Brain Drain and Brain Gain: Selected Country Experiences and Responses

Transcription

1 Brain Drain and Brain Gain: Selected Country Experiences and Responses Manuel M. Dayrit MD, MSc Dean, Ateneo School of Medicine and Public Health Manila, Philippines

2 Australia, Canada, UK and US together account for 72% of foreign-born nurses and 69% of foreign-born doctors working in the OECD. Source: WHO EB132/23 14 December 2012,

3 The Philippines -- top source for nurses in the US, UK, Canada; third-largest source in Australia. India -- top source for doctors in the US, UK, Australia; recently second place in Canada. Source: WHO EB 132/23, 14 December 2012.

4 International Migration of Health Personnel towards and between OECD countries i) Nurses: Top 10 countries of origin ii) Doctors: Top 10 countries of origin Philippines United Kingdom Germany Jamaica Canada India Ireland Nigeria Haiti Former Yug. 0 20,000 40,000 60,000 80, , ,000 India Germany United Kingdom Philippines China Former USSR Algeria Pakistan Canada Iran 0 10,000 20,000 30,000 40,000 50,000 60,000 Source: OECD,

5 Philippines is top exporter of 2000: 163,756 nurses working abroad 110,774 (67%) in OECD nurses to OECD Nurses migrating ,014 US Philippines Salary (US$/month) Source: Kanchanachitra C. et al. Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services. The Lancet 2011:377:769-81

6 Manila taxi: for all types of jobs

7 The Philippines is trying to address its nursing imbalances NARS Nurses Assigned to Rural Service programme; unemployed nurses sent; Project EntrepreNurse Nurses as independent primary care providers in nursemanaged cooperatives; Pilot project The Nurse Roadmap Strengthen professional norms and organization within nursing sector. Source: Dimaya RM, McEwen MK, Curry LA et al. 2012

8 Poor countries lose large percentages of their doctors and nurses to OECD countries i) Expatriation rates for nurses in OECD countries, circa 2000 ii) Expatriation rates for doctors in OECD countries, circa 2000 Liberia Trinidad and Tobago Antigua and Barbuda Saint-Kitts and Nevis Barbados Guyana Saint Vincent and the Grenadines Belize Grenada Jamaica Haiti 0% 20% 40% 60% 80% 100% Haiti Saint-Vincent and the Grenadines Trinidad and Tobago Tanzania Sierra Leone Fiji Angola Mozambique Guyana Grenada Antigua and Barbuda 0% 20% 40% 60% 80% 100% Source: OECD,

9 Health worker shortages in countries Critical threshold: 2.3 workers per 1,000 population Source: WHO (2006). The World Health Report 2006 Working Together for Health. Geneva, World Health Organization

10 Physician, nurse, midwife density in Asia Countries Latest year All HRH density Afghanistan Bangladesh Bhutan Cambodia India Indonesia Myanmar Pakistan PDR Laos PNG Global Health Workforce Statistics, World Health Organization

11 Physician density in Asian countries Countries Latest year Physician density Afghanistan Bangladesh Bhutan Cambodia India Indonesia Myanmar Pakistan PDR Laos PNG Global Health Workforce Statistics, WHO

12 Nurse & Midwife density in Asian countries Countries Latest year Nurses and Midwives density Afghanistan Bangladesh Bhutan Cambodia India Indonesia Myanmar Pakistan PDR Laos PNG Global Health Workforce Statistics, WHO

13 Nursing migration to the United Kingdom Significant variations over time among major source countries 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1, / / / / / / / / /07 India Philippines Australia Nigeria Pakistan Nepal Zimbabwe China New Zealand Ghana Zambia South Africa Kenya Canada

14 UK increased nurse production, now trend has reversed From 1995 to 2005, progressive increase of annual production of nurses from 11,000 to 23,000; midwives from 600 to 1,600. Since 2010, declining level of funded training places, much lower than the number of applications to nursing schools Source: Department of Health, UK, Buchan and Seccombe 2012

