Governance systems for skilled health worker migration, their public value and competing priorities: an interpretive scoping review

Abstract

Background Governments worldwide participate in skilled health worker (SHW) migration agreements to protect access to health services in their countries. Previous studies have described the value offered by these agreements in separate source and destination country perspectives. Objective We sought to identify and summarise existing literature on shared value creation for both source and destination countries. Method We conducted a systematic scoping review of health databases and grey literature. Using Mark Moore and Colin Talbot frameworks, we summarised the public value propositions in migration agreements and how state actors addressed competing priorities. Results Most articles (34/63, 53.9%) reported transnational SHW mobility as the public value proposition for source and destination countries. Fewer articles, 14 (22.2%) and 9 (14.3%) articles, respectively, referred to achieving health workforce sustainability and building capacity for SHW migration governance as shared public values. The most identified competing public value (CPV) was an overriding focus on addressing SHW shortages in destination countries (20/63, 37.7%). Efforts to address this CPV include mitigation of the adverse effects of migration (43/63, 68.3%) and promoting health workforce development in source countries (15, 23.8%). At the same time, state actors retained regulatory discretion for protecting their country’s public health interest (34, 54%). Most articles reported the lack of funds (15/63, 23.8%) and implementation mechanisms (19/63, 30.2%) as constraints on the authorising environment and the operational capacity of SHW migration governance systems. Conclusion Regarding SHW migration governance, the literature reports shared public value propositions for source and destination countries. It also shows how the value-creating process in the management of SHW migration favours destination countries. Future studies will need to explore shared value creation models that ensure equity in the governance of SHW migration.

Migration Intent of Health Care Workers during the COVID-19 Pandemic in Kosovo

“…Various short, medium and long term measures have been implemented to address HCW migration. A recent review [ 50 ] noted that HCW migration flows are impacted by factors other than professional, macroeconomic and political, including family and social networks, which are more difficult to address. Long-term policy action should target workforce sustainability, which includes personnel development and health labour market measures.…”

Promoting equitable health workforce distribution through improved migration governance: A mixed methods study of African health professionals' perceptions in Australia

“…6 Similarly, HICs contribute to the health workforce equity gap by not compensating LMICs for recruiting their SHWs and relying solely on SHW migration to meet their health workforce deficits. 6,7 Mutually beneficial migration processes as described in international instruments (e.g. the WHO Code) will require domestic governance systems that are equity-focused (i.e.…”

“…While there are multiple examples of LMIC and HIC SHW migration agreements, they often focus on short‐term benefits. For example, agreements that seek to address unemployment in LMICs by sending ‘surplus’ SHWs to address workforce shortages in HICs 6 . As a result, LMIC state actors perpetuate the global health workforce equity gap by focussing on reducing unemployment rates in the short‐term, without considering how they can expand their ability to retain an adequate number of SHWs 6 .…”

“…For example, agreements that seek to address unemployment in LMICs by sending ‘surplus’ SHWs to address workforce shortages in HICs 6 . As a result, LMIC state actors perpetuate the global health workforce equity gap by focussing on reducing unemployment rates in the short‐term, without considering how they can expand their ability to retain an adequate number of SHWs 6 . Similarly, HICs contribute to the health workforce equity gap by not compensating LMICs for recruiting their SHWs and relying solely on SHW migration to meet their health workforce deficits 6,7 .…”

The factors that are associated with nurse immigration in lower‐ and middle‐income countries: An integrative review

“…Research on emigration, particularly in developing countries, has fallen short of assessing the determinants because cross-sectional studies considered a diverse perspective of nurse emigration with limited integration of these factors across countries. Also, several reviews are conducted on nurse/health worker migrations (Sterud et al, 2018;Te et al, 2018;Yakubu et al, 2022).…”