1 migration in the caribbean region dr. gillian barclay, advisor human resources development

1Office of Caribbean Program CoordinationOffice of Caribbean Program Coordination

Migration in the Caribbean Region

Dr. Gillian Barclay, Advisor Human Resources Development

2Office of Caribbean Program Coordination

OCPCAN OVERVIEW OF MIGRATION IN THE CARIBBEAN REGION

3

Countries

GUADELOUPE

FR. GUIANA

DOM. REPUBLIC

MARTINIQUE


OCPCTHE CARIBBEAN REGION AND

MIGRATION

• Over the past 4 decades, the Caribbean

region has lost more than 5 million people to

migration

• The net migration rate in the Caribbean region is

one of the highest in the world with great variation within the region

• Jamaica, Guyana, St. Lucia and Suriname have shown the greatest losses to international migration.

Data from United Nations Population Division, 2003


OCPCTHE CARIBBEAN REGION AND

MIGRATION

Dynamics: Workforce

• Migration is international, intraregional, and into the region

Other Dynamics:

• Human trafficking of women and children

• Return of deportees


OCPCMIGRATION IN THE CARIBBEAN

REGION

International Migration: Workforce and Brain Drain

• Migration to the US, Canada and the UK

• Skilled migration rates from the Caribbean region are some of the highest in the world (IADB, 2006)



REGION

International Migration: Workforce and Brain drain

• More than 60% of highly-skilled or tertiary-educated migrating

• More than 30% of secondary-educated migrating • Jamaica, Guyana, Grenada, Haiti, more than 80% of

tertiary-educated skilled labour migrating with increased migration to the United States



REGION

Reasons for migration to the United States: Workforce• Proximity to the Caribbean• Wages and increased earning capacity• Common language for English-speaking islands• Social and family networks resident in the United

States• Favourable immigration policies for skilled labour

such as nurses, physicians, teachers and other professionals



REGION

There are positive impacts of international migration

and some of these include:• Return or transfer of knowledge, for example the

strengthening of health and education facilities through partnerships and contribute to country level development

• Remittances and economic investments although the data for the health professions is not known.



REGION

Negative impacts of international migration include:

• Loss of human capital

• Reduced productivity

• Loss of financial investments borne by countries

These are critical issues for some of the countries in the

region that are undergoing public sector and health

sector reforms.



REGION

Intraregional migration in the Caribbean: Workforce

The Caribbean Single Market and Economy (CSME)

was established in 1989 by the Heads of Government of

CARICOM through the Grand Anse Declaration



REGION

Intraregional migration in the Caribbean: Workforce

• Major goals of CSME are to deepen the integration

process and to strengthen the Caribbean community in all its dimensions

• Facilitate the free movement of labour and abolish needs for work permits for workforce from CSME participating countries.

• This represents the move towards a common policy agenda for migration at the intra-regional level



REGION

Migration and the Health Workforce



REGION

• Health today is complex and needs a public health and population approach

• Critical needs to address include the capacity to use trans-sectoral approaches to:

-measure needs

-manage, plan and evaluate

-conduct research and development

-strengthen information systems

-develop health, education and social programs


OCPCMIGRATION AND BRAIN DRAIN IN THE CARIBBEAN

REGION: DATA AND EVIDENCE

• Lack of data and evidence-base for country and regional level policy development for migration especially as this relates to the health workforce

• Difficult to move towards policy when the evidence base regarding the health workforce is questionable.


OCPCMIGRATION AND BRAIN DRAIN IN THE CARIBBEAN

REGION: DATA AND EVIDENCE

• Trans-sectoral approaches needed to gather evidence that must involve the inclusion of labour, trade, education, health and social development

• Important to share data because governments will find it easier to design, monitor and evaluate the impact of migration policies

• Need to have policies in place to protect personal information to balance the need to share information



REGION

Migration in the Caribbean region is an important issue for the health sector since labour market needs for this sector are aligned to the skills of the secondary and tertiary educated workforce.


OCPC

THE CONTEXT: THE MIGRATION DISCUSSION IS OCCURING IN PARALLEL WITH HIGHLY VISIBLE

EVENTS

“These examples illustrate the enormous richness and diversityof the workforce needed to tackle specific health problems”World Health Report, 2006



REGION

Migration and the Health Workforce• Historical regional migration and a shared sense of

regional integration• CSME has enhanced the migration or free movement

of qualified professionals and skills within the region by liberalizing conditions of access to markets and skills within the region

• July 2006: Extension of the free movement agreement to include nurses among other professionals

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Health Workforce in the CaribbeanNurses Physician Dentist

