High Level Meeting on Migration and Mobility of Health Personnel in the Region of the Americas – PAHO/WHO

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Date: October 17 and 18, 2024
Place: Conference Room B, PAHO/WHO Headquarters, Washington, DC
Format: In-person.

Goals

  • Engage in a high-level dialogue on issues related to migration and mobility of health workers and define strategic directions for a roadmap in line with the WHO Global Code of Practice on International Recruitment of Health Workers.
  • Reach agreement on key policy areas to optimize the benefits of migration and mitigate its negative effects in the Region.
  • Identify innovative mechanisms to foster collaboration between countries in order to achieve equity and promote the exchange of knowledge around the migration of health personnel, facilitating the obtaining of specific solutions for the Region of the Americas.

Background

International mobility and migration of health personnel has steadily intensified over the years. Between 2008 and 2018, migrant medical and nursing staff in Organization for Economic Co-operation and Development (OECD) countries increased by 60% (1). In eight densely populated OECD countries, the percentage of medical staff trained abroad increased from 32% in 2010 to 36% in 2020 (2). This trend was exacerbated by the COVID-19 pandemic. Economic projections regarding the demand and supply of health professionals appear to indicate a continued increase in the displacement of health personnel around the world. Furthermore, the persistent global shortage of human resources for health is widespread, but not evenly distributed across regions. By 2030, Latin America and the Caribbean (LAC) is expected to be among the regions with the greatest net shortages (3).

The migration of human resources for health (HRH) from low- and middle-income countries is a global health problem with important implications for both countries of origin and destination, shaped by a complex interrelation of factors. of expulsion and attraction at the individual and systemic level. At the individual level and in relation to migration, better employment opportunities, working conditions and career prospects, as well as higher salaries, are pull factors. At a systemic level, weak health systems, limited career development opportunities, political instability and poor governance can be push factors for HRHs, driving them to seek employment elsewhere. In addition, the global distribution of health personnel is influenced by macroeconomic factors such as the globalization of the economy, international trade agreements, rigidity of supply systems and aging populations in high-income countries, which increases the demand and intensify labor force migration from low- and middle-income countries (4).

In the Region of the Americas, the phenomenon of migration and mobility of health personnel is not recent, but has become a pressing issue in recent years due to the great shortage of health personnel in low-income countries. and medium. In the case of Central America and the Caribbean, the capacity of health systems to respond to public health emergencies and provide essential health services to meet the health needs of the population has been compromised. The migratory flow has been exacerbated by private, for-profit companies dedicated to recruiting personnel, which are entering this market in increasing numbers and influencing migration patterns.

A study carried out in 2023 by PAHO and the Caribbean Commission on Human Resources for Health (5) showed that, with regard to migration, the main expulsion factors are inadequate remuneration, few opportunities for professional development and stressful working conditions. The prospect of better salaries appears to be a strong motivator for migration in the Caribbean subregion. A study published in 2019 (6) on remuneration disparities between health personnel working in the Caribbean and those working in selected destination countries showed that purchasing power parity (PPP) of adjusted HRH salaries in three selected destination countries (Canada, United States and United Kingdom) is much higher than that of comparable RHSs working in selected Caribbean countries (Dominica, Grenada, Jamaica and Saint Lucia). This could explain why for HRHs who were trained and work in the Caribbean subregion, financial incentives continue to be a strong motivation for migration.
The proposed Human Resources Roadmap for Health in Central America and the Dominican Republic, prepared under the direction of the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) in 2023, highlights the urgent need to address the high rates of migration and mobility of health personnel (7). The priorities are to guarantee decent working conditions and protect health personnel. Measures such as improving the labor market, security conditions and promoting bilateral agreements are also crucial to address this issue.

In some countries, insecurity and political instability play a fundamental role in migration, including that of health personnel, who tend to seek better opportunities within and outside the Region.

According to OECD data from 2017 to 2021, the countries with the largest number of doctors trained in Latin America are Germany, Canada and Chile. Most of these doctors come from Colombia, Ecuador and Venezuela. Large numbers of foreign-trained nurses from the English Caribbean emigrate to Canada and the United Kingdom; Most nurses come from Barbados, Guyana, Jamaica and Trinidad and Tobago (8). There is also an important socioeconomic factor that must be considered as an expulsion factor, especially in the case of nursing staff, mostly women, who earn 20% less than men, have little access to leadership positions and are underrepresented in positions. at a high level, both in health systems and in the political sphere (9).

