OECD/WHO proposed framework for a regular monitoring of trends in the international migration of health personnel

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1 OECD/WHO proposed framework for a regular monitoring of trends in the international migration of health personnel Jean-Christophe Dumont OCDE, Paris Pascal Zurn WHO, Geneva OECD-WHO Technical Workshop: Monitoring Health Workforce Migration OECD, Conference Center, Paris, 31 May 1 June 2010

2 Outline Background Basic principles for the data collection Identifying migrant health workers Defining the Minimum Data Set (MDS) Review of potential data sources for MDS Synthesis

3 Background OECD/WHO work on migration of health professionals ( International fora (G8 meetings, Kampala declaration March 2008) WHO global code of practice on the international recruitment of health personnel Need to better monitor international migration of health workers

4 Basic principles for the data collection Which category of health personnel to include? Monitoring international migration from destination countries Develop efforts to collect better health workforce data in origin countries

5 Identifying migrant health workers Defining migration : Foreign-trained or foreignborn or foreigners? Identifying the target group: who should be included? Distinguishing active from inactive migrant health workers? Capturing both information on stocks and/or flows of migrant health workers?

6 Minimum Data Set (MDS)

7 Review of potential data sources Work permits Licensing & recognition of foreign credentials Professional registries Surveys of health personnel Labour force surveys Population censuses

8 Work Permits Advantages: Centrally administered. Variables like sex, age and nationality are collected Work permit data can be used to monitor flows Limitations: Not every migrant needs a work permit No information on place of education and on stocks Doctor Migration to Canada, 2000 to 2005 Source: OECD, 2007

9 Licensing & Recognition of Foreign Credentials Advantages: Comprehensive picture of annual flows Licensing data easily available for a relatively large number of countries including middle and low-income countries Information on the country of first qualification is collected Limitations: Recognition of foreign qualifications does not always imply migration No information on the stocks of health workforce migrants Approach difficult to replicate for non-regulated occupations

10 Professional Registries Advantages: In place in a large number of countries Information on the country of qualification, year of registration and demographic variables Monitoring of both stocks and flows Limitations: Different types and/or definitions of registration Active/inactive distinction is not always available Country of usual residence not always identified Migrant nurses in the OECD (latest year available) NURSES Year Share Sources Foreign-trained (%) Finland 2008 Netherlands National Supervisory Authority for Welfare and Health (Valvira) 1.4 BIG Register (Beroepen in de Individuele Gezondheidszorg) Sweden Swedish National Board of Health and Welfare United States National Council of State Boards of Nursing (NCSBN) Denmark National Board of Health, Nursing Adviser Canada CIHI Workforce Trends of Regulated Nurses in Canada United Kingdom Nursing and Midwivery Council New Zealand 2008 Foreign Nurses Belgium Ministry of Health/Nursing Council of New Zealand France DREES, ADELI Federal Public Service Health, Food Chain Safety and Environment Portugal Ordem dos Enfermeiros Italy Federazione Ipasvi Source: OECD, 2009

11 Survey of health personnel Advantages: Collects more detailed information Monitoring of both stocks and flows Limitations: Only implemented in a few countries In some cases, non-response may be an issue as well as the lack of representativity

12 Labour Force Surveys Advantages: Already carried out in a regular basis in a large number of countries Easily identify active individuals in the labour market Limitations: Sample size Lack of information on place of education Country AT BE CH CY CZ DE DK EE ES FI FR GR HU IE IS IT LT LU LV MT NL NO PL PT SE SI SK UK Doctors (ISCO4D 2221) Nurses (ISCO4D ) Source: EU-LFS 2005

13 Population censuses Advantages: Covers the entire population Implemented in a large number of countries Possibility to disaggregate data on demographic, social and economic characteristics Limitations: Only conducted at lengthy intervals (every 5-10 years) Time lag between data collection and dissemination Lack of information on place of education Share of foreign-born doctors in OECD countries New Zealand*** Australia*** Ireland*** Canada*** United Kingdom Luxembourg Switzerland United States*** Sweden*** Portugal France*** Netherlands Norway*** Austria Belgium Germany Hungary Denmark*** Greece Spain Turkey Finland*** Poland Mexico 0% 10% 20% 30% 40% 50% Source: OECD, 2007

14 Synthesis Data source Resource implications Frequency Coverage Institutional Constraints Work permits Low Annual High High Licensing Low Annual (continuous) Very high Low Registries Low or large Annual (continuous) Very high Moderate to High Surveys of health personnel Moderate to large, depending on methodology Annual or periodical (High) Low Labour force surveys Nil or large Annual Representativity problems Very High Censuses Nil or large Every 5 to 10 years Very high Very High

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