migration of health workforce

1. Migration of health workforce
Presented by : Sharmistha Sharma

2. Introduction
Health workers are all people primarily engaged in
actions with the primary intent of enhancing health. [1]
This includes [1] ;
• physicians,
• nurses and midwives, also laboratory technicians, public
health professionals,
• community health workers, pharmacists, and all other
support workers whose main function relates to delivering
preventive, promotive or curative health service

3. Contd..
• Human movement from one area to another area is a natural
phenomena and this movement is predominantly due to
economic and social reasons.[2]
• With globalization and increasing needs migration of health
professionals is also increasing from poor countries to richer
developed countries.
• Health workers are the core of health systems: without health
workers there is no health care

4. Health workers in all sectors[2]

5. What motivates health workers migration?
Push factor [1,2] Pull factor [1,2]
low employment opportunity
Low wages, poor living conditions
Lack of schooling for children
Lack of promotion prospects, poor and
unsupportive management, and high level
of violence/insecurity/
Terrorism
Improved employment opportunities
and/or career prospects
Higher income, better living conditions
better remuneration, upgrading
qualifications
safe environment and family-related
matters

6. Global scenario
• In 2006 , WHO stated that globally there was a shortage of
almost 4.3 million doctors, midwives, nurses, and other health
workers. [2]
• WHO estimated a gap of 7.2 million professional health
workers in 2012, set to rise to 12.9 million over the next
decades.[1]
• WHO Region of the America with 10% of the global burden
of disease, has 37% of the world’s health workers[1]
• The African Region has 24% of the burden but only 3% of
health workers [1]

7. • South-East Asia is home to approximately 25% of the world's
population with almost 30% of the global disease burden, but it has
only 10% of the global health workforce . [4]
• The World Health Report 2006 demonstrates that a minimum of 2.3
health workers per 1000 population is needed to meet health related
MDGs , where Nepal is far from meeting the threshold (0.7 HWs
per 1000 population). [1]
• Nepal has been identified by the WHO as one of 57 nations with a
critical shortage of health workers.[5]
• Two-thirds of health staffs are working in either the Kathmandu
Valley or in other cities, leaving rural areas under-staffed, with
absenteeism a growing problem [6]

8. Percentage of career development
opportunities of HWs
Source [6] : Health resource information center

9. Effects of health workforce migration [7]
Cost
• Shortages in domestic healthcare service capacity
• Some administrative costs involved
• Financial loss in investment of training and educating the
workforce
• Financial loss of consumption and tax receipts
• Decline in morale and commitment among remaining
workers
• Loss of expert knowledge in academia and education
centers
• Loss of role models for young students

10.  Benefits
• Remittances received from people working abroad
• Relief of supply shortages
• Improvements in skills of returnees
• Improved quality of healthcare
• Tax receipts from foreign workers

11. Policy to control health workers migration[8]
A. Fifty-seventh world health assembly (WHA) in 2004 adopted a
resolution to urge member countries to develop strategies
– to mitigate the adverse effect of migration of health workers
– to develop policies that could provide incentive for health
workers to remain in their countries
A. The WHO Global Code of Practice on the International
recruitment of Health Personnel is a voluntary protocol that sets
principles and recommendations for health workers and
associated stakeholders concerning migration.
- It serve as a policy framework for addressing the health
workforce crisis at a global scale.

12. The key components of the code are :
1. Commitment to assisting countries facing critical health
workforce shortages.
2. Investment in information systems to monitor international
migration of health workers.

13. Contd..
3. Emphasis on education and efforts to retain health
workforces in member states
4. Protection of migrant worker’s rights
4. Responsible recruitment by destination/receiving countries
and fair treatment of migrant health workers

14. Conclusion
• The phenomenon of health workforce migration can be taken
as global health issue .
• The migration of skilled health workforce has adverse effects
and potential negative impacts on health systems of the
country.
• Health workers worldwide are becoming increasingly mobile,
connected, and aware of the opportunities in other, more
affluent countries

15. • Developing countries should focus on investing in human
resource development, on education and primary care to
improve better working environment

16. References
1. World Health organization. The world health report
2006:working together for health. World Health Organization,
Geneva .
2. Khan A J. Migration of health personnel and its impact on
health systems in developing countries. J Ayub Med
Coll.2007;19(4)
3. World Health organization. Increasing access to health workers
in remote and rural areas through improved retention :
background paper. World health organization , Geneva. 2009
Feb .
4. Connell, J 2010, Migration of health workers in the Asia-
Pacific region,Human Resources for Health Knowledge Hub,
University of New South Wales, Sydney.

17. Contd..
5. Joint Learning Initiative Global Equity Initiative Harvard, Human
Resources for Health: Overcoming the Crisis
6. Human Resource Information Center, Ministry of Health and
Population Report . Kathmanu .2008
7. Aluttis C . The workforce for health in a globalized context
global shortages and international migration : review article .
Global health action . 2013 Dec.
8. World health organization . WHO Global Code of Practice on the
International Recruitment of Health Personnel: Sixty-third World
Health Assembly. World health organization, Geneva . May
2010.

18. Thank you