By 2030, there will be a shortage of between 600,000 and 2 million health professionals in Latin America and the Caribbean (10-12), scarcity that will be unequally distributed within and between countries. The migration of health professionals represents a form of brain drain from the most affected subregions and countries, which will record the majority of the HRH shortfall projected by 2030. Furthermore, the shortage is already greatest in rural and underserved areas , leading to pronounced disparities in health care (4).

Migration and mobility of health personnel are issues of great relevance for the labor market. Considering that the health sector is one of the main employers in many countries, the immigration issue influences spheres that are under the supervision not only of the ministry of health, but also of the ministries of labor and education. On the other hand, much less attention has been paid to the mobility of health personnel, an area in which more in-depth analysis is needed.

Justification

Although the migratory phenomenon of health personnel has been recognized and addressed in many countries in the Region of the Americas with initiatives such as the Caribbean Roadmap on Human Resources for Universal Health (2018-2022) and the proposal of Roadmap for Human Resources for Health in Central America and the Dominican Republic prepared by COMISCA in 2023, it is still necessary to expand and encourage open dialogue between the countries of the Region to reach an agreement on specific interventions consistent with the Code of WHO Global Practices on International Recruitment of Health Personnel (13) and with bilateral agreements. There is also a need to gather more information on issues such as equity in the gender pay gap and the relationship between health professionals and low-paid health workers, which is crucial for care delivery (e.g. , nursing assistants, cleaning and food preparation personnel and personnel who provide long-term care for older adults with disabilities), taking into account that these jobs are overwhelmingly occupied by women and migrant health personnel (14).

References
  1. World Health Organization (WHO). (n.d.). International Platform on Health Worker Mobility. World Health Organization. Available from: https://www.who.int/teams/health-workforce/migration/int-platform-hw-mobility
  2. WHO 75th World Health Assembly A75/14. (2022). Human resources for health. WHO Global Code of Practice on the International Recruitment of Health Personnel: fourth round of national reporting. Available from: Human resources for health – WHO Global Code of Practice on the International Recruitment of Health Personnel: fourth round of national reporting. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_14-sp.pdf.
  3. Liu, J.X., Goryakin, Y., Maeda, A. et al. Global Health Workforce Labor Market Projections for 2030. Hum Resour Health 15, 11 (2017). https://doi.org/10.1186/s12960-017-0187-2
  4. Toyin-Thomas P, Ikhurionan P, Omoyibo EE, et al. Drivers of health workers’ migration, intention to migrate and non-migration from low/middle-income countries, 1970–2022: a systematic review BMJ Global Health 2023;8:e012338. https://gh.bmj.com/content/8/5/e012338
  5. PAHO/WHO, HRH Caribbean Commission (2023). Policy brief on Interventions to address mobility of health workers in the Caribbean with special emphasis on the training and retention of Human Resources for Health.
  6. George G, Rhodes B, Laptiste C. What is the financial incentive to migrate? An analysis of salary disparities between health workers working in the Caribbean and popular destination countries. BMC Health Serv Res. (2019) Feb 8;19(1):109. doi:10.1186/s12913-019-3896-5. PMID: 30736771; PMCID: PMC6368691. https://doi.org/10.1186/s12913-019-3896-5
  7. Pan American Health Organization. PAHO supports Central American countries in strengthening their governance in human resources for health [web site].(2024) https://www.paho.org/en/news/25-3-2024-paho-supports-central-american-countries-strengthening-their-governance-human.
  8. OECD Statistics & Data (2017-2021, most recent data)
  9. The gender pay gap in the health and care sector: a global analysis in the time of COVID-19. Geneva: World Health Organization and the International Labor Organization; 2022. https://www.who.int/publications/i/item/9789240052895
  10. World Health Organization. (2016). Global Strategy on Human Resources for Health: Workforce 2030. Available from: https://iris.who.int/bitstream/handle/10665/250368/9789241511131-eng.pdf
  11. 60th Directing Council, 75th Session of the Regional Committee of WHO for the Americas. (2023). CD60.R4. Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems. Washington, DC, USA, September 25-29, 2023. Available from: CD60.R4 – Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems – PAHO/WHO | Pan American Health Organization.
  12. Measuring the availability of human resources for health and their relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 399, Issue 10341(2022).
  13. WHO (2010) WHO Global Code of Practice on the International Recruitment of Health Personnel, Geneva: WHO. https://www.who.int/publications/m/item/nri-2021
  14. Mignon Duffy. Why Improving Low-Wage Health Care Jobs Is Critical for Health Equity. AMA J Ethics. (2022);24(9): E871-875. https://journalofethics.ama-assn.org/sites/joedb/files/2022-08/pfor1-peer-2209.pdf

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