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Impact of Migration on Health

Kannan Srinivasan, AMCHSS, SCTIMST

3 December 2008

Organization

● Migration● Human Resources in Health● Migration and HR● Migration and Health● Migration in India

Human Resources in Health

● Human Resources(health workforce) is prime in advancementsin health

● Health depends more on people to carry out its mission

● Health workers– Professionals– Technicians– Auxiliaries

● Human Resources for health are, the stock of all individuals engaged in Promotion, protection of population health

Human Resources for Health

● All men and women who work in health field– Not just physicians and nurses but also– Public health workers– Policy makers– Educators– Clerical staff– Scientists– Pharmacists

● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007

● For every 30,000 – PHC● PHC- 2 to 3 Physicians, 1 ISM Physician, 1

Male Health Assistant, 1 Female Health Assistant, 1 BEE, 1F Health Worker(ANM), 1 LT, 1 Statistician, 1 Driver, 1 Store keeper and ancillary staffs and attendants

● For every 5,000 – SC● 1 MPW, 1 FMPW, For every 1000

Community Health Volunteer● There are 23236 PHCs, 3346 CHCs and

146026 SCs (GoI)and Taluka, Dist Hospitals● Population of Indiab 1,028 million (2001 Census)



● There are 6,43,520 Allopathic Medical prac-titioners practicing in different states in India registered with different MCs (76925 +23858 = 1,00,783 in Public)

● There are 55000 dental surgeons registered with different DCs (up to 2005)

● There are 8,39,862 General Nursing Mid-wives, 5,02,503 Auxillary Nursing Midwives and 40,536 Health visitor and Health super-visors(Upto 2002) Nursing Councils

● (in Public 1,79,495 – 2005)● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India

2007


● Shortages and Vacancies (2006)– 6.5 % PHCs without Doctor – 4.7 % of SCs without HW(F)– 39.2 % of SCs without HW (M)– Short fall of 19,311 MPW (F)– Shortfall of 64,211 MPW(M)– Shortfall of 4,214 LHV/HA– Shorfall of 5290 HA(M)– 4.8% MPW(F) posts vacant– 24.1 %MPW(M) Vacant– 13.2 % LHV/HA Vacant– 25.4 % HA(M) Vacant– 17.5 % Doctors at PHCs Vacant



● Migration of Health Personnel● Estimation 50% of AIIMS students migrated

to overseas or to the private sector● Around 1,00,000 doctors of Indian origin

settled in the USA and UK alone(WHO 2007) ● Around 81,091 nurses migrated to USA from

India● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India

2007


Migration● Movement of people from one place to another

has shaped today's political, social and economic wourld and major influence on society.(Stilwell et. al)

● In 2000 almost 175 million people or 2.9% of world population, were living outside their country of birth for longer than one year.

● Of these, 65 million are economically active● It is significant for many resource poor countries as

they lose their better education nationals to richer countries

● 65% of all economically active migrants who have moved to developed countries are classified as 'highly skilled'

Migration in Health Sector

● In health, this refers to physicians, nurses, dentists, and pharmacists

● Nurses are in high demand● USA and UK have shortfall of nurses in 10-

20 years time. They pay high compensation to attract

● There is an international concern expressed about the loss of skilled health professionals from health-care systems in poorer coun-tries that are already weak.

● For policy options for managing migration, evidence of the magnitude of the problem and an understanding of the context of the labour markets is needed(Stilwell et.al.2004)

● health workers migration● Migration of health professionals not been

studied extensively● Last study was in 1970s● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,

"Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)

Portuguese speaking African countries to Portugal

migration

No of Physicians No of Nurses Source country In Portugal In Source Country In Portugal In Source CountryAngola 820 961 383 14288Guinea-Bissau 358 197 253 1299Sao Tome and Principe 238 67 84 183Cape Verde 231 71 40 232

Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)

● Migration of health workers is primarily demand led

● Especially to UK and USA● Increase in number of nurses leaving the

Philippines and certain African countries influenced by high rates of nursing vacancies in Canada, USA, UK

● Disparities in working conditions and pay are "pull" factors

● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)

● Survey on African countries found the factors affecting migration

● In Cameroon● lack of promotion opportunities, working

conditions, and desire to gain experience were reasons for migration

● In Uganda and Zimbabwe, wages were the most important factor

● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)