Anguilla 31.3 9 1.3

Antigua and Barbuda 33.2 10.5 2.2

Bahamas 23.8 16.7 2.5

Barbados 51.2 13.7 1.9

Belize 12.3 10.2 1.3

Cayman 53 21.5 3.9

Dominica 41.6 4.9 0.6

Grenada 19.5 8.1 1.1

Guyana 8.6 2.6 0.4

Jamaica 16.5 8.5 0.8

Montserrat 29.1 1.8 0.9

St. Kitts and Nevis 49.8 11.7 2

St. Lucia 22.6 5.8 0.9

St. Vincent & Grenadines 19.8 6.9 1.4

Suriname 22.8 5 0.8

Trinidad & Tobago 28.7 7.5 0.9

Turks and Caicos 19.3 7.3 0.7

Virgin Islands ( British) 33 11.5 2

Health Workforce in the Caribbean Region per 10,000 Population (PAHO 2004)


OCPCMIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION: THE EXAMPLE OF NURSING

New Challenges for Nursing:

• Large numbers of nurses leaving the region• Loss of more experienced nurses• Loss of nursing educators• Limited educational capacity to replace lost nurses


OCPCMIGRATION OF THE HEALTH WORKFORCE

IN THE CARIBBEAN REGION

New Challenges for Nursing:

• Inability to assimilate ‘returnees’• Image and work conditions for nurses• Aggressive recruitment of nurses by companies

representing employers from countries with shortages




• The wage differential is the major pull factor for Caribbean health professionals, especially physicians and nurses.

• A comparison of average monthly wages show that Caribbean nurses working in the US are paid $3,056, in Canada $2,812, and in the United Kingdom $2,578. In Trinidad and Tobago nurses are paid an average monthly salary of $913.




• 42% of nursing positions were vacant in 2005 (CARICOM/PAHO 2005)

• PAHO estimates that the departure of 300 nurses from the Caribbean represented losses of $15 to $16.5 million US dollars in training costs




Most common reported reasons for resignation were: - Poor remuneration- Limited opportunities for professional development

and career mobility- Non-involvement in the decision-making process- Poor working environment- Lack of support from supervisors

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Number of Registered Nurses, Vacancies and

Vacancy Rates by Country (Hewitt, 2004) Country # of Registered Nurses # of Vacancies Vacancy Rate

Antigua 320 56 17.5

Barbados 930 192 20.6

Dominica 177 11 6.2

Jamaica 2256 1317 58.4

St Kitts 192 50 26

St. Lucia 409 18 4.4

St Vincent 216 34 15.7

Trinidad 2125 1132 53.3

Total 6625 2810 42.4

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Registered Nurses' Resignations with Declared Intentions to Migrate to the UK, USA, or Canada, by

Year and Country (Hewitt 2004)

Country Year

1998 1999 2000 2001 2002 Total

Antigua 0 0 9 0 3 12

Barbados 16 22 61 31 45 175

Dominica 3 0 2 4 4 13

Jamaica 90 135 159 152 109 645

St. Kitts 0 2 1 3 2 8

St- Lucia 11 18 17 10 10 66

St. Vincent 9 8 30 22 5 74

Total 129 185 279 218 178 993



OF THE CARIBBEAN REGION

Development concerns:

• A highly skilled health workforce plays a major role in a country’s sustainable development

• Countries are experiencing severe limitations in their capacity to provide affordable, quality, health and social services to their nationals.

• The lack of skilled workforce in the health sectors slows the steps or progress in improvements in economic and social sectors in the region

Caribbean Commission on Health and Development Report, 2005

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THE FUTURE: POLICY IMPLICATIONS

• The issue of migration does not belong to any one organization, thus faces challenges relating to:

- Funding- Coordination- Infrastructure

• Difficult to put into place appropriate evaluation, measurement and dissemination mechanisms

• In the Caribbean region there is the need for a coordinated approach to the issue of migration.


OCPCTHE FUTURE: POLICY IMPLICATIONS

• Necessary to consider the multilateral approach to managing migration

• Use the experience in bilateral agreements as building blocks to wider market access

• Governments may experience increased pressure to ensure that conditions of work and pay are satisfactory


OCPCTHE FUTURE: POLICY IMPLICATIONS

• Evolution from individual and country specific work to efforts relating to major regional health, social and economic policy.

• Changed nature of collaboration and partnerships in ways that reflect movement from program and

evidence to policy.


OCPC“At the heart of each and every health system the workforce is central to advancing health.”

World Health Report, 2006

1 migration in the caribbean region dr. gillian barclay, advisor human resources development

Documents

workforce migration

increased migration

migration dynamics

overview of migration

caribbean region reasons

caribbean wages

caribbean community

net migration rate