course material

1. INTERNATIONAL WORK FORCE
INTERNATIONAL WORK FORCEThere is a growing concern regarding to the unbalanced
distribution of health workers between developed and developing nations. The unbalanced
distribution of health worker has deprived the poor countries of health workers and has
impaired their ability to train and retain replacements (Global Health Blog, 2010). The
migration of health workers to other countries necessitates a country to come up public
health policy to improve healthcare services. According to WHO statistics, there are
currently an estimated 2.4 million health practitioners, nurses and midwifes around the
world to provide health care services to patients (Alkire, & Lincoln, 2004).Shortage of
healthcare practitioners requires an adoption of a global approach to improve the numbers
of health workers. There are many factors that have contributed to migration and
subsequent brain drain of health workers globally. This paper discusses the global policy
implications of the shortage of health care workers and the brain drain from poor countries
to the developed countries.DiscussionThe world’ s healthcare systems are currently facing
crisis. This crisis is experienced by both the developing and developed countries’ systems
which are at the moment struggling towards meeting the healthcare needs of their citizens.
Among the challenges facing both the developing and developing systems, is the inadequate
availability of healthcare professionals in their health sector. The developing nations are
seen to periodically experience shortages of nurses in their national healthcare system.
These shortages are dictated by market forces which in this case the demand is increasing
at a faster rate than the supply healthcare professionals. Thus, in these developed countries,
there is an increasingly high technology health care and increased demand of health care
workers. On the other hand, the developing nations have poor planning and less investment
in the education of health workers prompting migration of health care workers to the
developed nations (Alkire & Lincoln, 2004). The majority of developing countries that are
located in the southern hemisphere have experienced economic policies that have
contributed to poor investment in the healthcare sector. This has impacted their health
sector for it has resulted to the reduced opportunity of getting education for health care
workers (Bach, 2003).The other factors that have contributed to health workers migration
are attributed to poor working conditions coupled with limited economic prospects in their
home countries. This has created a situation whereby health workers choose to migrate
from their home countries to look for better opportunities in rich nations (Bach, 2003). This
has made the developing countries to experience a considerable outflow of health
professionals leading to reduced healthcare service provision. The developing nations

2. spend a lot of money educating health workers who later migrate to the developed
countries to look for lucrative job opportunities.This migration of health workers can be
viewed as developing nations helping the developed nations in the health sector. It is
estimated that developing nations spend approximately $ 500 million yearly to educate
health workers who later migrate to other countries such as USA, Europe, and south Asia
(Bach, 2003). Healthcare service delivery of developing nations has been greatly weakened
by shortage of health workers and risk further collapse. The developed governments tend to
receive a lot of benefit resulting from the inflow of healthcare workers in their countries.
Some of the benefits include reduction in the inadequacy of skilled healthcare professionals
that was experienced by the countries. Bearing in mind that these developed nations’
healthcare systems are facing a shortage, the problem could have clearly been much worse
if there were no foreign health professionals. Secondly, the quality of healthcare services
provided to the consumers is bound to improve compared to when the shortages are
greater in addition, there will be reduced public health risks (Bach, 2003). Lastly, the
employment of these immigrant healthcare professionals has the impact of reducing the
salary packages of employees in the healthcare sector. This in infect increases the financial
benefit of consumers through reduced prices healthcare services, since the labour costs will
decrease because of the increased supply of health workersA resolution by African
Ministers of health provided food for thought to the WHO, for they presented their
grievance stating that the migration of health practitioners from their countries has greatly
crippled their health care systems. The unmonitored movement of health practitioners from
poor countries has left these regions with a great need for medical professionals. It has been
estimated that over 36% of health care workers stay and work in USA and Canada. It is very
ironical since these countries with a large number of health care human resources have the
least burden of diseases, less than 10%. This situation contrasts what is experienced in
Africa which constitutes only less that 3% of the worlds health care human resources, but
has more than 24% of the disease burden globally (Alkire & Lincoln, 2004).Due to the
problems associated with migration of health workers from poor countries to rich
countries, developed countries are facing severe shortages particularly in rural areas as
health workers move to the rich countries to look for job opportunities. In order to correct
the imbalances that currently exist in the healthcare, adequate policies should be designed
to protect the right of health workers to migrate legally and ensure a balance in the
distribution of health workers globally (Bach,2003). An effort to promote such an approach,
involved launching of a Health Worker Migration Policy Initiative.The Migration Policy
Initiative has brought together many healthcare professional organizations to develop
codes of practices for the migration of health workers. In addition various individual health
care institutions have developed ethical codes of practice to put into consideration an
ethical practice in recruitment of health professionals. This initiative intended to focus on
the benefits and equitable migration of health professional between developed and
developing nations (Buchan and Sochaiski, 2003). In addition, the initiative intends to
create national as well as international guidelines to act as a guideline for the migration of
health workers through bilateral agreements which are important to ensuring that the least
developed countries also benefit from the migration of health practitioners. This type of

