GLOBAL INEQUITIES AND HEALTH PROFESSION MIGRATION Janet Hatcher Roberts Anita A. Davies International Organization for Migration Geneva, Switzerland

Global Inequities Health Profession Migration

What is Migration Origin Transit Destination Return

What are the Global Health Determinant Inequities?

Total Population Source: worldmapper.org

Global Inequities: Wealth Distribution of the World’s Wealth USA India Indonesia Bangladesh Philippines China Japan Russian Federation Australia Germany Spain Switzerland Fr Guyana UK Italy Source: worldmapper.org

Global Inequity: Poverty Distribution of Poverty in the World USA Canada Nigeria Ethiopia Egypt Kenya India Indonesia Bangladesh Philippines China Japan Russian Federation Australia Pakistan Thailand South Africa

Access to Water: Privatization of a public good

Access to Water

What are the global health burden disease inequities? Proportional distribution of diseases and deaths Proportional distribution of diseases and deaths Those who suffer or who benefit least deserve help from those who benefit most.” Quote from the Millennium Declaration’s statement about the challenge of globalization

Proportional Distribution of people living with HIV, years (2003) NigeriaEthiopia Kenya India South Africa Tanzania Botswana Zimbabwe Russian Federation N=29.2 million

Proportional Distribution of Malaria Deaths, N= Sudan Uganda India Malawi Tanzania Mozambique Zimbabwe Demo Rep Congo Ghana Angola

Proportion of Cholera cases, N=152,929 Sudan Somalia Pakistan Zambia Tanzania Mozambique Demo Rep Congo Ghana Angola

Deaths from all Disasters

Deaths caused by Drought

Deaths caused by Floods

Deaths from Extreme Temperature

Distribution of Underweight Children Half of all children under the age of 5 years old that are underweight live in Southern Asia. Almost half of all children under 5 in Bangladesh, Nepal and India are underweight. Half of all children under the age of 5 years old that are underweight live in Southern Asia. Almost half of all children under 5 in Bangladesh, Nepal and India are underweight. Southeastern Africa, Asia Pacific, Northern Africa and Eastern Asia are also home to relatively large numbers of underweight children. Within these regions the territories with the largest populations of underweight children are: Ethiopia, Indonesia, Nigeria and China Southeastern Africa, Asia Pacific, Northern Africa and Eastern Asia are also home to relatively large numbers of underweight children. Within these regions the territories with the largest populations of underweight children are: Ethiopia, Indonesia, Nigeria and China

Source: WHO World Health Report 2002

What about the distribution of health workers? Can they address these growing inequities?

Global Inequities: World distribution of health workers (2006)

The Health Workforce in the Americas vs. Sub-Saharan Africa,

The PUSH for Migration of Health Professionals Poverty Employment Education Safe clean water: ability to deliver good quality care Social exclusion   Urban / Rural: huge disparities in health worker distribution   Gender: power relationships within the professions Poor infrastructure Poor, dysfunctional health systems: impact of SAP, no solid investment in the health system, no professional growth

The PULL for Migration of Health Professionals Sharp rise in demand for health workers in countries of destination: who is recruiting; why are they recruiting, the role of private sector recruitment ….one hundred percent of graduating class in Guyana had tickets to leave the next day Sharp rise in demand for health workers in countries of destination: who is recruiting; why are they recruiting, the role of private sector recruitment ….one hundred percent of graduating class in Guyana had tickets to leave the next day Factors that drive migration also drives the mobility of health workers Factors that drive migration also drives the mobility of health workers  the role of private sector and international organizations  Brain waste: the driver is a trained doctor/ the maid is a trained orthopaedic surgeon

Determinants of health are inequitably distributed Determinants of health are inequitably distributed Health professionals are inequitably distributed Health professionals are inequitably distributed Many diseases and causes of death are also inequitably distributed with a greater burden in low income countries Many diseases and causes of death are also inequitably distributed with a greater burden in low income countries How can there be a better balance with more responsive health and human resourcing? How can there be a better balance with more responsive health and human resourcing?

Strategies

Addressing the inequitable distribution of health professionals National code of practice National code of practice  UK code of practice on international recruitment Multilateral code of practice Multilateral code of practice  Commonwealth code of conduct Bilateral agreements-MOUs Bilateral agreements-MOUs  UK / South Africa

Lessons learnt Codes of conduct not legally binding Codes of conduct not legally binding Bilateral agreements encourage circular migration and transfer of skills Bilateral agreements encourage circular migration and transfer of skills Stakeholders must have common goals Stakeholders must have common goals National interests need to be in line with wider development objectives National interests need to be in line with wider development objectives We need to think beyond national borders We need to think beyond national borders More emphasis needs to be placed on retention More emphasis needs to be placed on retention

How can the migration of health professionals be better managed ?

