Impact of Migration on Health

1. Impact of Migration on Health
Kannan Srinivasan,
AMCHSS,
SCTIMST
3 December 2008

2. Organization
● Migration
● Human Resources in Health
● Migration and HR
● Migration and Health
● Migration in India

3. Human Resources in Health
● Human Resources(health workforce) is
prime in advancementsin health
● Health depends more on people to carry out
its mission
● Health workers
– Professionals
– Technicians
– Auxiliaries
● Human Resources for health are, the stock
of all individuals engaged in Promotion,
protection of population health

4. Human Resources for Health
● All men and women who work in health field
– Not just physicians and nurses but also
– Public health workers
– Policy makers
– Educators
– Clerical staff
– Scientists
– Pharmacists
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007

5. Human Resources for Health
● For every 30,000 – PHC
● PHC- 2 to 3 Physicians, 1 ISM Physician, 1
Male Health Assistant, 1 Female Health
Assistant, 1 BEE, 1F Health Worker(ANM), 1
LT, 1 Statistician, 1 Driver, 1 Store keeper
and ancillary staffs and attendants
● For every 5,000 – SC
● 1 MPW, 1 FMPW, For every 1000
Community Health Volunteer
● There are 23236 PHCs, 3346 CHCs and
146026 SCs (GoI)and Taluka, Dist Hospitals
● Population of Indiab 1,028 million (2001 Census)
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007

6. Human Resources for Health
● There are 6,43,520 Allopathic Medical prac-
titioners practicing in different states in India
registered with different MCs (76925
+23858 = 1,00,783 in Public)
● There are 55000 dental surgeons registered
with different DCs (up to 2005)
● There are 8,39,862 General Nursing Mid-
wives, 5,02,503 Auxillary Nursing Midwives
and 40,536 Health visitor and Health super-
visors(Upto 2002) Nursing Councils
● (in Public 1,79,495 – 2005)
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007

7. Human Resources for Health
● Shortages and Vacancies (2006)
– 6.5 % PHCs without Doctor
– 4.7 % of SCs without HW(F)
– 39.2 % of SCs without HW (M)
– Short fall of 19,311 MPW (F)
– Shortfall of 64,211 MPW(M)
– Shortfall of 4,214 LHV/HA
– Shorfall of 5290 HA(M)
– 4.8% MPW(F) posts vacant
– 24.1 %MPW(M) Vacant
– 13.2 % LHV/HA Vacant
– 25.4 % HA(M) Vacant
– 17.5 % Doctors at PHCs Vacant
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007

8. Human Resources for Health
● Migration of Health Personnel
● Estimation 50% of AIIMS students migrated
to overseas or to the private sector
● Around 1,00,000 doctors of Indian origin
settled in the USA and UK alone(WHO 2007)
● Around 81,091 nurses migrated to USA from
India
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007

9. Migration
● Movement of people from one place to another
has shaped today's political, social and economic
wourld and major influence on society.(Stilwell et.
al)
● In 2000 almost 175 million people or 2.9% of world
population, were living outside their country of birth
for longer than one year.
● Of these, 65 million are economically active
● It is significant for many resource poor countries as
they lose their better education nationals to richer
countries
● 65% of all economically active migrants who have
moved to developed countries are classified as
'highly skilled'

10. Migration in Health Sector
● In health, this refers to physicians, nurses,
dentists, and pharmacists
● Nurses are in high demand
● USA and UK have shortfall of nurses in 10-
20 years time. They pay high compensation
to attract
● There is an international concern expressed
about the loss of skilled health professionals
from health-care systems in poorer coun-
tries that are already weak.

11. ● For policy options for managing migration,
evidence of the magnitude of the problem
and an understanding of the context of the
labour markets is needed(Stilwell et.al.2004)
● health workers migration
● Migration of health professionals not been
studied extensively
● Last study was in 1970s
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management"
Bulletin of the World Health Organization August 2004, 82 (8)

12. Portuguese speaking African
countries to Portugal
migration
No of Physicians No of Nurses
Source country In Portugal In Source Country In Portugal In Source Country
Angola 820 961 383 14288
Guinea-Bissau 358 197 253 1299
Sao Tome and Principe 238 67 84 183
Cape Verde 231 71 40 232
Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal
Poz, "Migration of health-care workers from developing countries: strategic approaches to its
management" Bulletin of the World Health Organization August 2004, 82 (8)

13. ● Migration of health workers is primarily
demand led
● Especially to UK and USA
● Increase in number of nurses leaving the
Philippines and certain African countries
influenced by high rates of nursing vacancies
in Canada, USA, UK
● Disparities in working conditions and pay are
"pull" factors
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management"
Bulletin of the World Health Organization August 2004, 82 (8)

