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GLOBAL INEQUITIES AND HEALTH PROFESSION MIGRATION

GLOBAL INEQUITIES AND HEALTH PROFESSION MIGRATION. Janet Hatcher Roberts Anita A. Davies International Organization for Migration Geneva, Switzerland. Global Inequities. Health Profession Migration. What is Migration. Origin. Return. Transit. Destination.

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GLOBAL INEQUITIES AND HEALTH PROFESSION MIGRATION

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  1. GLOBAL INEQUITIES AND HEALTH PROFESSION MIGRATION Janet Hatcher Roberts Anita A. Davies International Organization for Migration Geneva, Switzerland

  2. Global Inequities Health Profession Migration

  3. What is Migration Origin Return Transit Destination

  4. What are the Global Health Determinant Inequities?

  5. Total Population Source: worldmapper.org

  6. Russian Federation UK Germany China USA Japan Switzerland Bangladesh Italy Spain India Philippines Fr Guyana Indonesia Australia Global Inequities: WealthDistribution of the World’s Wealth Source: worldmapper.org

  7. Russian Federation Canada USA China Pakistan Japan Egypt Bangladesh India Ethiopia Nigeria Thailand Philippines Kenya Indonesia Australia South Africa www.worldmapper.org Global Inequity: PovertyDistribution of Poverty in the World

  8. Access to Water:Privatization of a public good http://hdr.undp.org/

  9. Access to Water http://hdr.undp.org/

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

  11. Proportional Distribution of people living with HIV, 15 -49 years (2003) RussianFederation India Nigeria Ethiopia Kenya Tanzania Zimbabwe Botswana SouthAfrica www.worldmapper.org N=29.2 million www.worldmapper.org

  12. Proportional Distribution of Malaria Deaths, 2003 Sudan India Uganda Ghana Demo Rep Congo Tanzania Angola Malawi Zimbabwe Mozambique N=109612 www.worldmapper.org www.worldmapper.org

  13. Proportion of Cholera cases, 2003 Pakistan Sudan Somalia Ghana Demo Rep Congo Tanzania Angola Zambia Mozambique www.worldmapper.org N=152,929 www.worldmapper.org

  14. Deaths from all Disasters www.worldmapper.org

  15. Deaths caused by Drought www.worldmapper.org

  16. Deaths caused by Floods www.worldmapper.org

  17. Deaths from Extreme Temperature www.worldmapper.org

  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 www.worldmapper.org

  19. http://www.who.int/mediacentre/factsheets/fs310.pdf

  20. Source: WHO World Health Report 2002

  21. Source: WHO World Health Report 2002

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

  23. Global Inequities: World distribution of health workers (2006) http://www.who.int/mediacentre/factsheets/fs302/en/index.html

  24. The Health Workforce in the Americas vs. Sub-Saharan Africa, 2006 http://www.who.int/mediacentre/factsheets/fs302/en/index.html

  25. 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

  26. 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

  27. 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?

  28. Strategies

  29. 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

  30. 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

  31. How can the migration of health professionals be better managed ?

  32. Security Development Health Trade Labour Education Human Rights Foreign Affairs Intersectoral Collaboration is Key Need for coherence Migration & Health Professional Policies Interact with related policy domains

  33. 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

  34. Country of Origin Donors for Development Host Countries Who Are The Stakeholders? International Organizations Diaspora Academic/Health Institutions Private Sector/Civil Society Health Professional Orgs

  35. Diaspora Diaspora professionals address health inequity through: • Financial remittances • Social remittances • Technological remittances • Political remittances • Structural remittances • Human resources for health remittances

  36. 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

  37. Ethical Practices Migration for Development in Africa (MIDA) Small-scale enterprise development Information Campaigns - Dialogue and migration policy option Skills transfer Assessment database development Remittances programmes

  38. 1 Guinean women Ghanaian health sector 7 6 East African Community (EAC) Sierra Leonean and Ghanaian diasporas 2 7 3/4 5 1 5 5 Ethiopian and Ghanaian expatriates in Italy 6 3/4 5/6/7 2 The Great Lakes 3 The Great Lakes region 4 MIDA projects

  39. 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

  40. What Do We Mean By Strengthening Health Systems

  41. Frameworks: Population Health/Health Promotion Equity/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 society Accountable and Transparent Public /Private Sector

  42. The Impact of Decentralization on Human Resource Response National Money remains at the national level Intervention, Prevention Strategies Policy Devt Problem Identification Data Analysis Programs & Services GAVI GFHIVTBM Continuum of Health Response Capacity is not being developed and sustained at the right level Data Collection Local Needs coordination Local Community

  43. 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

  44. 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

  45. 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

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