Intersectoral Collaboration is Key Interact with related policy domains Migration & Health Professional Policies Development Trade Labour Human Rights Security Health Education Foreign Affairs Need for coherence

Harmonize policies on retention and recruitment of health professionals, nationally, regionally and globally Harmonize policies on retention and recruitment of health professionals, nationally, regionally and globally  Policy research  Policy coherence & comprehensiveness Capacity Building: training; scholarships; graduate programmes and creative opportunities for research Capacity Building: training; scholarships; graduate programmes and creative opportunities for research

Who Are The Stakeholders? Donors for Development International Organizations Diaspora Private Sector/Civil Society Country of Origin Host Countries Academic/Health Institutions Health Professional Orgs

Diaspora professionals address health inequity through: Financial remittances Financial remittances Social remittances Social remittances Technological remittances Technological remittances Political remittances Political remittances Structural remittances Structural remittances Human resources for health remittances Human resources for health remittances Diaspora

IOM experience: Migration for Development in Africa (MIDA) The MIDA initiative is an innovative framework that engages with the diaspora and facilitates the transfer of skills for capacity development in Africa The MIDA initiative is an innovative framework that engages with the diaspora and facilitates the transfer of skills for capacity development in Africa

Dialogue and migration policy option Assessment database development Skills transfer Remittances programmes Information Campaigns - Small-scale enterprise development Migration for Development in Africa (MIDA) Ethical Practices

MIDA projects 7 Ghanaian health sector Sierra Leonean and Ghanaian diasporas 6 5/6/7 3/ 4 Ethiopian and Ghanaian expatriates in Italy 5 Guinean women 1 East African Community (EAC) 2 The Great Lakes 3 The Great Lakes region /

Ghana MIDA Health Project A bilateral programme of the governments of Ghana and The Netherlands A bilateral programme of the governments of Ghana and The Netherlands A feasibility study identified the interest of Ghanaian diaspora in Europe A feasibility study identified the interest of Ghanaian diaspora in Europe Skill gaps identified in Ghana Skill gaps identified in Ghana Skill needs matched with Diaspora skills Skill needs matched with Diaspora skills IOM facilitated temporary return of health professionals IOM facilitated temporary return of health professionals IOM facilitated internships and training from Ghana to the Netherlands and UK IOM facilitated internships and training from Ghana to the Netherlands and UK Diaspora professionals can contribute to strengthening the health system Diaspora professionals can contribute to strengthening the health system

What Do We Mean By Strengthening Health Systems

Frameworks: Population Health/Health Promotion Equity/Determinants of Health Inter Sectoral Policy Development Research for Development: Capacity, Funding and Policies support evidence based policies Capacity Building for Planning Evidence Based Resource Allocation Integrated health information systems: data for decision making Human Resource Development/Continuing Education Equitable access to treatment, services and programs Community Interventions and Health Promotion Programs Evidence based Decision Making (Clinical and Community based) Strong and vibrant civil society Accountable and Transparent Public /Private Sector

The Impact of Decentralization on Human Resource Response National Local Community Continuum of Health Response Problem Identification Data Analysis Intervention, Prevention Strategies Policy Devt Local Needs coordination Programs & Services Capacity is not being developed and sustained at the right level Money remains at the national level Data Collection

Policies that influence the migration of health professionals The factors that shape immigration policies are complex and intertwined as governments struggle to balance economic, labor market, social, demographic, human rights, humanitarian, international, and political goals

The way forward Target-oriented, training and education of health professionals to enhance knowledge of global health and migration issues Target-oriented, training and education of health professionals to enhance knowledge of global health and migration issues Identify a comprehensive matrix of health professionals that can reinforce and sustain health systems capacity building and facilitate exchange and return of diaspora: a balanced approach: gender, professionals not just doctors; community based Identify a comprehensive matrix of health professionals that can reinforce and sustain health systems capacity building and facilitate exchange and return of diaspora: a balanced approach: gender, professionals not just doctors; community based Promote and support ethical recruitment and retention strategies, agreements, guidelines Promote and support ethical recruitment and retention strategies, agreements, guidelines Promote and support dialogue on exchange of experiences Promote and support dialogue on exchange of experiences

Global Health Workforce Alliance Addresses the recruitment and retention of health workers Addresses the recruitment and retention of health workers Addresses the need for rapid scaling up of health workers Addresses the need for rapid scaling up of health workers Addresses the tools and methods for training Addresses the tools and methods for training Developing processes for advocacy for receiving and sending countries Developing processes for advocacy for receiving and sending countries

A global approach is needed We need to: work together learn from each other

Thank you