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Migration in the Caribbean Region
Dr. Gillian Barclay, Advisor Human Resources Development
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AN OVERVIEW OF MIGRATION IN THE CARIBBEAN REGION
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Countries GUADELOUPE FR. GUIANA DOM. REPUBLIC MARTINIQUE
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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
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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
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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)
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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
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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
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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.
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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.
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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
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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
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MIGRATION IN THE CARIBBEAN REGION Migration and the Health Workforce
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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
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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.
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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
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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.
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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
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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
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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)
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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
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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
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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.
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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
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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
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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
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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
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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
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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.
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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
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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.
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“At the heart of each and every health system the workforce is central to advancing health.”
World Health Report, 2006
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