GLOBAL INEQUITIES AND HEALTH PROFESSION MIGRATION

1. GLOBAL INEQUITIES AND  HEALTH PROFESSION MIGRATION

2. Global Inequities Health Profession Migration

3. What is Migration The migration process has a stage of origin, transit, destination and return. The patterns of migration can be very complex. Each stage of migration exposess the migrant to different health hazards.The migration process has a stage of origin, transit, destination and return. The patterns of migration can be very complex. Each stage of migration exposess the migrant to different health hazards.

4. What are the Global Health Determinant Inequities?

5. Total Population

6. Global Inequities: WealthDistribution of the World�s Wealth This wealth map shows which territories have the greatest wealth when Gross Domestic Product (GDP) is compared using currency exchange rates. This indicates international purchasing power - what someone�s money would be worth if they wanted to spend it in another territory. For some their money will gain value when they move - others� money will lose value. This facilitates the movement of some people, whilst severely limiting that of others. Wealth, as reflected by GDP per person, is highest in Luxembourg, Norway and Switzerland. It is lowest in Ethiopia, Burundi and the Democratic Republic of Congo. This wealth map shows which territories have the greatest wealth when Gross Domestic Product (GDP) is compared using currency exchange rates. This indicates international purchasing power - what someone�s money would be worth if they wanted to spend it in another territory. For some their money will gain value when they move - others� money will lose value. This facilitates the movement of some people, whilst severely limiting that of others. Wealth, as reflected by GDP per person, is highest in Luxembourg, Norway and Switzerland. It is lowest in Ethiopia, Burundi and the Democratic Republic of Congo.

7. Global Inequity: PovertyDistribution of Poverty in the World Poverty is not just a financial state. Being poor affects life in many ways. The human poverty index uses indicators that capture non-financial elements of poverty, such as life expectancy, adult literacy, water quality, and children that are underweight. The 30 territories of the Organisation for Economic Cooperation and Development use a different index which includes income and long-term unemployment; and not water quality or underweight children. This implies that the poor in richer territories are materially better off. The highest human poverty index scores are in Central Africa, the lowest are in Japan.2002 Territory size shows the proportion of the world population living in poverty living there (calculated by multiplying population by one of two poverty indices). Poverty is not just a financial state. Being poor affects life in many ways. The human poverty index uses indicators that capture non-financial elements of poverty, such as life expectancy, adult literacy, water quality, and children that are underweight. The 30 territories of the Organisation for Economic Cooperation and Development use a different index which includes income and long-term unemployment; and not water quality or underweight children. This implies that the poor in richer territories are materially better off. The highest human poverty index scores are in Central Africa, the lowest are in Japan.2002 Territory size shows the proportion of the world population living in poverty living there (calculated by multiplying population by one of two poverty indices).

8. Access to Water: Privatization of a public good Water costs nothing for those with everything, and everything for those with nothingWater costs nothing for those with everything, and everything for those with nothing

9. Access to Water

10. What are the global health burden disease inequities?  Proportional distribution of diseases and deaths

11. Proportional Distribution of people living with HIV, 15 -49 years (2003) HIV, or Human Immunodeficiency Virus Infection, attacks the immune system. It eventually causes AIDS, which stands for Acquired Immune Deficiency Syndrome. With cases first recognised in the United States in 1981, AIDS increases the risk of many infections and tumours.In 2003, the highest HIV prevalence was Swaziland, where 38%, or almost 4 in every 10 people aged 15 to 49 years, were HIV positive. All ten territories with the highest prevalence of HIV are in Central and Southeastern Africa.Transmission of HIV is through sex, using infected needles and in the womb. Infected children are not shown here. HIV/AIDS often has an acquired social stigma.�I have come to the conclusion that HIV/AIDS is not entirely about death. People die and will continue to die for one reason or the other. AIDS is also about the living.� Kiiza Ngonzi, 2004Territory size shows the proportion of all people aged 15-49 with HIV (Human Immunodeficiency Virus) worldwide, living there."HIV, or Human Immunodeficiency Virus Infection, attacks the immune system. It eventually causes AIDS, which stands for Acquired Immune Deficiency Syndrome. With cases first recognised in the United States in 1981, AIDS increases the risk of many infections and tumours.In 2003, the highest HIV prevalence was Swaziland, where 38%, or almost 4 in every 10 people aged 15 to 49 years, were HIV positive. All ten territories with the highest prevalence of HIV are in Central and Southeastern Africa.Transmission of HIV is through sex, using infected needles and in the womb. Infected children are not shown here. HIV/AIDS often has an acquired social stigma.�I have come to the conclusion that HIV/AIDS is not entirely about death. People die and will continue to die for one reason or the other. AIDS is also about the living.� Kiiza Ngonzi, 2004Territory size shows the proportion of all people aged 15-49 with HIV (Human Immunodeficiency Virus) worldwide, living there."