● Factors affecting health professionals' decision to migrage from five African countries were

● Desire to work in better managed health system

● Desire to continue education or taining● Want a more conducive working environment● Desire for better or more realistic

remuneration● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,

"Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)

●

In India● A Case study● The reasons for medical professionals want to

go abroad mainly to gain professional experience- higly valued in India when they come back

● Other attraction - higher earnings, perks, high quality of life

● Nurses want to settle down abroad permanently - career prospects are not bright in India

● Doctors some settle abroad● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health

Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703

Health workers

● Health workers● Out-migration of health workers● Dr.s and nurses from India to developed

economies● Foreign educated (mainly Russia) returning

doctors ● the official recognition of their educational

credentials for practicing medicine in India● AIIMS - 56% of graduating doctors migrated

between 1956 - 80 - 1992 study● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Intended reasons for out migration

● The purpose of intended(reasons) out migration of doctors- quoted by Khadaria study is

● to get jobjs with better training opportunities● to ensure rapid progress in the medical profession● to obtain a specific kind of training not easily

available in India● to move abroad for getting god employment

opportunities● medical experience not easily available in Inda● to get a job with better training opportunities

overseas● to progress at a comparale faster pace in the

professional career● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals",

OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703

Motivating factors

● Motivating factors for out-migration of doctors● Better education institutions for children in host

country● Relatives in the host country● Easy access to communication facilities overseas● scope for self employment / entrepreneurship● Conducing immigration and settlement policies of

the host country● proficiency in English language● Satisfactory health facilities overseas ● Comparatively lower real earnings in India● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Motivating factors

● Bleak employment prospects in India● Better professional infrastructure overseas● Increasing employment opportunities

overseas● To get experience that will later be highly

valued in India● Quality of day-to-day life in host country● Better income prospects overseas● Availability of experts in the host country● Higher education in the host country● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


● Faourite destinations● USA - for medical professionals● UK - second preferred destination● Australia - third preferred destination● then Canada, Kuwait, New Zealand,

Germany● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Specialisations● Cardiology and internal medicine are the most

preferred specialisation for the prospective migrant doctors for those with the USA as destination

● internal medicine was the most preferred specialisation for those intending to go to the United Kingdom, and surgery was the preferred specalisation

● Majority reported 4-6 years as intended duration of stay overseas after their planned migration

● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703

Doctors' perceptions

Doctors' perceptions about the Quality of medical education and training in India

● Majority felt they were moderately satisfied

Level of satisfaction with present salary in India

● Many reported dissatisfied followed by moderately satisfied


Nurses case study

● Majority of nurses are married - 88 %● Half are from Kerala● Most completed diploma in nursing● Majority 27/36 planning for one to two years

to overseas● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Source of inspiration

Source of inspiration for emigration for nurses ( in order)

● self● friends overseas● family● friends in Indi● Relatives● Mentor/ Teacher / Senior doctors● Career counselor● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Purpose of out-migration

Purpose of intended out-migration of nurses● better training opportunities● obtain a specific kind of training● Progress faster in medical profession● get employment● permanent settlement in host country ● research assignments● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Motivating factors

Motivating factors for out-migration of nurses● Better income prospects overseas● Quality of day-to-day life overseas● Better infrastructure overseas● Better education institutions for children● Get valuable experience● Higher education overseas● Increasing employment opportunities

overseas● Relatives in the host country● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Motivating factors

● Proficiency in English language● Lower real earning in India● Bleak employment prospects in India● Satisfactory health facilities● Conducive immigration and settlement

policies● scope for self employment entreprneurship● availability of experts in host country● easy access to communication facilities● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Preferred destination

Preferred destination countries for out-migration of nurses( In order)

● USA● UK● Australia● Canada● African Countries● Gulf Countries● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health


Level of satisfaction with education in India

Level of satisfactor with education, training, and experience in India

● Majority were Moderately satisfied● Level of satisfaction with present salary in

India● Majority said moderately satisfied


Mobility or Migration Management

31208mig

Documents

advancementsin health

health sector

health visitor

health shortages

health field

migration of health

world health organization

healthcare systems