1. Migration in the Caribbean Region
Dr. Gillian Barclay, Advisor
Human Resources Development

2. AN OVERVIEW OF MIGRATION IN THE CARIBBEAN REGION

3. Countries
GUADELOUPE
FR. GUIANA
DOM. REPUBLIC
MARTINIQUE

4. THE CARIBBEAN REGION AND MIGRATION
Over the past 4 decades, the Caribbean
region has lost more than 5 million people to
migration
The net migration rate in the Caribbean region is
one of the highest in the world with great variation within the region
Jamaica, Guyana, St. Lucia and Suriname have shown the greatest losses to international migration.
Data from United Nations Population Division, 2003

5. THE CARIBBEAN REGION AND MIGRATION
Dynamics: Workforce
Migration is international, intraregional, and into the region
Other Dynamics:
Human trafficking of women and children
Return of deportees

6. MIGRATION IN THE CARIBBEAN REGION
International Migration: Workforce and Brain Drain
Migration to the US, Canada and the UK
Skilled migration rates from the Caribbean region are some of the highest in the world (IADB, 2006)

7. MIGRATION IN THE CARIBBEAN REGION
International Migration: Workforce and Brain drain
More than 60% of highly-skilled or tertiary-educated migrating
More than 30% of secondary-educated migrating
Jamaica, Guyana, Grenada, Haiti, more than 80% of tertiary-educated skilled labour migrating with increased migration to the United States

8. MIGRATION IN THE CARIBBEAN REGION
Reasons for migration to the United States: Workforce
Proximity to the Caribbean
Wages and increased earning capacity
Common language for English-speaking islands
Social and family networks resident in the United States
Favourable immigration policies for skilled labour such as nurses, physicians, teachers and other professionals

9. MIGRATION IN THE CARIBBEAN REGION
There are positive impacts of international migration
and some of these include:
Return or transfer of knowledge, for example the strengthening of health and education facilities through partnerships and contribute to country level development
Remittances and economic investments although the data for the health professions is not known.

10. MIGRATION IN THE CARIBBEAN REGION
Negative impacts of international migration include:
Loss of human capital
Reduced productivity
Loss of financial investments borne by countries
These are critical issues for some of the countries in the
region that are undergoing public sector and health
sector reforms.

11. MIGRATION IN THE CARIBBEAN REGION
Intraregional migration in the Caribbean: Workforce
The Caribbean Single Market and Economy (CSME)
was established in 1989 by the Heads of Government of
CARICOM through the Grand Anse Declaration

12. MIGRATION IN THE CARIBBEAN REGION
Intraregional migration in the Caribbean: Workforce
Major goals of CSME are to deepen the integration
process and to strengthen the Caribbean community in all its dimensions
Facilitate the free movement of labour and abolish needs for work permits for workforce from CSME participating countries.
This represents the move towards a common policy agenda for migration at the intra-regional level

13. MIGRATION IN THE CARIBBEAN REGION Migration and the Health Workforce

14. MIGRATION IN THE CARIBBEAN REGION
Health today is complex and needs a public health and population approach
Critical needs to address include the capacity to use trans-sectoral approaches to:
-measure needs
-manage, plan and evaluate
-conduct research and development
-strengthen information systems
-develop health, education and social programs

15. MIGRATION AND BRAIN DRAIN IN THE CARIBBEAN REGION: DATA AND EVIDENCE
Lack of data and evidence-base for country and regional level policy development for migration especially as this relates to the health workforce
Difficult to move towards policy when the evidence base regarding the health workforce is questionable.

16. MIGRATION AND BRAIN DRAIN IN THE CARIBBEAN REGION: DATA AND EVIDENCE
Trans-sectoral approaches needed to gather evidence that must involve the inclusion of labour, trade, education, health and social development
Important to share data because governments will find it easier to design, monitor and evaluate the impact of migration policies
Need to have policies in place to protect personal information to balance the need to share information

17. MIGRATION IN THE CARIBBEAN REGION
Migration in the Caribbean region is an important issue for the health sector since labour market needs for this sector are aligned to the skills of the secondary and tertiary educated workforce.

