31208mig

581 views
522 views

Published on

Impact of Migration on Health

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
581
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

31208mig

  1. 1. Impact of Migration on Health Kannan Srinivasan, AMCHSS, SCTIMST 3 December 2008
  2. 2. Organization ● Migration ● Human Resources in Health ● Migration and HR ● Migration and Health ● Migration in India
  3. 3. Human Resources in Health ● Human Resources(health workforce) is prime in advancementsin health ● Health depends more on people to carry out its mission ● Health workers – Professionals – Technicians – Auxiliaries ● Human Resources for health are, the stock of all individuals engaged in Promotion, protection of population health
  4. 4. Human Resources for Health ● All men and women who work in health field – Not just physicians and nurses but also – Public health workers – Policy makers – Educators – Clerical staff – Scientists – Pharmacists ● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
  5. 5. Human Resources for Health ● For every 30,000 – PHC ● PHC- 2 to 3 Physicians, 1 ISM Physician, 1 Male Health Assistant, 1 Female Health Assistant, 1 BEE, 1F Health Worker(ANM), 1 LT, 1 Statistician, 1 Driver, 1 Store keeper and ancillary staffs and attendants ● For every 5,000 – SC ● 1 MPW, 1 FMPW, For every 1000 Community Health Volunteer ● There are 23236 PHCs, 3346 CHCs and 146026 SCs (GoI)and Taluka, Dist Hospitals ● Population of Indiab 1,028 million (2001 Census) ● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
  6. 6. Human Resources for Health ● There are 6,43,520 Allopathic Medical prac- titioners practicing in different states in India registered with different MCs (76925 +23858 = 1,00,783 in Public) ● There are 55000 dental surgeons registered with different DCs (up to 2005) ● There are 8,39,862 General Nursing Mid- wives, 5,02,503 Auxillary Nursing Midwives and 40,536 Health visitor and Health super- visors(Upto 2002) Nursing Councils ● (in Public 1,79,495 – 2005) ● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
  7. 7. Human Resources for Health ● Shortages and Vacancies (2006) – 6.5 % PHCs without Doctor – 4.7 % of SCs without HW(F) – 39.2 % of SCs without HW (M) – Short fall of 19,311 MPW (F) – Shortfall of 64,211 MPW(M) – Shortfall of 4,214 LHV/HA – Shorfall of 5290 HA(M) – 4.8% MPW(F) posts vacant – 24.1 %MPW(M) Vacant – 13.2 % LHV/HA Vacant – 25.4 % HA(M) Vacant – 17.5 % Doctors at PHCs Vacant ● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
  8. 8. Human Resources for Health ● Migration of Health Personnel ● Estimation 50% of AIIMS students migrated to overseas or to the private sector ● Around 1,00,000 doctors of Indian origin settled in the USA and UK alone(WHO 2007) ● Around 81,091 nurses migrated to USA from India ● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
  9. 9. Migration ● Movement of people from one place to another has shaped today's political, social and economic wourld and major influence on society.(Stilwell et. al) ● In 2000 almost 175 million people or 2.9% of world population, were living outside their country of birth for longer than one year. ● Of these, 65 million are economically active ● It is significant for many resource poor countries as they lose their better education nationals to richer countries ● 65% of all economically active migrants who have moved to developed countries are classified as 'highly skilled'
  10. 10. Migration in Health Sector ● In health, this refers to physicians, nurses, dentists, and pharmacists ● Nurses are in high demand ● USA and UK have shortfall of nurses in 10- 20 years time. They pay high compensation to attract ● There is an international concern expressed about the loss of skilled health professionals from health-care systems in poorer coun- tries that are already weak.
  11. 11. ● For policy options for managing migration, evidence of the magnitude of the problem and an understanding of the context of the labour markets is needed(Stilwell et.al.2004) ● health workers migration ● Migration of health professionals not been studied extensively ● Last study was in 1970s ● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
  12. 12. Portuguese speaking African countries to Portugal migration No of Physicians No of Nurses Source country In Portugal In Source Country In Portugal In Source Country Angola 820 961 383 14288 Guinea-Bissau 358 197 253 1299 Sao Tome and Principe 238 67 84 183 Cape Verde 231 71 40 232 Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
  13. 13. ● Migration of health workers is primarily demand led ● Especially to UK and USA ● Increase in number of nurses leaving the Philippines and certain African countries influenced by high rates of nursing vacancies in Canada, USA, UK ● Disparities in working conditions and pay are "pull" factors ● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
  14. 14. ● Survey on African countries found the factors affecting migration ● In Cameroon ● lack of promotion opportunities, working conditions, and desire to gain experience were reasons for migration ● In Uganda and Zimbabwe, wages were the most important factor ● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
  15. 15. ● Factors affecting health professionals' decision to migrage from five African countries were ● Desire to work in better managed health system ● Desire to continue education or taining ● Want a more conducive working environment ● Desire for better or more realistic remuneration ● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8) ●
