Date: October 17-18, 2024
Location: Conference Room B, PAHO/WHO Headquarters, Washington, DC
Format: Face-to-face.
the purpose
Hold a high-level dialogue on issues related to migration and mobility of health workers and define the strategic direction of the roadmap in line with the WHO Global Code of Practice on the international recruitment of health personnel. Agree on key policy areas to optimize benefits. Identify innovative mechanisms to foster cooperation between countries to achieve equity and facilitate knowledge exchange on migration and mobility of health workers, thereby providing specific guidance for the Americas region. Facilitate the development of solutions.
background
International mobility and immigration of healthcare workers has steadily increased over the years. Between 2008 and 2018, the number of immigrant doctors and nurses in Organization for Economic Co-operation and Development (OECD) countries increased by 60% (1). In eight densely populated OECD countries, the proportion of foreign doctors increased from 32% in 2010 to 36% in 2020 (2). This trend has been further exacerbated by the COVID-19 pandemic. Economic forecasts regarding the supply and demand of healthcare professionals suggest that the global movement of healthcare professionals will continue to increase. Furthermore, the persistent global shortage of human resources for health (HRH) is widespread and further unevenly distributed across regions. For example, Latin America and the Caribbean (LAC) is expected to be one of the regions with the highest net deficits by 2030 (3).
Migration of human resources for health (HRH) from low- and middle-income countries (LMICs) is a global health issue with significant impacts on both source and receiving countries, and is a global health issue with significant impacts on both individual and individual drivers and pulls. It is formed by complex interrelationships. whole body level. At the individual level, better employment opportunities, improved working conditions, higher salaries and better career prospects are the pull factors for migration. At the system level, shortages of health workers and weak health systems in host countries, poor working conditions, limited professional development opportunities, political instability and poor governance in countries of origin, and HRH You may be forced to look for a job. Additionally, the global distribution of healthcare workers is influenced by macro-level factors such as economic globalization, international trade agreements, rigid supply systems, and aging populations in high-income countries, leading to increased demand. , the movement of labor from small and medium-sized enterprises outside the country is intensifying (4).
In the Americas region, migration and mobility of health workers is not a recent phenomenon, but has become a pressing issue in recent years due to significant shortages of health workers in small and medium-sized regions. In the case of Central America and the Caribbean, the ability of health systems to respond to public health emergencies and provide essential health services to meet the health needs of their populations has been compromised. Migration flows are further exacerbated as private commercial recruitment agencies increasingly enter this market and shape migration patterns.
A study conducted in 2023 by PAHO and the Caribbean Health Human Resources Commission (5) found that the main drivers of migration are inadequate remuneration, limited professional development opportunities, and stressful working conditions. Shown. The perspective of improved salaries appears to be a strong motivator for migration in the Caribbean region. A study published in 2019 (6) examined the pay disparity between healthcare workers in the Caribbean and selected destinations, after adjusting for three selected destination countries (Canada, UK-UK, and USA). Purchasing power parity (PPP) of HRH salaries are shown. (Province) numbers were much higher than those for comparable HRHs working in some Caribbean countries (e.g. Dominica, Grenada, Jamaica, St. Lucia). This may explain the continued trend of health workers trained and employed in the Caribbean to migrate for economic incentives.
The proposed health workforce roadmap for Central America and the Dominican Republic in 2023, led by the Council of Ministers of Health in Central America and the Dominican Republic (COMISCA), addresses the urgent need to address high rates of migration and migration among the population. is emphasized. Healthcare workers (7). Priorities include ensuring decent working conditions and protecting health workers. Measures such as improving the labor market, the security situation, and promoting bilateral agreements are also recognized as important to addressing this problem.
In some countries, insecurity and political instability play a crucial role in migration, as healthcare workers also tend to seek better opportunities within and outside the Americas region.
According to OECD data from 2017 to 2021, the countries with the highest number of foreign-trained doctors from Latin America are Canada, Chile, and Germany. The majority of these doctors are from Colombia, Ecuador, and Venezuela. Many foreign-trained British Caribbean nurses have moved to Canada and the UK. Most of the nurses are from Barbados, Guyana, Jamaica, and Trinidad and Tobago (8). There are also important socio-economic drivers that influence nurses. Nurses are predominantly women, earn 20% less than men, have limited access to leadership positions, and are underrepresented in senior positions in both the health care system and politics (9).
By 2030, the shortage of health professionals in the Americas is expected to be as low as approximately 600,000 and as high as 2 million (10-12 people) in the LAC, unevenly distributed within and between countries. Migration of health professionals has become an important means of brain drain from the most affected regions and countries, which will bear the brunt of the expected HRH shortage by 2030. Moreover, rural and underserved areas already have the highest and highest shortage rates. Significant healthcare disparities (4).
Furthermore, migration and mobility of health workers has become an issue closely related to the labor market. Considering that the health sector is one of the main employers in many countries, these issues affect not only the Ministry of Health, but also the areas covered by the Ministries of Labour, Education and Economy. The effects of labor migration are felt not only in the health sector, but also in other social development sectors and across the economy.
Justification
This situation is evidenced by initiatives such as the Caribbean Roadmap on Human Resources for Universal Health (2018-2022) and COMISCA’s proposed Health Human Resources Roadmap 2023, Although recognized and addressed by countries, in Central America and the Dominican Republic, there are There remains a need to expand and promote dialogue. Recruitment of health personnel (13 people) and bilateral agreements. It also requires more attention on issues such as equity around the gender pay gap and the relationship between lower-paid health care workers and health care professionals essential to the delivery of care (nursing assistants, cleaners, food preparation, etc.). Information needs to be collected. (e.g., workers in health care facilities and those providing long-term care for older adults with disabilities), given that the majority of these jobs are held by women and immigrant health workers (14).
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