12. Proportional Distribution of Malaria Deaths, 2003

13. Proportion of Cholera cases, 2003

14. Deaths from all Disasters

15. Deaths caused by Drought

16. Deaths caused by Floods

17. Deaths from Extreme Temperature

18. Distribution of Underweight Children Half of all children under the age of 5 years old that are underweight live in Southern Asia. Almost half of all children under 5 in Bangladesh, Nepal and India are underweight. Southeastern Africa, Asia Pacific, Northern Africa and Eastern Asia are also home to relatively large numbers of underweight children. Within these regions the territories with the largest populations of underweight children are: Ethiopia, Indonesia, Nigeria and China

21. Prevalence of risk factors is often directly linked with the prevalence of certain diseases. For example, there is a direct, continuous association between high blood pressure and ischemic heart disease. Europe and South-East Asia both provide an excellent example of with high mortality attributable to both ischemic heart disease and high blood pressure.Prevalence of risk factors is often directly linked with the prevalence of certain diseases. For example, there is a direct, continuous association between high blood pressure and ischemic heart disease. Europe and South-East Asia both provide an excellent example of with high mortality attributable to both ischemic heart disease and high blood pressure.

22. What about the distribution of health workers?Can they address these growing inequities?

23. Global Inequities: World distribution of health workers (2006)

26. The Health Workforce in the Americas vs. Sub-Saharan Africa, 2006

27. 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

31. The PULL for Migration of Health Professionals Sharp rise in demand for health workers in countries of destination: who is recruiting; why are they recruiting, the role of private sector recruitment �.one hundred percent of graduating class in Guyana had tickets to leave the next day Factors that drive migration also drives the mobility of health workers the role of private sector and international organizations Brain waste: the driver is a trained doctor/ the maid is a trained orthopaedic surgeon

32. Determinants of health are inequitably distributed Health professionals are inequitably distributed Many diseases and causes of death are also inequitably distributed with a greater burden in low income countries How can there be a better balance with more responsive health and human resourcing?

33. Strategies

34. Addressing the inequitable distribution of health professionals National code of practice UK code of practice on international recruitment Multilateral code of practice Commonwealth code of conduct Bilateral agreements-MOUs UK / South Africa

35. Lessons learnt Codes of conduct not legally binding Bilateral agreements encourage circular migration and transfer of skills Stakeholders must have common goals National interests need to be in line with wider development objectives We need to think beyond national borders More emphasis needs to be placed on retention

36. How can the migration of health professionals be better managed ? WE all can promote and support the health of migrants through Harmonizing policies to include the needs of migrants & communities through Policy research, Policy coherence & comprehensiveness, Evidence�based advocacy Strengthening the capacity for migrant health friendly services Policies of Prevention & Care Strategies that make health a tool for inclusion not exclusion, reduce vulnerability of migrants and improve access to health care Cooperation & Partnership of all stakeholders that interact with migrants at phases of the migration process WE all can promote and support the health of migrants through Harmonizing policies to include the needs of migrants & communities through Policy research, Policy coherence & comprehensiveness, Evidence�based advocacy Strengthening the capacity for migrant health friendly services Policies of Prevention & Care Strategies that make health a tool for inclusion not exclusion, reduce vulnerability of migrants and improve access to health care Cooperation & Partnership of all stakeholders that interact with migrants at phases of the migration process

37. Intersectoral Collaboration is Key

38. Harmonize policies on retention and recruitment of health professionals, nationally, regionally and globally Policy research Policy coherence & comprehensiveness Capacity Building: training; scholarships; graduate programmes and creative opportunities for research

40. Diaspora professionals address health inequity through: Financial remittances Social remittances Technological remittances Political remittances Structural remittances Human resources for health remittances Members of the diaspora contribute towards remittances thus can also contribute towards strengthening human resources for health & health systems social: accountability, social benefits and contributions eg education systems, cultural political remittances: reinforcing democracy and good governance, transparency Members of the diaspora contribute towards remittances thus can also contribute towards strengthening human resources for health & health systems social: accountability, social benefits and contributions eg education systems, cultural political remittances: reinforcing democracy and good governance, transparency

41. IOM experience: Migration for Development in Africa (MIDA) The MIDA initiative is an innovative framework that engages with the diaspora and facilitates the transfer of skills for capacity development in Africa

44. Ghana MIDA Health Project A bilateral programme of the governments of Ghana and The Netherlands A feasibility study identified the interest of Ghanaian diaspora in Europe Skill gaps identified in Ghana Skill needs matched with Diaspora skills IOM facilitated temporary return of health professionals IOM facilitated internships and training from Ghana to the Netherlands and UK Diaspora professionals can contribute to strengthening the health system

45. What Do We Mean By Strengthening Health Systems

46. Make note that it is just not care workers but includes policy research hr for hr� Make note that it is just not care workers but includes policy research hr for hr�

48. 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

49. The way forward Target-oriented, training and education of health professionals to enhance knowledge of global health and migration issues Identify a comprehensive matrix of health professionals that can reinforce and sustain health systems capacity building and facilitate exchange and return of diaspora: a balanced approach: gender, professionals not just doctors; community based Promote and support ethical recruitment and retention strategies, agreements, guidelines Promote and support dialogue on exchange of experiences

50. Global Health Workforce Alliance Addresses the recruitment and retention of health workers Addresses the need for rapid scaling up of health workers Addresses the tools and methods for training Developing processes for advocacy for receiving and sending countries

51. A global approach is needed We need to: work together learn from each other

52. Thank you