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Trade and Health Workforce Migration In recent decades, globalization has brought nations of the world closer, allowing more fluid dissemination of information and more efficient trade of goods through improvements in transportation and communication. Globalization has also led to a rise in the migration of health workers. Health workers represent all individuals who provide health services (e.g., doctors, nurses, pharmacists, and dentists), as well as management and support workers (e.g., hospital administrators, financial professionals, cooks, and ambulance drivers). Recently, the introduction of the General Agreement in Trade of Services (GATS) has allowed health workers to move more fluidly as temporary workers abroad. Migration does not only apply to international migrants from developing to developed nations, but also refers to internal migration from rural to urban areas, or from low-income states/provinces to their high-income counterparts. Some of the most prominent reasons contributing to this migration include: • • •

www.globalhealth.org

An increased demand for skilled workers in high-income countries that are unable to produce enough health workers locally; Better opportunities – higher wages, more training options – in urban areas and/or abroad; An aging workforce that new local/domestic entrants cannot replace so outside recruitment is needed; An increased need for health workers in developed countries to care for an aging population with chronic conditions.1

Scale of the Problem The WHO estimates that currently 57 countries in Africa suffer from a health workforce shortage, and that it will require approximately 4.3 million health care workers to fill the gap.2 The problem of health worker migration is not isolated to developing countries; it is also a problem in rural areas of middle- and high-income countries, such as the United States, South Africa, and China. • • • •

On average, one in four doctors in OECD countries was trained in Africa; Some of the hardest hit countries by migration include Ghana where 29 percent of physicians are working abroad, and Zimbabwe, which has sent 34 percent of its nurses abroad;3 In Canada, the United Kingdom, and the United States, one-quarter of all physicians were trained abroad; Urban areas of South Africa have 14 times more physicians than the national average, leaving many rural areas without adequate access to care.4 America’s Health Workforce versus Sub-Saharan Africa5



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Effects of Health Worker Migration Health worker migration affects individual migrants, the countries they leave and the countries to which they go for employment. The current health professional migration scenario benefits developed nations or urban areas, particularly those that already have relatively stable medical systems in place. Families in developing nations benefit in that migration generates billions of dollars of remittances each year. Another positive aspect of cross-border migration is that after a period of learning and training abroad or in cities, some migrants will return to their home country with important skills and expertise. 6 The Impact of GATS There are four modes of delivery guaranteed under GATS, including: cross boarder supply of services (Mode 1), consumption of services abroad (Mode 2), foreign direct investment (Mode 3), and the movement of health professionals (Mode 4). Under Mode 4, health professionals and supporting manpower reserve the right for temporary settlement abroad. However, as GATS does not clearly define temporary migration, the migration may become a permanent settlement. Similarly, many bilateral and multilateral trade agreements have drafted legislation similar to GATS, which has made boarders more permeable for health workers.7 This has been accomplished through the standardization of qualifications and a simpler visa process within certain trade zones. Policy Implications The World Health Organization has identified a number of methods to combat the problem of health worker migration in developing countries. Some of the most pertinent issues that need to be addressed are: • • • • • •

Encouragement of women to join the health workforce; Fairer treatment and protection of heath workers; Agreements made on the recruitment and working conditions of migrant health workers; More assistance from developed countries to assist countries in crisis; More comprehensive multilateral policies governing the migration of health workers; Better delegation of healthcare tasks to increase efficiency in developed and developing countries.

Further Reading World Health Organization: http://www.who.int The Lancets Series on Trade and Health: http://www.thelancet.com/ Health Worker Migration: http://www.healthworkermigration.com/

MARCH 2010

References 1 World Health Organization. Migration of Health Workers. Fact Sheet. Geneva: World Health Organization. 2006 2 World Health Organization. The global Shortage of Health workers and its impact. Fact Sheet. Geneva: World Health Organization. 2006 3 World Health Organization. Migration of Health Workers. Fact Sheet. Geneva: World Health Organization. 2006 4 Mills EJ, Schabas WA. Should Active recruitment of health workers from sub-Saharan Africa be viewed as a crime? The Lancet 2008; 371(9613): 685-688. 5 World Health Organization. The global Shortage of Health workers and its impact. Fact Sheet. Geneva: World Health Organization. 2006 6 World Health Organization. Migration of Health Workers. Fact Sheet. Geneva: World Health Organization. 2006 7 Smith RD, Chanda R, Tangcharoensathien V. Trade in Health Services. The Lancet. 2009; 373(9663):593-601.

Trade and Health Workforce Migration  

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