14. ● Survey on African countries found the factors
affecting migration
● In Cameroon
● lack of promotion opportunities, working
conditions, and desire to gain experience
were reasons for migration
● In Uganda and Zimbabwe, wages were the
most important factor
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management"
Bulletin of the World Health Organization August 2004, 82 (8)

15. ● Factors affecting health professionals'
decision to migrage from five African
countries were
● Desire to work in better managed health
system
● Desire to continue education or taining
● Want a more conducive working environment
● Desire for better or more realistic
remuneration
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management"
Bulletin of the World Health Organization August 2004, 82 (8)
●

16. In India
● A Case study
● The reasons for medical professionals want to
go abroad mainly to gain professional
experience- higly valued in India when they
come back
● Other attraction - higher earnings, perks, high
quality of life
● Nurses want to settle down abroad permanently
- career prospects are not bright in India
● Doctors some settle abroad
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703

17. Health workers
● Health workers
● Out-migration of health workers
● Dr.s and nurses from India to developed
economies
● Foreign educated (mainly Russia) returning
doctors
● the official recognition of their educational
credentials for practicing medicine in India
● AIIMS - 56% of graduating doctors migrated
between 1956 - 80 - 1992 study
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703

18. Intended reasons for out
migration
● The purpose of intended(reasons) out migration of
doctors- quoted by Khadaria study is
● to get jobjs with better training opportunities
● to ensure rapid progress in the medical profession
● to obtain a specific kind of training not easily
available in India
● to move abroad for getting god employment
opportunities
● medical experience not easily available in Inda
● to get a job with better training opportunities
overseas
● to progress at a comparale faster pace in the
professional career
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals",
OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703

19. Motivating factors
● Motivating factors for out-migration of doctors
● Better education institutions for children in host
country
● Relatives in the host country
● Easy access to communication facilities overseas
● scope for self employment / entrepreneurship
● Conducing immigration and settlement policies of
the host country
● proficiency in English language
● Satisfactory health facilities overseas
● Comparatively lower real earnings in India
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703

20. Motivating factors
● Bleak employment prospects in India
● Better professional infrastructure overseas
● Increasing employment opportunities
overseas
● To get experience that will later be highly
valued in India
● Quality of day-to-day life in host country
● Better income prospects overseas
● Availability of experts in the host country
● Higher education in the host country
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

21. ● Faourite destinations
● USA - for medical professionals
● UK - second preferred destination
● Australia - third preferred destination
● then Canada, Kuwait, New Zealand,
Germany
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

22. Specialisations
● Cardiology and internal medicine are the most
preferred specialisation for the prospective
migrant doctors for those with the USA as
destination
● internal medicine was the most preferred
specialisation for those intending to go to the
United Kingdom, and surgery was the preferred
specalisation
● Majority reported 4-6 years as intended duration
of stay overseas after their planned migration
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703

23. Doctors' perceptions
Doctors' perceptions about the Quality of
medical education and training in India
● Majority felt they were moderately satisfied
Level of satisfaction with present salary in India
● Many reported dissatisfied followed by
moderately satisfied
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

24. Nurses case study
● Majority of nurses are married - 88 %
● Half are from Kerala
● Most completed diploma in nursing
● Majority 27/36 planning for one to two years
to overseas
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

25. Source of inspiration
Source of inspiration for emigration for nurses (
in order)
● self
● friends overseas
● family
● friends in Indi
● Relatives
● Mentor/ Teacher / Senior doctors
● Career counselor
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

26. Purpose of out-migration
Purpose of intended out-migration of nurses
● better training opportunities
● obtain a specific kind of training
● Progress faster in medical profession
● get employment
● permanent settlement in host country
● research assignments
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

27. Motivating factors
Motivating factors for out-migration of nurses
● Better income prospects overseas
● Quality of day-to-day life overseas
● Better infrastructure overseas
● Better education institutions for children
● Get valuable experience
● Higher education overseas
● Increasing employment opportunities
overseas
● Relatives in the host country
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

28. Motivating factors
● Proficiency in English language
● Lower real earning in India
● Bleak employment prospects in India
● Satisfactory health facilities
● Conducive immigration and settlement
policies
● scope for self employment entreprneurship
● availability of experts in host country
● easy access to communication facilities
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

29. Preferred destination
Preferred destination countries for out-
migration of nurses( In order)
● USA
● UK
● Australia
● Canada
● African Countries
● Gulf Countries
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

30. Level of satisfaction with
education in India
Level of satisfactor with education, training,
and experience in India
● Majority were Moderately satisfied
● Level of satisfaction with present salary in
India
● Majority said moderately satisfied
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703

31. Mobility or Migration
Management