PHA-Exchange> The Brain Drain of Health Professionals

Mon Jul 30 20:36:11 PDT 2007

 from "Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG> -----
 EQUIDAD at LISTSERV.PAHO.ORG

		The Brain Drain of Health Professionals from Sub-Saharan
Africa to Canada

		Ronald Labonte, Corinne Packer, Nathan Klassen, Arminee
Kazanjian, Lars Apland, Justina Adalikwu,Jonathan Crush, Tom McIntosh,
		Ted Schrecker, Joelle Walker, David Zakus
		Series Editor: Prof. Jonathan Crush
		African Migration and Development Series No. 2, 2006
		Southern African Migration Project (SAMP) ISBN
1-920118-38-1 Produced by Idasa Publishing

		Available online PDF [92p.] at:
http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf
<http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf
>  

		Website:
http://www.queensu.ca/samp/sampresources/samppublications/
<http://www.queensu.ca/samp/sampresources/samppublications/> 

		Significant numbers of African-trained health workers
migrate every year to developed countries developed countries including
Canada. They leave severely crippled health systems in a region where
life expectancy is only 50 years of age, 16 per cent of children die
before their fifth birthday and the HIV/AIDS crisis continues to
burgeon.1 The population of Sub-Saharan Africa (SSA) totals over 660
million, with a ratio of fewer than 13 physicians per 100,000.2 SSA has
seen a resurgence of various diseases that were thought to be receding,
while public health systems remain inadequately staffed. 

		According to one report, the region needs approximately
700,000 physicians to meet the Millennium Development Goals.3
Understaffing results in stress and increased workloads.4 Many of the
remaining health professionals are illmotivated, not only because of
their workload, but also because they are poorly paid, poorly equipped
and have limited career opportunities. These, in turn, lead to a
downward spiral where workers migrate, crippling the system, placing
greater strain on the remaining workers who themselves seek to migrate
out of the poor working conditions.5 The ultimate result is an
incontestable crisis in health human resources throughout SSA, the
region suffering most from the brain drain of health care
professionals.6 

		The situation in SSA has become severe enough that the
final report of the Joint Learning Initiative on Human Resources for
Health - a two-year global initiative sponsored by a number of donors
studying various aspects of human resources for health performance - has
concluded that the future of global health and development in the 21st
century lies in the management of the crisis in human resources for
health.7

		"..... a study of the impact of international
recruitment and migration of health care professionals to Canada from
SSA countries was undertaken. Two research methodologies were used for
this study. T

		The empirical research consisted of:
		(a) Focus groups conducted at the International Society
for Equity in Health conference in Durban, South Africa (June 2004) 
		(b) Interviews with a sample of physicians who had
immigrated to the Canadian province of Saskatchewan from SSA.
		(c) Semi-structured interviews conducted with a
purposive sample of key Canadian organizations addressing questions
related to existing recruitment policies and practices; determinants of
migration decisions; and feasibility and desirability of policy options.
The key informants from these organizations included federal officials,
leaders of national associations of health professionals,
		(d) The entire set of findings from the interviews,
together with policy recommendations from African-based researchers
reflecting the choices favoured by source countries, were presented in a
day-long colloquium held in Ottawa on 14 October 2005. 

		Second, a literature review supplemented the empirical
research for this study, using published and unpublished sources. Three
topics were the foci of this review:
		1. The known and potential impact on health professional
migration of the liberalization of health services under Mode 4
(movement of persons) of the World Trade Organization's General
Agreement on Trade in Services.
		2. The availability, validity, reliability and policy
relevance of existing Canadian and international data sources pertinent
to all aspects of our study. 
		3. Existing studies assessing the push/pull factors for
health professional migration, and policy options for managing the flow
so that it does not create any net loss for "sending" countries....." 

		Contents

		1 Introduction 
		2 Selected SSA Countries Affected by Brain Drain
		3 Methodology 
		4 Foreign Health Professionals in Canada 
		4.1 Background 
		4.2 Physicians 

		Source Countries
		4.3 Nurses 
		4.4 Reasons for Migration 
		4.5 Active and Passive Recruitment 
		4.6 Government Measures Bolstering Passive Recruitment 
		4.7 The Recruiters 
		5 Shortages of Health Professionals in Canada 
		6 Brain Drain from Canada to USA and Other Countries 
		7 Costs and Benefits to Canada and Source Countries 

		8 Policy Options
		8.1 Codes of Practice for Ethical Recruitment 
		8.2 Improved Health Human Resources Planning in Canada 
		8.3 Multilateral and Bilateral Agreements 
		8.4 Reparation Payments and Restitution to Source
Countries 
		8.5 Increased Training of Auxiliary Workers in Source
Countries 
		8.6 Restrictions on Health Professional Migration from
Underserved 56

		Source Countries
		8.7 Bonding of Health Care Professionals 
		8.8 Health System Strengthening in Source Countries 
		8.9 Human Rights Issues Surrounding the Brain Drain and
Policy Options 
		8.10 Inadequately Protected Rights in Source Countries
Leading to Migration 
		8.11 The Rights of the Professional to Leave and Enter a
Country 
		8.12 The Right to Health in Source and Recipient
Countries
		8.13 Human Rights Obligations of Recipient Countries 
		9 Measures Adopted by Other Countries 
		9.1 Australia 
		9.2 Norway 
		9.3 The Netherlands 
		9.4 The United Kingdom 
		9.4.1 NHS Code of Practice 
		9.4.2 UK-South Africa Memo of Understanding 

		10 Conclusions

		MIGRATION AND DEVELOPMENT IN AFRICA: AN OVERVIEW

		Richard Black, Jonathan Crush, Sally Peberdy with Savina
Ammassari, Lyndsay McLean Hilker, Shannon Mouillesseaux, Claire Pooley,
Radha Rajkotia 
		African Migration and Development Series No. 1, 2006

		PDF [169p.] at:
http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_1.pdf
<http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_1.pdf
> 

		"....The aim of this study is to synthesise existing
research on migration in Africa, and its relationship to development
policy. The report focuses on the relationship between migration,
poverty and pro-poor development policy. Propoor policy is taken here to
mean policies that are context-specific, listen and react to poor
people's voices, and/or seek to assist poor people to become less
vulnerable and build up their income and assets. 

		Government health and education policies might not be
considered intrinsically pro-poor, but become so where they are targeted
at widening access to health and education services, and especially
basic health and education services (e.g. primary care, vaccination
campaigns, primary schooling), or at responding to the specific needs of
the poor. ..." 

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