3. agreement can be compared with that between UK and South Africa that has allowed for a
health care worker exchange that is tie limited, this initiative has led to the pairing of the
hospitals from these nations to enhance sharing of best practices in healthcare.It has been
concluded that such initiatives are very important particularly in avoiding brain drain that
results from the migration of skilled health care professionals from less developed nations.
In addition it also prevents brain waste when the skilled migrants cannot get jobs in their
fields of expertise hence ending up in other unrelated jobs that are low paying (Buchan and
Sochaiski, 2003). Such international agreements can facilitate implementation of this
initiative by improving health workers training in their respective countries of origin and
assist employers in the recruiting nations to have a better understanding of cultural
diversity, strengths in training, and identify areas where the skilled workers require
additional training (Dovlo, and Tim, 2004).Preventing brain waste may have many
implications to the migration of health care workers from the less developed nations to the
rich nations. It ensures that migrating health professionals have their skills not wasted and
allows them and their countries to benefit from the bilateral agreements. It is necessary to
understand how best to integrate the migrant workers into the work place. A code has been
developed by WHO that requires governments in both rich and poor countries to address
the pull factors that lure workers to migrate to the developed nations and the push factors
that make them to stay in their home countries not attractive (Global Health Workforce
Alliance, 2011). Enough health workers should be produced and adjustments should be
made in the health training programs which should get more funding from the developed
nations.Sources nations, mostly the developing nations have proposed introduction of
policy intervention to curb health workers migration in the healthcare labour market. This
involved raising the cost of recruiting registered nurses and medical doctors that come from
less developed nations (Bach, 2003). This is achieved through imposing taxes or tariff on
such transactions with the objective of recovering some of the training costs. However, this
has proved to have negative impact and so far there is no country that has implemented this
policy.Conclusion/SummaryIn a nutshell, the migration of health workers will continue to
take place. Countries with high numbers of healthcare workers emigration are mostly
recorded from Sub-Saharan nations which are highly affected by the migration of healthcare
workers (Global Health Blog, 2010). Many challenges that face such countries are political,
economic instability, and poor governance. Factors such as salaries and benefits are
considered in the extremes in the wage differences between the developing and developed
nations. For example wages that health care workers obtain in Canada and Australia are
more than those earned by health care workers in South Africa. Search for a better income
is not the only reason for migration of health practitioners from their home countries to rich
nations, other factors include poor working environments that occurs due to heavy
workload, poor, and limited organizational capacity.It is appropriate to work towards
developing self sufficiency in the developing countries by the developed world. The
Migration Policy Initiative has helped in the equitable migration of health professional
between the developed and developing nations. The developed nations need to provide
support to the developing countries that have the pool of workers by providing financial
assistance to train the health care human resource and improve the health care

4. infrastructure. Through such initiatives, it has been observed that the trained healthcare
workers can be retained in their respective home countries. It is imperative for less
developed nations to improve the work place conditions for health care workers so that a
large number of health care practitioners are retained in their home countries to prevent
brain drain and brain waste.RecommendationsTo achieve a balanced distribution of health
care workers globally, it is important to have a global partnership that will address the
shortage of health workers by drawing and mobilizing key stakeholders to assist developing
nations to have a better plan. The plan should enhance an opportunity for education and
employment of health practitioners. In addition developing countries should improve
working conditions for health workers by boosting their income and creating opportunities
for them to advance through offering training. In addition, it is important to improve
financial assistance to enable developing nations to drugs and medical equipments readily
available. The programs should include funds and other incentives that can easily boost
recruitment and expand locally available training programs and facilities. Such programs
can make health care workers to move back to their home countries.ReferencesAlkire, S. &
Lincoln, C. (2004). “ Medical Expectations in International Migration: Should Doctors and
Nurses Be Treated Differently.” Paper presented at Global Migration Regimes Workshop.
Stockholm, Sweden.Bach, S. (2003). International Migration of Health Workers: Labour and
Social Issues. International Labour Office, Geneva.Buchan, J. T. Park and Sochaiski, J. (2003).
“ International Nurse Mobility: Trends and Policy Implications.” World Health
Organization, Geneva.Dovlo, D. and Tim, M. (2004). “ A Review of the Migration of Africa’ s
Health Professionals.” Paper Commissioned by the Joint Leaning Initiative on Human
Resources for Health, Africa Working Group.Global Health Workforce, (2011). Increasing
access to health workers in remote and rural areas through improved retention. Retrieved
on 12th October 2011 from: http://www.eldis.org/go/topics/resource-guides/health-
systems/geneva-health-forum/the-global-health-workforceGlobal Health Workforce
Alliance, (2011).Investing in health personnel treating mental health conditions, World
Health Organization. Retrieved on 12th October 2011 from:
http://www.who.int/workforcealliance/en/Global Health Blog, (2010). Top 10 Myths
about the Global Health Workforce Crisis Busted at the National Physicians Alliance
Conference. Retrieved on 12th October 2011 from: http://www.intrahealth.org/page/top-
10-myths-about-the-global-health-workforce-crisis-busted-at-the-national-physicians-
alliance-conference.