Developing evidence-based ethical policies on the migration of health workers : conceptual and practical challenges

K. Diallo and P. Zurn performed the statistical analyses. All authors participated in interpreting the results, and read and approved the final manuscript.It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills. The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed. The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.sch_nur1. Iredale R: The migration of professionals: theories and typologies. International Migration Quarterly Review 2001, 39(5):7-27. Special Issue 1 2. Organisation for Economic Co-operation and Development: Trends in International Migration. Annual Report. Paris 2001. 3. Commander S, Kangasniemi M and Winters AL: The brain drain: curse or boon? A survey of the literature. Draft report. Private communication to OSD . 4. Martineau T, Decker K and Bundred P: Briefing note on international migration of health professionals: levelling the playing field for developing country health systems. Liverpool: Liverpool School of Tropical Medicine 2002 [http://www.liv.ac.uk/lstm/ hsrintro.html]. Last accessed 15 August 2003 5. International Organization for Migration: Migration Management Training Programme. Chapter 1. Geneva 1995. 6. United Nations Population Division Populations Database [http://esa.un.org/unpp]. Last accessed 20 November 2002 7. Buchan J, Parkin T and Sochalski J: International nurse mobility: Trends and policy implications Geneva: World Health Organization; 2003. (WHO/EIP/OSD/2003.3) 8. Frommel D: Quand le Nord dbauche les mdecins du Sud. Le Monde diplomatique 2002:28 [http://www.monde-diplomatique.fr]. Last accessed 14/10/03 9. Kingma M: Nurse migration: global treasure hunt or disaster in the making? Nurse Inquiry 2001, 8(4):205-212. 10. Buchan J: International recruitment of nurses: United Kingdom case study London: Royal College of Nursing; 2002. 11. Nyberg-Sorensen N, Van Hear N and Engberg-Pedersen P: The migration- development nexus: evidence and policy options Copenhagen: Centre for Development Research; 2002. 12. United States Agency for International Development: The Health Sector Human Resources Crisis in Africa: An issues paper Washington, DC: USAID Bureau for Africa, Office of Sustainable Development; 2001. 13. Castles S: International migration at the beginning of the twenty-first century: global trends and issues. International Social Science Journal 2000, 52(165):269-281. 14. Stalker P: Workers without frontiers. The impact of globalization on international migration Geneva: International LabourOffice; 2000. 15. Mahroum S: Europe and the immigration of skilled labour. In: International Migration of the Highly Skilled. International Migration Quarterly Review 2001, 39(5):27-44. 16. Hoffmann E and Lawrence S: Statistics on international labour migration: a review of sources and methodological issues. Bureau of Statistics, Interdepartmental Project on Migrant Workers 1994-1995 Geneva: International Labour Office; 1996. 17. Athukorala P: Statistics on Asian labour migration: review of sources, methods and problems. Paper presented at the Regional Seminar on International Labour Migration Statistics in Asia, New Delhi 1993. 18. Mutizwa-Mangiza D: The impact of health sector reform on public sector health worker motivation in Zimbabwe. Major Applied Research 5. Working Paper 4. Partnerships for Health Reform. Bethesda: Abt Associates 1998. 19. Dovlo DY: Report on issues affecting the mobility and retention of health workers in Commonwealth African States. Unpublished report to Commonwealth Secretariat. Arusha, Tanzania 1999. 20. Zurn P, Dal Poz M, Stilwell B and Adams O: Imbalances in the health workforce. Geneva: World Health Organization 2002 in press. http://www.who.int/health-services-delivery 21. Dilip Ratha: Global development finance: Striving for stability in development finance. In Worker's remittances: an important and stable source of external development finance [http://www.world bank.org/prospects/gdf2003/tocvol1.htm]. Washington, DC: World Bank Last accessed 4/9/03 22. Findlay A: From brain exchange to brain gain: policy implications for the UK of recent trends in skilled migration from developing countries. International Migration Papers No. 42. Geneva: International Labour Office 2001. 23. Migration Research Unit: International migration and the United Kingdom. Draft final report to the Home Office London: University College; 2001. 24. South African Network of Skills Abroad: First Report (April) Mimeo, Science and Technology Policy Research Centre Cape Town: University of Cape Town; 1999. 25. Department of Health: Guidance on international recruitment London; 1999. 26. United Nations Economic and Social Council: Report of the Regional Conference on Brain Drain and Capcity Building in Africa. E/ECA/IDRC/IOM/2000L 24 February 2000. Addis Ababa: Economic Commission for Africa 2000. 27. Arango J: Explaining migration: a critical view. International Social Science Journal 2000, 52(165):283-296. Publish with BioMed Central and every scientist can read your work free of charge BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime. Sir Paul Nurse, Cancer Research UK Your research papers will be: available free of charge to the entire biomedical community peer reviewed and published immediately upon acceptance cited in PubMed and archived on PubMed Central yours - you keep the copyright Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp BioMedcentral Human Resources for Health 2003, 1 http://www.human-resources-health.com/content/1/1/8 Page 13 of 13 (page number not for citation purposes) 28. Athukorala P: The use of migrant remittances in development: lessons from the Asian experience. Journal of International Development 1992, 4(5):511-529. 29. Loefler IJP: Medical migration. The Lancet 2000, 356(9236):1196. 30. Martinez J and Martineau T: Rethinking human resources: an agenda for the millennium. Health Policy and Planning 1998, 13(4):345-358. 31. Stilwell B: Health worker motivation in Zimbabwe. Internal report. Department of Organization of Health Care Delivery. Geneva: World Health Organization 2001. 32. Van Lerberghe W, Conceio C, Van Damme W and Ferrinho P: When staff is underpaid. Dealing with the individual coping strategies of health personnel. Bulletin of the World Health Organization 2002, 80(7):581-4. 33. Bundred PE and Levitt C: Medical migration: who are the real losers? The Lancet 2000, 356(9225):245-246.1pub20pub