global inequities and health profession migration janet hatcher roberts anita a. davies...
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GLOBAL INEQUITIES AND
HEALTH PROFESSION MIGRATION
Janet Hatcher RobertsAnita A. DaviesInternational Organization for MigrationGeneva, Switzerland
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Global Inequities
Health Profession MigrationHealth Profession Migration
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What is Migration
Origin
Transit
Destination
Return
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What are the Global What are the Global Health Determinant Health Determinant
Inequities?Inequities?
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Total Population
Source: worldmapper.org
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Global Inequities: WealthDistribution of the World’s Wealth
USA
India
Indonesia
Bangladesh
Philippines
China
Japa
n
Russian Federation
Australia
Germany
Spain
Switzerland
Fr Guyana
UK
Italy
Source: worldmapper.org
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Global Inequity: PovertyDistribution of Poverty in the
World
www.worldmapper.org
USA
Canada
Nig
eria Ethiopia
Egypt
Kenya
India
Indonesia
Bangladesh
Philippines
China
Japa
n
Russian Federation
Australia
Pak
ista
n
Thailand
South Africa
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Access to Water: Privatization of a public good
http://hdr.undp.org/
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Access to Water
http://hdr.undp.org/
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What are the global health burden disease inequities?
Proportional distribution of diseases and Proportional distribution of diseases and deathsdeaths
Those who suffer or who benefit least deserve help from those who benefit most.”
Quote from the Millennium Declaration’s statement about the challenge of globalization
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Proportional Distribution of people living with HIV, 15 -49
years (2003)
www.worldmapper.org
Nigeria Ethiopia
Kenya
India
South
Africa
Tanzania
BotswanaZimbabwe
Russian Federation
N=29.2 million www.worldmapper.org
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Proportional Distribution of Malaria Deaths, 2003
www.worldmapper.orgN=109612
Sudan
Uganda
India
Malawi
Tanzania
MozambiqueZimbabwe
Demo Rep Congo
Gha
naAngola
www.worldmapper.org
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Proportion of Cholera cases, 2003
www.worldmapper.orgN=152,929
Sudan
Som
alia
Pakistan
Zambia
Tanzania
Mozambique
Demo Rep Congo
Gha
na
Ang
ola
www.worldmapper.org
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Deaths from all Disasters
www.worldmapper.org
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Deaths caused by Drought
www.worldmapper.org
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Deaths caused by Floods
www.worldmapper.org
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Deaths from Extreme Temperature
www.worldmapper.org
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Distribution of Underweight Children
Half of all children under the age of 5 years old that are Half of all children under the age of 5 years old that are underweight live in Southern Asia. Almost half of all children underweight live in Southern Asia. Almost half of all children under 5 in Bangladesh, Nepal and India are underweight.under 5 in Bangladesh, Nepal and India are underweight.
Southeastern Africa, Asia Pacific, Northern Africa and Eastern Asia Southeastern Africa, Asia Pacific, Northern Africa and Eastern Asia are also home to relatively large numbers of underweight children. are also home to relatively large numbers of underweight children. Within these regions the territories with the largest populations of Within these regions the territories with the largest populations of underweight children are: Ethiopia, Indonesia, Nigeria and Chinaunderweight children are: Ethiopia, Indonesia, Nigeria and China
www.worldmapper.org
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http://www.who.int/mediacentre/factsheets/fs310.pdf
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Source: WHO World Health Report 2002
Morbidity by Risk Factor: Opportunities for Intervention
0
10000
20000
30000
40000
50000
60000
High C& A
High C/V High
A
V LowC & A
Low C& A
High C& A
Low C& A
High C& A
V LowC & A
Low C& A
Low C/High A
Low C& A
High C& A
V LowC & A
Low C& A
AFRICA AMERICAS EAST MED. EUROPE SOUTH-EASTASIA
WEST PACIFIC
Region and Mortality Stratum
DA
LYs
(000
s)
Childhood and maternalundernutrition - Underweight
Diet-related risks and physicalinactivity - Blood pressure
Sexual and reproductive healthrisks - Unsafe sex
Addictive substances - Tobacco
Environmental risks - Unsafewater, etc.