  16. 16. In India ● A Case study ● The reasons for medical professionals want to go abroad mainly to gain professional experience- higly valued in India when they come back ● Other attraction - higher earnings, perks, high quality of life ● Nurses want to settle down abroad permanently - career prospects are not bright in India ● Doctors some settle abroad ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  17. 17. Health workers ● Health workers ● Out-migration of health workers ● Dr.s and nurses from India to developed economies ● Foreign educated (mainly Russia) returning doctors ● the official recognition of their educational credentials for practicing medicine in India ● AIIMS - 56% of graduating doctors migrated between 1956 - 80 - 1992 study ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  18. 18. Intended reasons for out migration ● The purpose of intended(reasons) out migration of doctors- quoted by Khadaria study is ● to get jobjs with better training opportunities ● to ensure rapid progress in the medical profession ● to obtain a specific kind of training not easily available in India ● to move abroad for getting god employment opportunities ● medical experience not easily available in Inda ● to get a job with better training opportunities overseas ● to progress at a comparale faster pace in the professional career ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  19. 19. Motivating factors ● Motivating factors for out-migration of doctors ● Better education institutions for children in host country ● Relatives in the host country ● Easy access to communication facilities overseas ● scope for self employment / entrepreneurship ● Conducing immigration and settlement policies of the host country ● proficiency in English language ● Satisfactory health facilities overseas ● Comparatively lower real earnings in India ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  20. 20. Motivating factors ● Bleak employment prospects in India ● Better professional infrastructure overseas ● Increasing employment opportunities overseas ● To get experience that will later be highly valued in India ● Quality of day-to-day life in host country ● Better income prospects overseas ● Availability of experts in the host country ● Higher education in the host country ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  21. 21. ● Faourite destinations ● USA - for medical professionals ● UK - second preferred destination ● Australia - third preferred destination ● then Canada, Kuwait, New Zealand, Germany ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  22. 22. Specialisations ● Cardiology and internal medicine are the most preferred specialisation for the prospective migrant doctors for those with the USA as destination ● internal medicine was the most preferred specialisation for those intending to go to the United Kingdom, and surgery was the preferred specalisation ● Majority reported 4-6 years as intended duration of stay overseas after their planned migration ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  23. 23. Doctors' perceptions Doctors' perceptions about the Quality of medical education and training in India ● Majority felt they were moderately satisfied Level of satisfaction with present salary in India ● Many reported dissatisfied followed by moderately satisfied ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  24. 24. Nurses case study ● Majority of nurses are married - 88 % ● Half are from Kerala ● Most completed diploma in nursing ● Majority 27/36 planning for one to two years to overseas ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  25. 25. Source of inspiration Source of inspiration for emigration for nurses ( in order) ● self ● friends overseas ● family ● friends in Indi ● Relatives ● Mentor/ Teacher / Senior doctors ● Career counselor ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  26. 26. Purpose of out-migration Purpose of intended out-migration of nurses ● better training opportunities ● obtain a specific kind of training ● Progress faster in medical profession ● get employment ● permanent settlement in host country ● research assignments ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  27. 27. Motivating factors Motivating factors for out-migration of nurses ● Better income prospects overseas ● Quality of day-to-day life overseas ● Better infrastructure overseas ● Better education institutions for children ● Get valuable experience ● Higher education overseas ● Increasing employment opportunities overseas ● Relatives in the host country ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  28. 28. Motivating factors ● Proficiency in English language ● Lower real earning in India ● Bleak employment prospects in India ● Satisfactory health facilities ● Conducive immigration and settlement policies ● scope for self employment entreprneurship ● availability of experts in host country ● easy access to communication facilities ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  29. 29. Preferred destination Preferred destination countries for out- migration of nurses( In order) ● USA ● UK ● Australia ● Canada ● African Countries ● Gulf Countries ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  30. 30. Level of satisfaction with education in India Level of satisfactor with education, training, and experience in India ● Majority were Moderately satisfied ● Level of satisfaction with present salary in India ● Majority said moderately satisfied ● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
  31. 31. Mobility or Migration Management

×