15 Forecasts of shortages in recent nursing workforce studies Country Source Estimated shortage /gap Australia Canada USA Health Workforce Australia (Federal government agency) Academic researchers (Tomblin-Murphy et al., 2012) US Department of Labor, : Do nothing scenario shows shortfall of 90,000 to 109, : required FTE / 199,000 FTE available = 60,000 shortage 2020 Projected growth of 711,000 jobs (+26% in demand) USA UK Academic research Auerbach, 2012 Academic research Buchan and Seccombe, : Forecast 94% growth in NP jobs 2021/22: Steady state scenario shows 309,297. Reduction of 42,807 over 2010 baseline (12.2% reduction) Source: Buchan and Seccombe, 2012

16 Japan is recruiting nurses 2008: Bilateral agreements with Indonesia and the Philippines 2011: 200 nurses and 300 careworkers were allowed from each country 19/650 (3%) passed exams to stay in Japan Source:OECD, International Migration Outlook 2012

17 Will US recruitment of foreign medical graduates rise in next decade? the inflow of doctors into the United States has remained stable since the mid-2000s, whereas it has increased in Australia and Canada. WHO EB 132/23, 14 December 2012

18 Australia is increasing recruitment of physicians Professional registration requirements for international medical graduates have been liberalized for those who have been licensed to practise by trusted authorities in English-speaking countries. WHO EB132/23, 14 December 2012

19 Percentage of births attended by skilled health personnel by level of total health spending Low-and middle-income countries, latest available year 100 Thailand Brazil Peru Percentage of births attended by Skilled Birth Personnel Mauritania Malawi Tanzania Guinea Sudan Philippines Mali Nepal 10 Ethiopia Source: World Health Statistics, WHOTotal health expenditure per capita in (US$) (log-scale) Source: World Health Report2010

20 Malawi US$ 95.6M direct investment % Physicians % Nurses % HW density % Safe deliveries: Outpatient services: 15% increase 49% increase 13,187 lives saved

21 Promoting multiple strategies to improve retention in Thailand Bangkok vs. Rural Northeast (Doctor to Population Ratio) Strategies that worked: Regulatory: compulsory contract of 3 years of public work after graduation Economic: rural development project and financial incentives Education: rural recruitment and training in rural health facilities; development of community medicine Managerial: personnel management Social: movement for rural development Source: Wibulpolprasert S, 2003

22 Developments after WHO Code was adopted in /193 (25%) Members States have reported to WHO Secretariat 32/48 (67%) maintain statistical records on migrant health personnel 22/48 (46%) undertake research on migration 9/48 (19%) maintain records of authorized recruiters Source: WHO EB 132/23, 14 December 2012

23 Concluding Remarks Overall, international recruitment by OECD countries likely to increase in the next decade Key research, policies and investments in countries are essential to address HRH shortages and imbalances Ongoing health workforce planning is key to address labor market conditions and define policy responses

24 ANNEX The slides that follow are not for presentation but may be used in the open forum

25 Physician, nurse, midwife density in Asia Countries Ave. Annual Rate of Population change (%) Earliest year All HRH density Latest year All HRH density Afghanistan Bangladesh Bhutan Cambodia India Indonesia Myanmar Pakistan PDR Laos PNG WHO Global HRH Atlas 2013

26 Physician density in Asian countries Countries Ave. Annual Rate of Population change (%) Earliest year Physician density Latest year Physician density Afghanistan Bangladesh Bhutan Cambodia India Indonesia Myanmar Pakistan PDR Laos PNG WHO Global HRH Atlas 2013

27 Nurse & Midwife density in Asian countries Countries Ave. Annual Rate of Population change (%) Earliest year Nurses and Midwives density Latest year Nurses and Midwives density Afghanistan Bangladesh Bhutan Cambodia India Indonesia Myanmar Pakistan PDR Laos PNG WHO Global HRH Atlas 2013

28 Nursing migration to the United Kingdom Significant variations over time among major source countries Source: NMC, 2012

29 U.S. Supply of Active Physicians and Ratio to Population Actual and Projected Source: Fitzhugh Mullan, GWU, February 2008 Physicians Per 100,000 Population 1'000'000 Population is U.S. civilian population including possessions 800'000 Supply (Thousands) ' ' ' ' ' ' ' ' ' ' ' Source: Bureau of Health Professions/HHS