Health worker migration – push or pull?

The New Vision of Uganda reports that according to the 2009 Human Development Report, “THE majority of Ugandans who migrate to other countries are among the higher educated group. And those who migrate, whether within their own country or abroad, are doing better in terms of income, education and health than those who stayed where they were born.”

dscn3845a.JPGHealth workers are among those educated emigrants, but the factors behind their movement are complex.

Citing the case of health workers deserting Africa, (the World Development Report) explains that this is being caused by poor staffing levels and poor public health conditions. “Migration is more accurately portrayed as a symptom, not a cause, of failing health systems.”  It notes that improving working conditions at home might be a better strategy to stop the brain-drain than restricting emigration.

The Canadian Medical Association Journal explains the problem thus:

You can’t force someone to stay and attempt to work in a place that  is lacking even minimum provisions for them to do their job. “If you tell them they can only hand out band-aids and aspirin, no  one will stay,” says Dr. Otmar Kloiber, secretary general of the  World Medical Association. “People should have the privilege to  migrate. For medical workers it’s important to have exchanges in  order to learn and to work. You can’t put someone on a dead end road and ask them to build a health care system.”

WHO also reminds us that health workforce maldistribution and migration occurs within countries, too. “Approximately one half of the global population lives in rural areas, but these  people are served by only 38% of the total nursing workforce and by less than a  quarter of the total physicians’ workforce.” Health workers locate in urban centers to gain greater economic, educational and social opportunities for themselves and their families.”

The loss of health workers is a major impediment in implementing malaria coverage targets and making progress toward disease elimination even when malaria commodities are provided in adequate amounts. More generally, WHO notes that, “Without available, competent, and motivated health workers, the potential for  achieving the Millennium Development Goals, and for effective, efficient use of  the financial and other resources committed to achieving the Goals, remains  extremely limited.”

The solution, according to the comments above is not simply finding more people to deliver malaria services in isolation, but ensuring that malaria control services are integrated into a well functioning health system. Donors who provide malaria and other health and development support are also cautioned to become aware of how their own programs, policies and activities can disrupt the health workforce in the countries receiving aid.

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