Managing health professional migration from sub-Saharan Africa to Canada: a stakeholder inquiry into policy options

Abstract

<p>Abstract</p> <p>Background</p> <p>Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada?</p> <p>Methods</p> <p>We interviewed a small sample of émigré South African physicians (n = 7) and a larger purposive sample of representatives of Canadian federal, provincial, regional and health professional departments/organizations (n = 25); conducted a policy colloquium with stakeholder organizations (n = 21); and undertook new analyses of secondary data to determine recent trends in health human resource flows between sub-Saharan Africa and Canada.</p> <p>Results</p> <p>Flows from sub-Saharan Africa to Canada have increased since the early 1990s, although they may now have peaked for physicians from South Africa. Reasons given for this flow are consistent with other studies of push/pull factors. Of 8 different policy options presented to study participants, only one received unanimous strong support (increasing domestic self-sufficiency), one other received strong support (increased health system strengthening in source country), two others mixed support (voluntary codes on ethical recruitment, bilateral or multilateral agreements to manage flows) and four others little support or complete rejection (increased training of auxiliary health workers in Africa ineligible for licensing in Canada, bonding, reparation payments for training-cost losses and restrictions on immigration of health professionals from critically underserved countries).</p> <p>Conclusion</p> <p>Reducing pull factors by improving domestic supply and reducing push factors by strengthening source country health systems have the greatest policy traction in Canada. The latter, however, is not perceived as presently high on Canadian stakeholder organizations' policy agendas, although support for it could grow if it is promoted. Canada is not seen as "actively' recruiting" ("poaching") health workers from developing countries. Recent changes in immigration policy, ongoing advertising in southern African journals and promotion of migration by private agencies, however, blurs the distinction between active and passive recruitment.</p

Challenges of Gastrointestinal Endoscopy in Resource-Poor Countries

“…The number of pathologists in Nigeria is equally abysmally low for the population and only very few of them are trained specially for gastrointestinal diseases. Some high-income countries such as Austrialia, Canada, Saudi Arabia, the USA and the United Arab Emirates and the UK have sustained their relatively high physician -to population ratio by recruiting medical graduates from developing regions, including countries in sub-Saharan Africa (Labonte et al 2006, Mullan 2006, Pond et al 2006. In contrast, over half of the countries in sub-Saharan Africa do not meet the minimum acceptable physician to population ratio of one per 5000 (WHO 2007).…”

“…Around a third of medical graduates from Nigerian medical schools migrate within 10 years of graduation to Canada, the UK and the USA (Ihekweazu 2005). Nurses, who commonly bear the brunt of health-care delivery in sub-Saharan Africa are also not left out in the brain drain (Labonte 2006, Mandeville 2009 …”

An analysis of specialist surgeons and their practices

“…The Lancet (2000) reports that South Africa incurred a cost of nearly $37 million, due to the migration of health workers, and, although recent research examines emigration to places like Canada (Labonté, Packer & Klassen, 2006), the United States (Hagopian, Thompson, Fordyce, Johnson & Hart, 2004), the United Kingdom (Eastwood, Conroy, Naicker, West, Tutt & Plange-Rhule, 2005), and Australia (Mullan, 2005), there is little specific information with respect to the drivers of South African health worker emigration. To this end, the South African Medical Association (SAMA), in conjunction with the Foundation for Professional Development (FPD), sponsored a study of private specialists in Gauteng Province, South Africa.…”

“…Accordingly, 23 844 South African trained doctors remained in South Africa, while just over 7 000 emigrated; therefore, approximately 25 per cent of the trained stock has left the country. Despite the large proportion that has left, little is known about the reasons for departure, although Labonté et al (2006) interview seven South African émigré doctors, as well as a number of Canadian health organizations and stakeholder organizations. In their study, they identified a number of push factors, including: low salaries, non-payment of salaries, significant stress and exceedingly large patient-health care provider ratios.…”

Foreign advertisements for doctors in the SAMJ 2006 - 2010

“…[4][5][6] 'Pull' and 'push' factors in developed and developing countries, respectively, contribute to the migration of health professionals, typically from poorer to wealthier areas. [7][8][9] The recruitment and/or migration of health workers has been in the spotlight, especially with the adoption of the Millennium Development Goals (MDGs) which include health-specific targets 10,11 the attainment of which is linked to functional health systems, and, therefore, a credible workforce. This issue received more attention following the Joint Learning Initiative 12 report and the World Health Report in 2006.…”