Out-Migration/Brain Drain

In response to recent findings regarding migration of health workers out of Africa, we provide data from a survey of Indian nurses suggesting that up to one fifth of the nursing labour force may be lost to wealthier countries through circular migration. [abstract]

This presentation details the issues of migration and retention in Swaziland.

The International Council of Nurses expressed concerns regarding the aggressive international recruitment of nurses and maintained that internationally recruited nurses might be particularly at risk of exploitation or abuse. The purpose of this study was to explore and describe how recruitment agencies contributed to the emigration of South African nurses. [adapted from abstract]

The global shortage of nurses, creating opportunities for South African nurses to work in foreign countries, as well as a variety of factors related to nursing, health care and the general living conditions in South Africa influence nurses’ decisions to emigrate. The purpose of this study was to explore and describe the factors that influence nurses’ decisions to emigrate. [from abstract]

This presentation on the domestic training and international recruitment of health workers was offered during a dialogue hosted by the WHO and OECD.

This introductory presentation on migration and other health workforce issues in a global economy was offered during a dialogue hosted by the WHO and OECD.

Most healthcare in the UK is delivered through the National Health Service (NHS). Shortages of skilled staff led to policy changes including international recruitment of health professionals. Subsequent changes in the UK migration policy have impacted international recruitment, leading to a significant reduction in the inflow of international clinicians to the NHS. [adapted from summary]

Italy’s aging population is placing a strain on the public health system. Care for the aged has increasingly been delegated to informal immigrant workers. However, international migration will not be sufficient to solve Italy’s health care professional needs. [adapted from summary]

This OECD report examines the role played by immigrant health workers in the Canadian health workforce, as well as the interactions between migration policies and education and health workforce management policies. [adapted from introduction]

The recruitment of health care practitioners from developing to developed countries is an important topic in global health ethics. This paper examines the emergence of the debate over what is now popularly called the “Brain Drain” – the migration of physicians from developing to developed countries and between industrialized nations. [adapted from abstract]

This article describes the achievements of 11 Sudanese-Canadian physicians who completed medical training and returned to Southern Sudan to practice. Few internationally educated physicians are prepared to return to a homeland as challenging as Southern Sudan; this goes against the globally entrenched flow of physicians migrating from developing to developed countries. [from introduction]

This brief considers the policy implications in Europe of the international migration of health workers and addresses the question of how the migration of health service professionals can be managed in ways that reduce any negative effects on supply. [from executive summary]

The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States reflects the mutual recognition of stakeholder interests relevant to the recruitment of foreign educated nurses. It is based on an acknowledgement of the rights of individuals to migrate, as well as an understanding that the legitimate interests and responsibilities of nurses, source countries, and employers in the destination country may conflict.

This study was conducted to identify determinants, benchmarks and indicators of the costs and benefits and distributional impact of the migration of human resources for health on health services in Kenya and to make policy proposals for intervention. [from abstract]

This paper examines health workforce and migration policies in New Zealand, with a special focus on the international recruitment of doctors and nurses. [from abstract]

Balancing medical workforce supply with demand requires good information about factors affecting retention. Overseas qualified doctors comprise 30% of the National Health Service workforce in England yet little is known about the impact of country of qualification on length of stay. We aimed to address this need. [from abstract]

The so-called brain drain is a complex phenomenon with a web of push-pull factors determining final outcomes. There are no quick fixes. Yet, those on the front lines addressing the critical personnel shortages in South Africa’s public health system - especially in rural areas - have pointed to approaches that could slow the exodus and eventually turn the situation around. [from author]

This paper aims to present the existing HRH problems exemplified by migration in the light of other related issues such as the nurse medic phenomenon, foreign doctors taking up residency training, quality of nursing education, paradoxical enrollment trends in nursing and medicine and the effects of migration on health service delivery.

This is a review of current multi-lateral agreements, codes of practice, bilateral agreements, regional agreements, and strategies and position statements that govern the migration of health workers from ESA (East and Southern African) countries. The main purpose of this paper is to provide an overview of the current situation in ESA. [from executive summary]

This report summarizes the results of the first year of the two-year project entitled International Recruitment of Nurses to the United States: Toward a Consensus on Ethical Standards of Practice. It examines the structure and basic practices of the U.S. based international nurse recruitment industry. The purpose of the project is to facilitate consensus among stakeholders on how to reduce the harm and increase the benefits of international nurse recruitment for source countries and for migrant nurses themselves. [from author]

The Canadian health care system is one of the places where push comes to pull in terms of attracting health care professionals from sub-Saharan Africa. The authors call this the perverse subsidy: the costs of training these professionals are paid for by poorer people in poorer countries. The pull to Canada is equally a push from Africa. Reflections on a pilot study on a labour mobility issue that is equally a question of conscience. [from author]

This editorial describes the widespread recruitment of health workers from sub-Saharan Africa to developed nations by recruiting agencies. The authors describe international efforts to criminalize this practice and express concern at the continued practice of recruitment.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study done to analyze health worker perceptions of renumeration and determine the factors that affect the mobility of the health workforce in Burkina Faso

This presentation was given at the First Forum on Human Resources for Health in Kampala. It outlines HRH in the eastern Mediterranean region, trends in international nurse migration, and the Lebanese context. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It outlines the micro-economics of health worker behaviour and discusses a study done to evaluate migration in Ghana.

This article discusses the challenges related to preventing the out-migration of health care workers from the developing world. Experimental policies and best practices are outlined. The authors call for new policies to be created to encourage health workers to remain at home.

This study explores the views of nursing students in Uganda to assess their views on professional practice options and their intentions to migrate to wealthier countries. The surveys show that most students would like to work outside of Uganda. The authors conclude that nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda. [adapted from author]

This study shows that graduates from higher quality institutions account for a disproportionately large share of emigrating physicians in India. Even within high-end institutions, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. The findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel. [adapted from author]

It has been shown that, internationally, medical students of rural origin are more likely to practice in a rural area after graduation, but this has not been demonstrated in South Africa before. This study aimed to investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural origin students are currently practicing in a rural area. [from abstract]

In order to highlight the driving forces determining the international allocation of medical personnel, the cases of four countries (the Philippines and South Africa as source countries, and Saudi Arabia and the United Kingdom as destination countries) are examined. The paper concludes that changes in demand generated in major destination countries determine the international allocation of medical personnel at least in the short run. [from abstract]