18. THE CONTEXT: THE MIGRATION DISCUSSION IS OCCURING IN PARALLEL WITH HIGHLY VISIBLE EVENTS
“These examples illustrate the
enormous richness and diversity
of the workforce needed to tackle
specific health problems”
World Health Report, 2006

19. MIGRATION IN THE CARIBBEAN REGION
Migration and the Health Workforce
Historical regional migration and a shared sense of regional integration
CSME has enhanced the migration or free movement of qualified professionals and skills within the region by liberalizing conditions of access to markets and skills within the region
July 2006: Extension of the free movement agreement to include nurses among other professionals

20. Health Workforce in the Caribbean
Nurses
Physician
Dentist
Anguilla
31.3 9
1.3
Antigua and Barbuda
33.2
10.5
2.2
Bahamas
23.8
16.7
2.5
Barbados
51.2
13.7
1.9
Belize
12.3
10.2
Cayman 53
21.5
3.9
Dominica
41.6
4.9
0.6
Grenada
19.5
8.1
1.1
Guyana
8.6
2.6
0.4
Jamaica
16.5
8.5
0.8
Montserrat
29.1
1.8
0.9
St. Kitts and Nevis
49.8
11.7 2
St. Lucia
22.6
5.8
St. Vincent & Grenadines
19.8
6.9
1.4
Suriname
22.8 5
Trinidad & Tobago
28.7
7.5
Turks and Caicos
19.3
7.3
0.7
Virgin Islands ( British) 33
11.5
Health Workforce in the Caribbean Region per 10,000 Population (PAHO 2004)

21. MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION: THE EXAMPLE OF NURSING
New Challenges for Nursing:
Large numbers of nurses leaving the region
Loss of more experienced nurses
Loss of nursing educators
Limited educational capacity to replace lost nurses

22. MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION
New Challenges for Nursing:
Inability to assimilate ‘returnees’
Image and work conditions for nurses
Aggressive recruitment of nurses by companies representing employers from countries with shortages

23. MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION
The wage differential is the major pull factor for Caribbean health professionals, especially physicians and nurses.
A comparison of average monthly wages show that Caribbean nurses working in the US are paid $3,056, in Canada $2,812, and in the United Kingdom $2,578. In Trinidad and Tobago nurses are paid an average monthly salary of $913.

24. MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION
42% of nursing positions were vacant in 2005 (CARICOM/PAHO 2005)
PAHO estimates that the departure of 300 nurses from the Caribbean represented losses of $15 to $16.5 million US dollars in training costs

25. MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION
Most common reported reasons for resignation were:
Poor remuneration
Limited opportunities for professional development and career mobility
Non-involvement in the decision-making process
Poor working environment
Lack of support from supervisors

26. Number of Registered Nurses, Vacancies and Vacancy Rates by Country (Hewitt, 2004)
# of Vacancies
Vacancy Rate
Antigua
320 56
17.5
Barbados
930
192
20.6
Dominica
177 11
6.2
Jamaica
2256
1317
58.4
St Kitts 50 26
St. Lucia
409 18
4.4
St Vincent
216 34
15.7
Trinidad
2125
1132
53.3
Total
6625
2810
42.4

27. Registered Nurses' Resignations with Declared Intentions to Migrate to the UK, USA, or Canada, by Year and Country (Hewitt 2004)
Country
Year
1998
1999
2000
2001
2002
Total
Antigua 9 3 12
Barbados 16 22 61 31 45
175
Dominica 2 4 13
Jamaica 90
135
159
152
109
645
St. Kitts 1 8
St- Lucia 11 18 17 10 66
St. Vincent 30 5 74
129
185
279
218
178
993

28. MIGRATION OF THE HEALTH WORKFORCE OF THE CARIBBEAN REGION
Development concerns:
A highly skilled health workforce plays a major role in a country’s sustainable development
Countries are experiencing severe limitations in their capacity to provide affordable, quality, health and social services to their nationals.
The lack of skilled workforce in the health sectors slows the steps or progress in improvements in economic and social sectors in the region
Caribbean Commission on Health and Development Report, 2005

29. THE FUTURE: POLICY IMPLICATIONS
The issue of migration does not belong to any one organization, thus faces challenges relating to:
Funding
Coordination
Infrastructure
Difficult to put into place appropriate evaluation, measurement and dissemination mechanisms
In the Caribbean region there is the need for a coordinated approach to the issue of migration.

30. THE FUTURE: POLICY IMPLICATIONS
Necessary to consider the multilateral approach to managing migration
Use the experience in bilateral agreements as building blocks to wider market access
Governments may experience increased pressure to ensure that conditions of work and pay are satisfactory

31. THE FUTURE: POLICY IMPLICATIONS
Evolution from individual and country specific work to efforts relating to major regional health, social and economic policy.
Changed nature of collaboration and partnerships in ways that reflect movement from program and evidence to policy.

32. “At the heart of each and every health system the workforce is central to advancing health.”
World Health Report, 2006