Environmental risks - Indoorsmoke from solid fuels
Occupational risks - Risk of injury
Occupational risks - Airborneparticulates
Other - Unsafe health careinjections
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Source: WHO World Health Report 2002
Mortality by Risk Factor: Opportunities for Intervention
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Hig
h C
& A
Hig
h C
/ VH
igh
A
V Lo
w C
& A
Low
C &
A
Hig
h C
& A
Low
C &
A
Hig
h C
& A
V Lo
w C
& A
Low
C &
A
Low
C/
Hig
h A
Low
C &
A
Hig
h C
& A
V Lo
w C
& A
Low
C &
A
AFRICA AMERICAS EAST MED. EUROPE SOUTH-EASTASIA
WESTPACIFIC
Region and Mortality Stratum
Dea
ths
(000
s)
Childhood and maternalundernutrition - Underweight
Diet-related risks and physicalinactivity - Blood pressure
Sexual and reproductive healthrisks - Unsafe sex
Addictive substances - Tobacco
Environmental risks - Unsafewater, etc.
Environmental risks - Indoorsmoke from solid fuels
Occupational risks - Risk ofinjury
Occupational risks - Airborneparticulates
Other - Unsafe health careinjections
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What about the What about the distribution of health distribution of health
workers?workers?
Can they address these Can they address these growing inequities?growing inequities?
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Global Inequities: World distribution of health workers
(2006)
http://www.who.int/mediacentre/factsheets/fs302/en/index.html
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The Health Workforce in the Americas vs. Sub-Saharan Africa,
2006
http://www.who.int/mediacentre/factsheets/fs302/en/index.html
0
10
20
30
40
50
60
World Population Global Burden of Disease World's Health Workers Global Health Expenditure
Per
cent
(%
)Americas Sub-Saharan Africa
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The PUSH for Migration of Health Professionals
Poverty Employment Education Safe clean water: ability to deliver good quality care Social exclusion
Urban / Rural: huge disparities in health worker distribution
Gender: power relationships within the professions Poor infrastructure Poor, dysfunctional health systems: impact of SAP, no
solid investment in the health system, no professional growth
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The PULL for Migration of Health Professionals
Sharp rise in demand for health workers in countries of Sharp rise in demand for health workers in countries of
destination: who is recruiting; why are they recruiting, the destination: who is recruiting; why are they recruiting, the
role of private sector recruitment ….one hundred percent of role of private sector recruitment ….one hundred percent of
graduating class in Guyana had tickets to leave the next daygraduating class in Guyana had tickets to leave the next day
Factors that drive migration also drives the mobility of health Factors that drive migration also drives the mobility of health
workersworkers
the role of private sector and international organizationsthe role of private sector and international organizations
Brain waste: the driver is a trained doctor/ the maid is a Brain waste: the driver is a trained doctor/ the maid is a
trained orthopaedic surgeontrained orthopaedic surgeon
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Determinants of health are inequitably Determinants of health are inequitably distributed distributed
Health professionals are inequitably Health professionals are inequitably distributeddistributed
Many diseases and causes of death are Many diseases and causes of death are also inequitably distributed with a also inequitably distributed with a greater burden in low income countries greater burden in low income countries
How can there be a better balance with How can there be a better balance with more responsive health and human more responsive health and human resourcing?resourcing?
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Strategies
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Addressing the inequitable Addressing the inequitable distribution of health distribution of health
professionalsprofessionals National code of practiceNational code of practice
UK code of practice on UK code of practice on international recruitmentinternational recruitment
Multilateral code of practiceMultilateral code of practiceCommonwealth code of conductCommonwealth code of conduct
Bilateral agreements-MOUsBilateral agreements-MOUsUK / South AfricaUK / South Africa
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Lessons learnt Codes of conduct not legally bindingCodes of conduct not legally binding Bilateral agreements encourage Bilateral agreements encourage
circular migration and transfer of skillscircular migration and transfer of skills Stakeholders must have common goalsStakeholders must have common goals National interests need to be in line National interests need to be in line
with wider development objectiveswith wider development objectives We need to think beyond national We need to think beyond national
bordersborders More emphasis needs to be placed on More emphasis needs to be placed on
retentionretention
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How can the migration of How can the migration of health professionals be health professionals be
better managed ?better managed ?
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Intersectoral Collaboration is Key
Interact with related policy domains
Migration&
Health Professional Policies
Development
Trade
Labour
Human Rights
Security
Health
Education
Foreign Affairs
Need for coherence
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Harmonize policies on retention and Harmonize policies on retention and recruitment of health professionals, recruitment of health professionals, nationally, regionally and globallynationally, regionally and globally Policy researchPolicy research Policy coherence & comprehensivenessPolicy coherence & comprehensiveness
Capacity Building: training; scholarships; Capacity Building: training; scholarships; graduate programmes and creative graduate programmes and creative opportunities for researchopportunities for research
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Who Are TheStakeholders?
