United States
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Migration of health professionals can include a range of critical consequences not only at the large-scale level for the source and destination countries but also for the workers and their families on the ground. I posit that developing an understanding of health workers' experiences of migration and settlement from the "ground up" will provide valuable insights into broader processes and effects of health migration at the societal level. I will examine the case of Indian immigrant nurses in the U.S.=2 0to consider how the context of migration, socioeconomic factors such as gender, race and class, and the status of the profession not only shape their experiences of migration and settlement but also collectively reverberate into societal consequences for both sending and host societies, with some implications for policy.

Shree Mulay. Does Migration of Health Care Workers Matter for the Marginalized in India?
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Migration for better opportunities is not new. For decades, engineers, computer scientists, doctors, nurses, live-in care givers, skilled workers and temporary workers have migrated from developing to developed countries. They form a continuum those with the most coveted and high-paying jobs in the professions to the less secure semi-skilled and temporary work. Health care workers are no exception; any hospital or clinic will provide the evidence that many physicians, nurses, pharmacists, technologists and nurses' aids are from elsewhere. Research in the field of health care human resources, examine qualifications and training of migrant health care workers and their integration in the recipient countries; they are equally concerned about the brain drain of health care workers from source countries. In order to mitigate the negative impact of migration of health care professionals in developing countries it is necessary to study factors which contribute to poor retention of medical personnel in the source countries. In the case of India, migration of health care workers outside the country seems to affect medical care in the private hospitals, clinics and practices which primarily serve the urban middle class; it has little impact on the rural poor. Our research in Punjab and Haryana provinces in India on health services and health outcomes suggests that while there are government-funded public health care programs in rural areas, they are poorly staffed because they are unable to retain trained professionals in the countryside. Thus the rural poor depend on quack doctors and healers for medical problems and on traditional birth attendants for delivery of newborns. In order to develop a sustainable health care system for the marginalized people in rural India an attempt needs to be made to recruit health care workers from rural areas and develop training programs geared to their needs and level of education to meet the health needs of vulnerable populations.

Patricia Fagen. Elder Care and Migration in the Western Hemisphere
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The presentation will combine two pieces of work:

  1. A review of Jamaica which is a major Caribbean source country for health care worker migrants to the US and Canada. Jamaica has made important investments in upgrading training facilities for nurses, thereby making it easier for nurses who wish to migrate to pass exams and obtain visas. However, the upgrading also contributes to the Caribbean efforts to manage migration /within/ the region. Training facilities and managed migration are only now beginning to affect direct care workers who also migrate in large numbers.
  2. A review of the state of research on health care workers' migration patterns in the Western Hemisphere, covering South-North migrants as well as migration within the region. It addresses the consequences of migration for health care in the Hemisphere. The emphasis is on direct service care providers.

Erlinda Palaganas. Deeper Reasons for the Phillipines' Health Worker Exodus.
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Analyzing migration could be enriched by looking at deeper reasons. Globalization should be treated more comprehensively - a much wider set of social processes, including the global spread of consumerism and other cultural values, the growing sophistication of technologies of communication, the rise of international migrants' advocacy movements, and the power of such global organizations as the World Bank and the IMF and market liberalization policies they impose on many countries throughout the world. As a semi-feudal and semi-colonial country, the Philippines remains backward, agrarian and without basic industries. Under these conditions, it cannot provide jobs to its people and solve the unemployment problem. Without solving the root causes of underdevelopment, the country would not be able to develop a sustainable, self-reliant and industrialized economy. This would keep its people from going abroad in order to look for work and better opportunities.

Session IV: Program and Policy Responses to Migration of Health Professionals

Anita Alero-Davies. Engaging with the diaspora to manage the migration of health care workers and strengthening health systems in countries of origin

Health professionals have been one of the cadre of skilled professionals that have participated in global migration. International organizations and governments of industrial countries have attracted highly skilled professionals and a wealth of knowledge and skills is concentrated in a few locations. In the spirit of promoting equal access of health services to all, it is of utmost importance that mechanisms are developed to engage with health professionals in the diaspora to strengthen crumbling health systems in their countries of origin. This can be done through the transfer of knowledge and skills, and through twining arrangements between health, academic and research institutions in both sending and receiving countries.

