CIHR/IGH CHAIR IN GENDER, WORK & HEALTH HUMAN RESOURCES

Global Migration of Health Workers:

Impact on Requirements for Competency

Assessment

Health Professional Migration Problematics

• Health professional migration is not a new phenomenon …– …and the role that internationally

educated health professionals play in some health systems has always been important,

• … but there has been a shift in pace and of source and destination countries

– …which has increasingly raised

ethical and other concerns

Health Professional Migration Problematics – Source to Destination Countries

• …a more complex picture [From Diallo (2004)]

Migration ‘Regulatory’ Tool:WHO Global Code of Practice on the International Recruitment of Health Personnel

• The Code includes articles advocating the establishment or strengthening of health personnel information systems, including health personnel migration and its impact on health systems, and the collection, analysis and translation of data into effective health workforce policies and planning in countries.

• Strive for self-sufficiency

• Treat émigré health workers equally to domestically trained workers

• Transparency, fairness and mutuality of benefits in recruitment

Migration of Health WorkersSource Country Perspectives

Bifurcation of concerns

• … coping with the consequences of out migration of needed human resources for health

• … whereas some (most notably the Philippines and India) are using the migration of health workers as a ‘development’ tool

Migration of Health WorkersSource Country Perspectives

• Proliferation of (mostly private) nursing schools in both India & the Philippines

– nursing education seen as opportunity to escape poverty.

– Higher incomes and remittances are a key reason for migrating.

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Training Program

Distribution of public/private nurse training in India, 2012

Public Private

Total: 46,719

Total: 80,245

Total: 22,655

Total: 10,026 Total: 3,737

Total: 109,224

Data source: Indian Council on Nursing (2012)

Migration of Health WorkersSource Country Perspectives

• Training is not intended for export but meant for domestic market – BUT noted that curriculum is focused on teaching nursing care in international contexts.

• Migration of nurses across international boundaries to other fields than nursing, including care work - ‘deskilling’ of migrant health workers.

Sask. attractive to Filipino nursesProfession a 'visa' for life in new country

Star Phoenix

March 17, 2008

"Nursing is universal. Basically, the general principles are there. It's just a matter of doing it,“ said Mendoza, who trained as a nurse in the Philippines and moved to Saskatoon about 18 months ago.

Implications for Competency Assessments

• Assessing equivalency

– Role of regulation is to protect the public

• High quality through standards

• Sufficient numbers? Access?

Migration of Health WorkersDestination Country Perspectives

Part of the debate is on the issue of safety/quality

e.g., 1. the temporary licensure program in Australia

○ due in large part to a recent celebrated case of Dr.

Death in Queensland

But there is evidence of comparable care

o Ko et al (2005) Quality of Care of International

and Canadian Medical Graduates in Acute

Myocardial Infarction. Arch Intern Med

Destination Country Perspectives BARRIERS TO LABOUR MARKET INTEGRATION

• Common across all professions:

– Language skills and profession specific language

– Place of origin/practice differences

– Financial difficulties

– Time

– Bureaucracy

– Cultural Competency

Health Professional Migration Problematics – Source & Destination Countries

• Keeping in mind that ‘source’ and ‘destination’ country is not a clear distinction– Some countries can be

both source and destination

– Also need to consider ‘chain’ migration as a series of source and destination country relations

Source: OECD (2007)

Key Take Home Messages

• The migration of health workers is an increasingly complex and increasingly ‘marketized’ phenomenon

• The implications for competency assessment in destination countries are marked

• Policies, programs and process need to be aware of the broader international context for fair, equitable and safe practices

For more information, copies of reports & update on progress please go to:

www.healthworkermigration.com

Thank you