WHY HEALTH CARE WORKERS MIGRATE AND HOW THEY ARE CREATING AN OCCUPATIONAL DIASPORA

Transcription

1 WHY HEALTH CARE WORKERS MIGRATE AND HOW THEY ARE CREATING AN OCCUPATIONAL DIASPORA Noreen M. Sugrue Women and Gender in Global Perspectives University of Illinois at Urbana-Champaign Carole Kenner College of Nursing University of Oklahoma Health Sciences Center 1

2 Outline The focus and two main arguments of our paper Health Care Workers (HCW) and their migration Why so much emphasis is placed on this topic Expanding how we understand and analyze HCW migration Focus on HCW who migrate and those who do not migrate Think of the migration of HCW as an occupational diaspora An alternative model for understanding HCW migration Policy implications of our work 2

3 Focus of Paper This paper is aimed at rethinking how HCW migration is understood and the correlated policy implications 3

4 The Two Main Arguments of The Paper Move away from economic and labor market models of explanation for HCW migration to a model that incorporates those concerns but also highlights the sociological and micro level motivations for why people leave There is too much focus on those who migrate To fully understand and address the HCW migration issue, the attention must be centered on those who migrate but also those who choose not to migrate 4

5 Why So Much Time On HCW Migration? Underscores inequities and mal-distribution of human capital All of the health and human capital indicators as well as the migration patterns indicate severe social, economic, political, ethical, and health consequences to the poorest people in the world Without an adequate health care system and personnel to work in it, the poor have unacceptably high rates of premature morbidity and mortality The social, political, and economic consequences to countries that cannot sustain an adequate health care workforce 5

6 Global Burden of Disease: Striking Contrasts 10 percent of the global burden of disease found in the US and Canada 37 percent of health workers live/work in US and Canada 24 percent of the global burden of disease is found in the African region 3 percent of all health care workers live/work in African region 6

7 Examples of Mal-Distribution of HCWs For example, in France there are 80 nurses/midwives per 10,000 population in Canada there are 101, Australia 97, the UK 128, and Norway 162 At the same time in Mali there are 6, Peru has 7, India 13, Mozambique 3, and Ghana 9 While Mozambique has less than 1 physician per 10,000 population, India has 6, Ghana 2, and Nigeria 3, Peru and China are somewhat better off at 12 and 20, respectively The US and Australia each have 26 physicians per 10,000 population and France has 34 In all but the poorest countries, almost all births are attended by Skilled Health Personnel, yet in India that percent is 47, Nigeria 35, Ghana 50, Chad 14, and Ethiopia 6 7

8 Nurse Numbers Are Especially Problematic Migration of nurses, in particular, is of important international concern because in developing countries nursing provides 80 percent of health care 8

9 Refocusing How We Think About HCW Migration Move away from focusing on who leaves Focus on who leaves and who stays This refocus came from discussions with migrant HCWs and a subsequent pilot study conducted on HCWs who migrate and those who do not The pilot study interviewed and collected data on migrant HCWs and those who chose not to migrate 9

10 When Those Migrate and Those Who Choose Not to Migrate are Studied When analyzing the data from our pilot study, we found the traditional economic and labor market models fall short of explaining migration 10

11 How Then Do We Think About HCW Migration? It is an Occupational Diaspora Why think about it in these terms? What are the implications of the Occupational Diaspora for developed and developing countries? 11

12 What does a model of HCW migration look like when one thinks in terms of an Occupational Diaspora? 12

13 Alternative Model Of HCW Migration HCW MIGRATES HCW DOES NOT MIGRATE OPPORTUNITIES/ POTENTIAL Economic Personal Professional PERSONAL EXPERIENCES/ RELATIONSHIPS Low Low Low Outward know people, especially other HCWs, who have migrated and it has been a success Acceptable or Greater Acceptable or Greater Acceptable or Greater Inward Do not now others who have migrated or know others who have it was not a good experience CRISS OF EXPECTATIONS Workplace Safety Able to Practice Their Trade Feel less than safe and that the occupational risks are not acceptable Unemployed or underemployed Occupational risks are not extraordinary or they are worth taking Employment level is acceptable or satisfactory OBLIGATIONS Self Family Community Country Primary Commitment Primary Commitment Secondary Commitment Secondary Commitment Secondary Commitment Secondary Commitment Primary Commitment Primary Commitment 13

14 What This Model Gets Us The rich stories Access to the complexities of deciding to migrate or not migrate It is not just economics or labor market conditions Emphasis that in order to address migration we must understand why people stay In understanding why people stay and why they leave we are in a better position to design public policies that either support or inhibit HCW migration 14

15 Public Policy Implications Delivery of health care and HCWs are essential to the economic, social, and political stability of a nation It essential that each nation address how that care is to be provided and by whom What policies give you the desired outcomes and least uncontrollable and unintended consequences 15

16 Public Policy Implications If priority is not to export HCWs How to structure policies to encourage people to stay For example, preventing migration is impossible, but a system of individual repayment for cost of education if they do work so many years in home country Identify the differences and therefore the strengths and weaknesses of those who stay and those who migrate how to structure educational and training system to ensure health care needs of population are met Ensure that when focusing on retaining people that the resource allocations to those concerns/priorities that keep HCWs from migrating receive continued support Structure controlled migration so that circular migration becomes a priority or even the norm The additional knowledge and skilled learned from migrating can enhance the health care services provided to population 16

17 Public Policy Implications If priority is to export HCWs How to incentivize more people to leave Ignore those issues/conditions which keep people from migrating and withhold support How are the health care needs of own population to be met Policies to import temporary or permanent health care workers to meet the health care demands of population Economic, social, and political implications of this position 17

18 Where Do We Go From Here? Additional Research Rethink Model That Provides Best and Richest Perspective to Understand, Analyze, and Address the Issue of HCW Migration Focus on Policy Implications and Consequences of How HCW Migration Is Conceptualized and Addressed 18