The International Organization for Migration through its Migration for Development in Africa Initiative, (MIDA) and collaboration with both sending and receiving countries, has facilitated the physical and virtual return of diaspora health professionals to contribute towards health system strengthening in their countries of origin.

Gillian Barclay. Programs and Policies to Enhance Infrastructure and Capacity for Health Workforce Development in the CARICOM Region.

Over the past generation, the Caribbean Community (CARICOM) has been an important source of health professional manpower for the United States, Canada and the United Kingdom. This is especially evident in the fields of nursing and medicine with negative consequences such as a diminished supply of skilled health professionals to meet country and regional needs, and depletions in the strength of health systems at the country level.

This has led to the development of policy and program responses at the CARICOM level to address these consequences. These policy responses are indicative of a move to upstream approaches, are evident within the education and health sectors, cover both the public and private sectors and support managed migration policies and programs. Within the education sector, these extend beyond the discourse of health workforce supply and demand, and instead focus upon the infrastructure and capacity needs of source countries with respect to training of the health workforce, accreditation and standard setting. Other program responses include those that strengthen existing health workforce skill sets and competencies in the areas of health care management and clinical care, and which are integrated into programs to support the intraregional migration of nurses and physicians.

Deloris Russell. Push-Pull Factors of Health Worker Migration: How a little human resource support can go a long way.
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South Africa has the largest number of persons living with HIV in the world. At the end of 2007, there were approximately 5.7 million people living with HIV and almost 1,000 AIDS deaths occurring every day. Average life expectancy decreased from 64 to 54 years. Hospitals are struggling to cope with the number of HIV-related patients that they care for. In 2006 it was estimated that HIV-positive patients would soon account for 60-70% of medical expenditure in South African hospitals.

The Canadian Nurses Association and the Democratic Nurses Organization of South Africa implemented a "Caring for the Caregiver model which utilized workplace HIV campaigns, information sessions and peer group support services to reduce the impact of HIV on the health profession. Findings indicate an increase in willingness to be tested for HIV, an increase in knowledge and an increase in personal well-being as a result of participating in the program. Greater workplace satisfaction can lead to increased willingness to not migrate.

Ron Labonte. Managing HHR Flows for Health Equity: Riding the rapids? Building better dams? Reversing the tides?

A number of policy options (national, bilateral, multilateral) have been suggested to manage migration more effectively. Little seems to work. What options could work (equity at the core)? What options might work (pragmatism at the core)? Which options are most likely to gain support and do they really matter (realpolitik at the core)?

Poster Presentations

Jelena Atanakovic, Rishma Paripia, Jane LeBrun, Judi Winkup, Ahmed Rashid, Ivy Lynn Bourgeault. The Role of Immigrant Care Workers in Aging Societies

Ivy Lynn Bourgeault, Rishma Parpia, Nadia Oryema, Husain Gulumhusein. Keeping Their Health Workers: "Source" Country Perspectives on Self Sufficiency

Abel Chikanda. Medical Migration from Zimbabwe: Trends and Impacts

Raywat Deonandan. The Epidemiology of International Medical Graduates in Canada

Veronica Patience Fynn. Outside the Grim of Push and Pull Factors: A Forced Migration Perspective

Yvonne LeBlanc, Johana Geraci, Rishma Parpia, Judi Winkup, Elena Neiterman, Ivy Lynn Bourgeault. Comparing Perspectives on the Role of Internationally Educated Health Professionals in Canada, USA, UK & Australia

Elena Neiterman, Ken Viers, Jane LeBrun, Judi Winkup, Elena Neiterman, Ivy Lynn Bourgeault. Reflecting on the Experiences of IEHPs in Canada

Brenda Ogembo. Push, Pull, Stick and Stay Factors: Exploring Policy Options in Managing Physician Migration from Uganda

Nadia Oryema. Health Human Resources: Comparing Self-Sufficiency and International Partnerships in Canada and Malawi

Joana Ribeiro. From Brain Waste to Professional Recognition: The Pathways of Internationally Educated Doctors and Nurses in Portugal

Mark Staz. Ethical Issues in Health Worker Recruitment and Migration


Last Updated on Thursday, 22 October 2009 13:53