1. International migration and recruitment of nurses Prof. James Buchan jbuchan@qmuc.ac.uk

2. International migration and recruitment of nurses Active recruitment UK Case study Code of Conduct EU Ghana case study

3. “Active recruitment”: recent initiatives in other “importer” countries

4. % of new nurse registrants from EEA, UK and “other” countries 1993-2003

5. UK: Total “outflow” of nurses / to USA

6. Net flow of nurses to/ from UK (NMC registrations)

7. Ireland: Home, EU and non EU nurse registrants

8. EU accession: Physicians intent to move (Source Open Society,2003)

9. Department of Health (England) Code Requires NHS employers not to “actively” recruit from developing countries, unless govt. to govt. agreement (India, Philippines, Indonesia) List of “preferred provider” recruitment agencies Issued Nov 2001 (but list of countries only available Jan 2003) Compliance difficult to monitor- NHS does not record international nurses Private sector (25% of workforce) not covered by Code

10. Annual no. of new entrants to UK nursing register, from selected sub Saharan African countries, 1998-2003

11. “Outflow” of nurses from Ghana (Ghana Nurses Council verifications)

12. Vacancy rates, Ghana Health Services, 1998 and 2002

13. Impact on source countries Understaffing / loss of skills Decreased capacity in health services Increased costs of recruitment and retention possible compromises in quality of care Low morale- remaining nurses and consumers (sources : DENOSA/ Caribbean, PAHO)

14. Inflow of nurses to developed countries, by World Bank status of source countries

15. Challenges and Opportunties OPPORTUNITIESCHALLENGES Destination countries Solve skills shortages Efficient (and ethical?) recruitment Source countries(Remittances) Upskilled returners Outflow causes skills shortages Mobile nursesImprove pay, career prospects Achieving equal opportunities destination country Static nurses(if oversupply)- improved job opportunities Increased workload, decreased morale

16. Policy Issues High level of reliance on international recruitment- necessary/ desirable/ sustainable? UK (DH England) Code- how effective? can it be strengthened? Bilateral agreements / managed migration: desirable?/ effective? “Ethical” frameworks / international monitoring: whose responsibility?

17. References Buchan J, Dovlo D 2004. International Recruitment of Health workers: a report fro DFID. http://www.dfidhealthrc.org/Shared/public ations/reports/int_rec/int-rec-main.pdf