Migration of healthcare professionals: practical and ethical considerations

A double jeopardy exists in resource-limited settings (RLS) in sub-Saharan Africa (SSA): there are a disproportionately greater number of acutely ill patients, but a paucity of healthcare workers (HCW) to care for them. SSA has 25% of the global disease burden but only 3% of the world's HCW. Thirty-two SSA countries do not meet the WHO minimum of 23 HCW per 10000 population. Contributing factors include insufficient supply, inadequate distribution and migration. Potential remedies include international workforce policies, non-governmental organisations, national and international medical organisations' codes of conduct, inter-country collaborations, donor-directed policies and funding to train more people in-country, and health system strengthening and task-shifting. Collaborations among academic institutions from resource-rich and poor countries can help address HCW supply, distribution and migration. It is now opportune to harness bright, committed people from academic centres in resource-rich and poor settings to create long-term, collaborative relationships focused on training, clinical skills and locally relevant research endeavours, who mutually strive for HCW retention, less migration, and ultimately sufficient HCW to provide optimal care in all RLS.

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“…The complex problem of HCW shortage, its causes and driving forces, are interrelated and require a multifaceted approach 56 57…”

Section: Strategies To Address Hcw Shortagementioning

confidence: 99%

Brain drain in sub-Saharan Africa: contributing factors, potential remedies and the role of academic medical centres

Kasper

Bajunirwe

2012

Arch Dis Child

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“…44 In short, the importation of thousands of physicians from overseas into the US physician labor force may help reduce the physician shortage in this country, but the drain on skilled health professionals in the countries from which they emigrated contributes to even more severe healthcare workforce shortages, perhaps to the point of healthcare system collapse in the near future. 45 Such a strategy is neither a practical, sustainable, nor ethical solution to the problem of the short-and longterm physician shortage in the United States.…”

Section: Physiciansmentioning

confidence: 99%

A Review of Demographic and Infrastructural Factors and Potential Solutions to the Physician and Nursing Shortage Predicted to Impact the Growing US Elderly Population

Cohen

2009

Journal of Public Health Management and Practice

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This review highlights several of the key demographic, infrastructural, and cultural factors associated with the predicted labor force shortage in the healthcare field. Population dynamics play a significant role in exacerbating the healthcare labor force shortage. These factors work to simultaneously increase the size and proportion of the population needing the most care, namely, the elderly, and also to reduce the availability of physicians and nurses to provide adequate care for the growing elderly population. Physicians and nurses have expressed consistent dissatisfaction with healthcare infrastructure and have cited decreased job satisfaction, further exacerbating the shortage. Potential solutions to the shortage, aside from dramatic changes to the healthcare system, include increased medical and nursing training in geriatrics and gerontology to increase interest, competency, and knowledge of health issues specifically pertaining to the elderly. Other solutions include monetary incentives for geriatric training for nurses and physicians. Any specific measures to remedy this growing problem should be implemented in a timely manner to reduce this critical shortage of healthcare workers that will only continue to grow in the coming decades.

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“…7,9,10 It is widely agreed that current shortages in the United States, Canada and United Kingdom have resulted from setting inappropriate targets for training positions in the 1990's. 3,9,11 It will take years, however, to rectify the consequences of these decisions. Until then, developing countries will continue to bleed trained professionals into the global work force market.…”

Section: Long-term Solutionsmentioning

confidence: 99%

“…Africa has more than 24% of the disease burden, 3% of the globe's health workers, and less than 1% of global financial health resources even when loans and grants are taken into account. D Although the ethics of this 'brain drain' has been deplored by many, 3,8,9,11 voluntary restraining measures have proved ineffective. 11 It has been suggested that receiving countries should at least be required to reimburse donor countries for the education cost of the professionals they receive, 8,13 but I am unaware that this ever occurs.…”

Section: Long-term Solutionsmentioning

confidence: 99%

“…D Although the ethics of this 'brain drain' has been deplored by many, 3,8,9,11 voluntary restraining measures have proved ineffective. 11 It has been suggested that receiving countries should at least be required to reimburse donor countries for the education cost of the professionals they receive, 8,13 but I am unaware that this ever occurs. Until such time as developed countries are training and retaining an adequate number of health professionals, the current drain from developing countries will persist.…”

Section: Long-term Solutionsmentioning

confidence: 99%

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Anesthesia and the role of short-term service delivery in developing countries

Froese

2007

Can J Anesth/J Can Anesth

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Purpose: To clarify the ongoing need for involvement of anesthesiologists in short-term surgical projects in developing countries, and provide information to guide the selection of, application for, and preparation for these rewarding experiences. Observations:The lack of safe anesthesia services severely limits the performance of needed surgical procedures in developing countries around the world. Even in countries where well-trained anesthesiologists are available in major urban centres, resources are often absent or limited for large numbers of people in rural or remote areas. Anesthesiologists are highly sought members of surgical teams. Internet sites provide extensive project information. Projects occur in Central and South America, Africa, Asia and Eastern Europe. Projects can bring specialized surgical expertise to an otherwise well-serviced urban area, or work in remote areas that have surgical services only when a team comes. Available equipment, drugs, housing, food and transportation vary markedly with project site. Flexibility, adaptability and problem-solving skills are essential. Translators provide language assistance. Anesthesiologists who have experience providing anesthetics in settings with less technological support can assist other anesthesiologists in adapting to less sophisticated settings. Conclusions:Severe shortages of trained health professionals plague developing countries, reflecting complex economic and political problems that will require decades for resolution. Until such time as surgical services are widely available and affordable in remote as well as urban areas of developing countries, anesthesiologists will continue to provide a valuable and personally rewarding contribution through short-term assistance.

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Migration of healthcare professionals: practical and ethical considerations

Cited by 9 publications

References 6 publications

Brain drain in sub-Saharan Africa: contributing factors, potential remedies and the role of academic medical centres

Brain drain in sub-Saharan Africa: contributing factors, potential remedies and the role of academic medical centres

A Review of Demographic and Infrastructural Factors and Potential Solutions to the Physician and Nursing Shortage Predicted to Impact the Growing US Elderly Population

Anesthesia and the role of short-term service delivery in developing countries

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