Donors for Development
International Organizations
Diaspora
Private Sector/Civil Society
Country of Origin
Host Countries
Academic/Health Institutions
Health Professional Orgs
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Diaspora professionals address health inequity
through: Financial remittances Financial remittances Social remittances Social remittances Technological remittancesTechnological remittances Political remittancesPolitical remittances Structural remittancesStructural remittances Human resources for health Human resources for health
remittancesremittances
Diaspora
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IOM experience: Migration for Development in Africa
(MIDA) The MIDA initiative is an The MIDA initiative is an
innovative framework that engages innovative framework that engages with the diaspora and facilitates with the diaspora and facilitates the transfer of skills for capacity the transfer of skills for capacity development in Africadevelopment in Africa
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Dialogue and migration policy
option
Assessment database
development
Skills transfer
Remittances programmes
Information Campaigns
-
Small-scale enterprise
development
Migration for Development in Africa (MIDA)
Ethical Practices
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MIDA projects
77 Ghanaian health sectorGhanaian health sector
Sierra Leonean and Sierra Leonean and Ghanaian diasporasGhanaian diasporas
6
5/6/7 5/6/7 3/3/
44
Ethiopian and Ghanaian Ethiopian and Ghanaian expatriates in Italyexpatriates in Italy
55
Guinean womenGuinean women11
East African Community East African Community (EAC)(EAC)
22
The Great LakesThe Great Lakes33
The Great Lakes regionThe Great Lakes region 4
1166
77
3/43/4
55
55
22
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Ghana MIDA Health Project A bilateral programme of the governments of Ghana A bilateral programme of the governments of Ghana
and The Netherlands and The Netherlands A feasibility study identified the interest of Ghanaian A feasibility study identified the interest of Ghanaian
diaspora in Europediaspora in Europe Skill gaps identified in GhanaSkill gaps identified in Ghana Skill needs matched with Diaspora skillsSkill needs matched with Diaspora skills IOM facilitated temporary return of health IOM facilitated temporary return of health
professionalsprofessionals IOM facilitated internships and training from Ghana to IOM facilitated internships and training from Ghana to
the Netherlands and UKthe Netherlands and UK Diaspora professionals can contribute to strengthening Diaspora professionals can contribute to strengthening
the health systemthe health system
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What Do We Mean By What Do We Mean By Strengthening Health Strengthening Health
SystemsSystems
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Frameworks: Population Health/Health PromotionEquity/Determinants of Health
Inter Sectoral Policy Development
Research for Development: Capacity, Funding andPolicies support evidence based policies
Capacity Building for Planning Evidence Based Resource Allocation
Integrated health information systems: data for decision making
Human Resource Development/Continuing Education
Equitable access to treatment, services and programs
Community Interventions andHealth Promotion Programs
Evidence based Decision Making (Clinical and Community based)
Strong and vibrant civil societyAccountable and Transparent Public /Private Sector
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The Impact of Decentralization on Human Resource Response
National
Local Community
Continuum of Health Response
Problem Identification
Data Analysis
Intervention, Prevention Strategies Policy
Devt
Local Needs coordination
Programs &
Services
Capacity is not being developed and sustained at the right level
Money remains at the national level
Data Collection
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Policies that influence the migration of health
professionals The factors that shape immigration
policies are complex and intertwined as governments struggle to balance economic, labor market, social, demographic, human rights, humanitarian, international, and political goals
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The way forward Target-oriented, training and education of Target-oriented, training and education of
health professionals to enhance knowledge health professionals to enhance knowledge of global health and migration issuesof global health and migration issues
Identify a comprehensive matrix of health Identify a comprehensive matrix of health professionals that can reinforce and sustain professionals that can reinforce and sustain health systems capacity building and health systems capacity building and facilitate exchange and return of diaspora: a facilitate exchange and return of diaspora: a balanced approach: gender, professionals balanced approach: gender, professionals not just doctors; community basednot just doctors; community based
Promote and support ethical recruitment Promote and support ethical recruitment and retention strategies, agreements, and retention strategies, agreements, guidelinesguidelines
Promote and support dialogue on exchange Promote and support dialogue on exchange of experiencesof experiences
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Global Health Workforce Alliance
Addresses the recruitment and Addresses the recruitment and retentionretention of health workers of health workers
Addresses the need for rapid scaling up Addresses the need for rapid scaling up of health workersof health workers
Addresses the tools and methods for Addresses the tools and methods for trainingtraining
Developing processes for advocacy for Developing processes for advocacy for receiving and sending countriesreceiving and sending countries
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A global approach is needed
We need to: We need to:
work together work together
learn from each learn from each other other
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Thank you
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