1. University of Alberta: Linda Ogilvie, RN, PhD Judy Mill, RN, PhD Barbara Astle, RN, PhD Candidate Anne Fanning, MD, FRCPS University of Ghana: Mary Opare, RN, MN Credentialing of Internationally Educated Health Professionals and the Nursing Exodus from sub-Saharan Africa

2. Africa is estimated to have 1.3% of the global health workforce and 25% of the disease burden (WHO, 2004)

3. Competing Rights Right to: health leave one’s country to seek a better life work and to just and favourable conditions of work an adequate standard of living education nondiscrimination and equality

4. CanadaGhana South Africa MalawiZimbabwe Life Expectancy (years) 78(M) 82(F) 57(M) 60(F) 48(M) 50(F) 41(M) 42(F) 37(M) 36(F) <5MR (probability of dying before fifth birthday per 1000) 6(M) 5(F) 99(M) 92(F) 70(M) 61(F) 182(M) 175(F) 133(M) 119(F) MMR (probability of maternal death per 100,000 live births) 554023018001100 Note: MMR from 2000; other statistics from 2003 Table 1: Comparison of Life Expectancy, Under Five Mortality (<5MR), and Maternal Mortality Ratio (MMR) for Canada, Ghana, Malawi, South Africa, and Zimbabwe (WHO, 2005)

5. CountryMalawiZimbabweGhana South Africa Physicians1:30,0001:50001:10,0001:5000 Nurses not reported 1:10001:20001:1000 Midwives not reported 1:2000 not reported Table 2: Physician, Nurse and Midwife Availability in Malawi, Zimbabwe, Ghana, and South Africa per Population around 1998 (WHO, 2002)

6. Brain Drain? Brain Gain? Brain Circulation?

7. Migration of Health Professionals from sub-Saharan Africa Pattern Poor data Extent (physicians) Extent (nurses)

8. Table 3: UK Licensure of Nurses from South Africa, Zimbabwe, Ghana, and Malawi from 1998-99 to 2002-03 Country1998-991999-002000-012001-022002-03 South Africa 5991,4601,0862,1141,480 Zimbabwe52221382473493 Ghana4074140195255 Malawi115457557 Adapted from Bach (2003) from UK Nursing and Midwifery Council data

9. Push-Pull Factors in International Health Professional Migration Common in general migration literature HIV/AIDS Worldwide shortage, particularly of nurses

10. Policy Response to International Health Professional Migration Attention to stick and stay factors within countries High-income countries meet own needs through education and retention Ethical recruitment practices Financial restitution Skill recirculation

11. Skill Recirculation or Brain Circulation? Initiatives from the diaspora International partnerships Reorientation of international aid priorities Integration of health systems

12. Coming Full Circle Barriers to credentialing of internationally educated health professionals are not useful as a strategy to reduce health inequities worldwide and need to be addressed only within the context of protection of the public within the receiving country