David R. Salmon | Making return migration work through healthcare reforms

Shannon is a young nurse who recently migrated to the United Kingdom (UK). The University of the West Indies graduate was eager to work for the National Health Service (NHS), attracted by the prospect of earning in pounds. This was especially appealing after she calculated the Jamaican-dollar equivalent of her new salary.

However, upon arriving, Shannon was confronted with several realities she had not anticipated. For one, life in Britain proved more expensive than she had initially thought. After income tax, National Insurance contributions, pension deductions, Council Tax and rent, roughly three-quarters of her gross salary disappeared. On top of this, she still had to pay for groceries and utilities, both of which had become significantly more expensive amid rising energy costs.

Within a year, the savings Shannon had expected to accumulate had simply not materialised. While her headline salary initially appeared impressive, her disposable income was considerably lower once the cost of living was factored in. Unfortunately, Shannon’s experience is not unique; it reflects many of the challenges associated with starting a new life in another country, particularly the UK.

Yet there is another option: Shannon could return home. Then again, even her relatively modest savings represent more than she believes she could realistically accumulate in Jamaica. Moreover, there is another issue weighing on her mind: the quality of healthcare at home. These are just some of the factors Shannon must consider before making a decision.

As a society, we must ask ourselves: What should we do to make it easier for our people to return home? What must be done to encourage our skilled professionals to stay? Answering these questions is critical to the next chapter of the nation’s development.

The Current Situation

The reality is that Jamaica is ageing, and ageing rapidly. By the end of 2025, net population growth stood at just 600 persons. Those over the age of 65 now account for 9.5 per cent of the population, while the fertility rate has fallen to 1.3, far below the replacement level.

This is a worrying trend. As the population ages, social care costs will increase as more older Jamaicans seek access to healthcare services. Furthermore, this will place greater pressure on public finances, meaning taxes may have to rise in the years ahead to help meet growing demand.

At the same time, unemployment remains at record-low levels, hovering below 4 per cent. Multiple industries also report difficulties in finding suitably qualified workers. In other words, Jamaica is a developing nation confronting the dual challenges of an ageing population and labour shortages, but with only a fraction of the resources available to larger, wealthier countries.

Importantly, Jamaica needs people, especially talented individuals, to chart the next phase of its development journey. To realise our aspiration of becoming a developed nation, we must expand our pool of skilled workers. Fortunately, while other countries must grapple with the challenge of attracting and integrating skilled workers from different cultural backgrounds, Jamaica already possesses a reservoir of talent upon which it can draw. To meet the nation’s current and future needs, the country should actively encourage members of its extensive diaspora to return home.

Disincentives to Return

A major disincentive to return migration is the state of the healthcare system. Chief among these concerns is the limited availability of specialist care. Having interacted with countless Jamaicans overseas, many, like Shannon, have expressed this reservation. Without meaningful improvements in healthcare delivery, most families would not seriously contemplate returning.

For this reason, I applaud the Government for making inroads in expanding the country’s healthcare infrastructure and recruiting skilled doctors and nurses to strengthen the system. Projects such as the construction of the new Spanish Town Hospital should be commended, particularly given the longstanding concerns surrounding the existing facility.

However, a healthcare system comparable to the NHS did not emerge overnight. Despite its well-documented challenges, the NHS has benefited from decades of investment, workforce development and international recruitment. Likewise, Jamaica must take deliberate steps to expand its own capacity. Strengthening the healthcare system would provide many Jamaicans abroad with another compelling reason to return home.

Attract Specialists from the Diaspora

Targeted reforms should begin with incentives that encourage healthcare professionals in the diaspora to practise locally. Overseas specialists could commit several weeks each year to designated hospitals across the island. Such a visiting consultant programme would provide professionals interested in returning with an opportunity to gain experience within the local healthcare system before making a long-term commitment.

Possible incentives could include fast-tracked temporary licensing arrangements for those who qualified overseas, as well as academic affiliations with institutions such as The University of the West Indies. The objective would be to create attractive opportunities for specialists in hard-to-fill areas of healthcare.

Reduce the Cost of Living

Beyond recruiting skilled professionals, additional reforms should be pursued to encourage healthcare workers to remain in the country. Jamaica trains a substantial number of doctors and nurses, to the point where there are sometimes challenges placing new graduates in healthcare facilities. Consequently, the shortage of healthcare professionals is not necessarily the result of insufficient training, but rather a failure of retention.

In the case of nurses, for example, Jamaica loses an average of 500 specialist nurses annually. Reducing this outflow is therefore critical to the development and sustainability of the healthcare system.

To achieve this, policymakers should explore measures aimed at lowering the cost of living for healthcare workers, as this remains one of the principal drivers of migration. One relatively straightforward initiative would be to expand the provision of publicly owned housing adjacent to healthcare facilities, allowing these workers to rent accommodation at below-market rates. Access to this subsidised housing could be linked to continued employment within the public health system. Such a proposal would significantly reduce both housing and commuting costs.

The cost of childcare should also be addressed. Childcare is among the largest expenses faced by young families. Through partnerships with the Jamaica Social Investment Fund, dedicated childcare centres could be established near healthcare facilities. Providing daycare and after-school services for healthcare workers and their families would substantially ease their financial burden.

With reforms such as these, Jamaica can become a place where healthcare workers choose to build their careers, raise their families and invest in their futures. Such measures would not only remove a major barrier discouraging members of the diaspora from returning home, but would also address one of the key reasons many leave in the first place. Ultimately, the country’s future depends on taking bold and practical steps to retain and attract the talent it needs to thrive.

David R. Salmon is Jamaica’s 2023 Rhodes Scholar and a PhD student in Public Policy at Oxford’s Blavatnik School of Government. His research examines economic diversification in small island developing states.