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Migration of health personnel
Challenges and opportunities in the MENA region
Christiane Wiskow
& Lamia Rhoufrani
ILO Sectoral Activities Department
Mobilising Migrants’ Skills for Development in the MENA region
UNFPA- OECD Conference, Tunis, 13-14 May 2013
Roundtable 3: brain drain versus brain gain
International Labour Organization
Migration for decent working & living conditions
• 214 million international migrants
105 million economically active
• Labour market shortages in many destination countries
EU: health, science & technology
• Fair deal for migrant workers:
Rights based approach
recognizing labour market needs
2
Youth unemployment: a significant concern for MENA countries
3
5/ 12/ 13 12:45 PMGlobal youth unemployment trends and projections from 2007 to 2013
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Image | 08 May 2013
Mouse over the chart to see the data
Tags: youth employment, unemployment, research, data analysis, projections
Regions and countries covered: Global
Unit responsible: Employment Trends (EMP/TRENDS)
Global youth unemployment trends and projections from 2007 to 2013After a brief recovery, global youth unemployment continues to rise.
Youth unemployment rat... Youth unemployment (m... 1/2
2007
2008
2009
2010
2011
2012p
2013p
9.5
9.9
10.3
10.7
11.1
11.5
11.9
12.3
12.7
13.1
13.5
60
62
64
66
68
70
72
74
76
78
80
Youth
unem
plo
ym
ent
rate
(%
)
You
th u
ne
mp
loym
en
t (m
illio
ns)
Youth unemployment rate, by region, 2007 to 2013
WORLD
Developed Economies
& European Union
Central &
South-Eastern Europe
(non-EU) & CIS
East Asia
South-East Asia & the
Pacific
South Asia
Latin America & the
Caribbean
Middle East
North Africa
Sub-Saharan Africa
2007
2008
2009
2010
2011
2012p
2013p5
10
15
20
25
30
ILO, 2013
World: 12.6 %
73.4 million unemployed
Youth and labour migration Making the most of young migrant skills?
Youth employment crisis
• 27 mill. young people seek jobs outside their country of birth
Support their families financially
Pursue studies
Gain work experience
Concern: De-skilling
• Demand in host country may not match migrant education & skill levels
• Highly skilled young migrants working below their qualification
4
DSPD/UNDESA/ILO: UN World Youth Report 2013;
Youth and labour migration online discussion, 2013
Health Worker Migration Why does is matter?
• Global health workforce shortage: 4 million
• Unequal distribution of health workers
5
Distribution of health workers by level of health and burden of disease,
WHO regions
0
5
10
15
20
25
30
35
0 5 10 15 20 25 30 35 40 45
% of global workforce
% o
f g
lob
al b
urd
en
of
dis
ease Africa
South-East Asia
Eastern Mediterranean
Western Pacif ic
EuropeAmericas
WHO, 2006
Health Workforce MENA region
6
0
2
4
6
8
10
12
MENA: Health professional (physicians, nurses & midwives) density per 1000 population
Nursing and Midwifery personnel density per 1000 Physician density per 1000
Critical shortage treshhold 2.3
WHO GHO; latest year available, ca 2007-2010
Gender matters: Women share in health professions
7
100 100 100 100 100
42.9
94.4
33.8
49.9
84.9
53
36 35.2
14.7
37.4
0
20
40
60
80
100
120
Algeria Egypt Iraq Jordan Oman
Wo
me
n (
% o
f h
eal
th p
rofe
ssio
ns)
Distribution of women in health professions in 5 countries (2004)
Percentage of Women in Midwifery
Percentage of Women in Nursing personnel
Percentage of Female physicians
WHO GHO, accessed 2013
Health worker migration
• Health labour markets globally dynamic;
• High demand in destination countries
— Nursing is no. 1 amongst occupations with job vacancies in Europe
8
(Sources: EC internal estimate, 2010; EU Skills Forecast 2012; European Vacancy Monitor)
Health worker migration MENA region
• Data on HW migration scarce
• Diverse picture:
— source countries & destination countries
— Gulf States: destination countries
— Lebanon, Morocco: source countries
9
Health professionals from MENA countries working in OECD countries
10
53.5
48.5
35.8
19.3 17.7 17.6 16.9 16.6
13.1 11.4
9.1 8.7
5.2
1.4 0.8 0.8
0
10
20
30
40
50
60
Expatriation rate of doctors and nurses in OECD countries, by country of birth in 2000.
expatriation rate of nurses in OECD countries
Expatriation rate of doctors in OECD countries
Total number ofexpatriate nurses and doctors in OECD countries
GCC: Destination Countries Reliance on international health professionals
11
McKinsey, 2007; based on MOH data 2003
Health worker migration policies: balancing rights and interests • Need to balance rights:
— Right to health versus freedom of movement
• Reconciling competing interests:
— Economical:
livelihoods, remittances;
— Social:
development, public health;
access to health services
12
Freedom of movement
Right to decent
working & living
conditions
Right to health
Rights-based approach to labour migration
• National policies based on international labour standards and other international instruments
C97 Migration for Employment Convention (Revised), 1949
C143 Migrant Workers (Supplementary Provisions) Convention, 1975
• Policies that manage migration in a way beneficial to
migrant workers, countries of origin and destination countries
• Fair, effective, coherent policies
— Consultation with social partners and civil society
• Protection of migrant workers — Equality of treatment between nationals and regular migrant
workers — Prevention of & protection against abusive migration practices — Licensing/regulating recruitment agencies ( C 181)
13
Fair approach to international recruitment of health personnel Ethical international recruitment
Aims:
• protecting vulnerable health systems
• protecting migrant health workers
• encouraging adequate workforce planning by all countries in order to meet their own needs
Instruments
WHO global code of practice on the international recruitment of health personnel, 2010
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Implementation WHO Global Code of Practice
15 WHO EB132/23; January 2013
Governance tools - New ?
“ Recruitment of foreign nursing personnel for employment should be authorized only—
(a) If there is a lack of qualified personnel for the posts to be filled in the country of employment;
(b) If there is no shortage of nursing personnel with the qualifications sought in the country of origin. (…)”
ILO Nursing Personnel Recommendation, 1977 ( R 157), Chapter XIII, Art. 67 (1)
16
Conclusion Health sector:
important employment sector
Health Worker migration:
opportunity where it is a choice
• contributes to meeting labour market needs
• contributes to development
— where migrants acquire new skills & return
Challenge for all countries:
• how to attract young people to health careers
and retain HW where they are needed?
17