Fixing Health: The brain drain of our health professionals
Nursing can increasingly be characterised as a mobile profession. Thousands of nurses migrate each year in search of better pay and working condition, career mobility, professional development, a better quality of life, personal safety, or sometimes just novelty and adventure (Kingma 2006).
The nursing shortage is presently on the political agenda. It is important to look at nurse mobility within the context of the nursing shortage and to consider the paradox of unemployed nurses in our country within the great shortage and to examine the contributory factors on the migration of nurses from our beloved country, Jamaica.
Critical nursing shortages in industrialised countries are generating a demand that is fuelling energetic, international recruitment campaigns. Structural adjustments in the developing countries have created severe workforce imbalances, and shortfalls often coexist with large numbers of unemployed health professionals.
A nurse's motivation to migrate is multifactorial - not limited to financial incentives - and barriers exist that discourage or slow the migration process. The migration flows vary in direction and magnitude over time, responding to socio-economic factors present in source and destination countries.
Health-care systems around the world have been suffering in both developed and developing countries. They have been struggling to meet the needs of the population they serve. One of the most challenging problems is that of shortage of health-care professionals, and, in particular, nurses and physicians.
The demand for and the size of the global health workforce is expected to grow substantially as a consequence of population and economic growth, combined with demographic and epidemiologic transitions, including ageing. These overall trends are accelerated by the need and the demand for health workers across the globe. However, the magnitude and rate of increase in demand and need for health workers vary from country to country.
Demographic factors are also affecting the health workforce. Recent reports point to increasing gaps between projected supply and demand for nurses in high-income countries, primarily because of ageing and increased retirements.
According to a report from WHO (World Health Organization), it is estimated that Latin America and the Caribbean will need over 25,000 nurses /midwives and physicians by 2020, compared to North America needing over 10,000 by 2020.
While there has been much discussion on the potential impact of the General Agreement on Trades in Services, negotiations to facilitate the temporary employment of foreign health-care workers have not progressed. Mutual recognition agreements have encouraged nurse migration at the regional level, for example, Protocol II of the Caribbean Community and Common Market, the North American Free Trade Agreement, and Nursing Directives of the European Union, this coupled with the fact that there is reciprocity of the Nursing Council of Jamaica with that of England and Wales.
The recruitment of health-care workers from less-developed countries has emerged as one of the main responses of developed countries to the shortage of health-care professionals. Nurses/midwives are increasingly recruited abroad in temporary or permanent positions. This has brought about a brain drain, resulting in less affluent countries being able to provide adequate care for its citizens.
Migration of health-care professionals from Jamaica, especially nurses, dates back to the 1950s. It was noted that between 2002 and 2006, more than 1,800 nurses left the region to work abroad. The report at that time stated that there was a shortage of these professionals, which had tangible impact that would compromise the ability of Jamaica to meet their key health-care services, especially in the areas of disease prevention and care.
It is well documented that worker migration is a result of the interplay of economic, social, cultural, political and legal forces.
These factors are often considered in two categories: supply - push factors, and demand - pull factors. According to Labonte 2007, these are some of the push/pull factors:
• Resource-poor health
• Low salaries
• Deteriorating work
• Inadequate medicine and equipment
• Poor human resource
• Political tension and upheaval
• Security of tenure
• Lack of transport
• Diminishing social systems (education, pension, etc)
• Available jobs
• Good pay
• Regular workload
• Reasonable conditions of work
• Economically and
politically stable country
• Safe living environment
• Good quality of life
• Better social system
• Better opportunities
Over time, migration patterns are sustained through networks that provide prospective migrants with information about job opportunities in destination countries, as well as various forms of support to help adjustment after migration.
What are some of the retention strategies we could use to encourage or retain health personnel in order to minimise the exodus of professionals from moving to the United States, Canada and the United Kingdom?
Retention strategies can either be financial or non-financial.
Financial strategies should include: compensation for the additional work hours; night-duty allowance; allowance for housing; allowance for equipment; and maintenance of equipment; and a salary top-up. There should be provisions of motor vehicles, solar panels to reduce the electricity bill, a child education allowance, a car loan and prioritise access to professional development opportunities.
Non-financial incentives should be designed to ensure that the nurses have access to basic infrastructure at the workplaces, for example, proper canteen facilities and access to health care. Workers will value having a career path; training; provision of mortgages/loans; and rewarding performance. Training should be in line with the labour market and the population demands.
Retention incentives can be effectively implemented if the institutional capacities are strengthened with the right person for the right job. Periodic review of staff development policies to address training issues, promotion and performance management system, that is, training of health-care workers in the use of health-care management tools.
A dysfunctional health system will not be able to retain or solve its nursing shortage if they are not able to attract and retain their nurses locally.