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Impact of Migration on Health
Kannan Srinivasan, AMCHSS, SCTIMST
3 December 2008
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Organization
● Migration● Human Resources in Health● Migration and HR● Migration and Health● Migration in India
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Human Resources in Health
● Human Resources(health workforce) is prime in advancementsin health
● Health depends more on people to carry out its mission
● Health workers– Professionals– Technicians– Auxiliaries
● Human Resources for health are, the stock of all individuals engaged in Promotion, protection of population health
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Human Resources for Health
● All men and women who work in health field– Not just physicians and nurses but also– Public health workers– Policy makers– Educators– Clerical staff– Scientists– Pharmacists
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
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● For every 30,000 – PHC● PHC- 2 to 3 Physicians, 1 ISM Physician, 1
Male Health Assistant, 1 Female Health Assistant, 1 BEE, 1F Health Worker(ANM), 1 LT, 1 Statistician, 1 Driver, 1 Store keeper and ancillary staffs and attendants
● For every 5,000 – SC● 1 MPW, 1 FMPW, For every 1000
Community Health Volunteer● There are 23236 PHCs, 3346 CHCs and
146026 SCs (GoI)and Taluka, Dist Hospitals● Population of Indiab 1,028 million (2001 Census)
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
Human Resources for Health
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● There are 6,43,520 Allopathic Medical prac-titioners practicing in different states in India registered with different MCs (76925 +23858 = 1,00,783 in Public)
● There are 55000 dental surgeons registered with different DCs (up to 2005)
● There are 8,39,862 General Nursing Mid-wives, 5,02,503 Auxillary Nursing Midwives and 40,536 Health visitor and Health super-visors(Upto 2002) Nursing Councils
● (in Public 1,79,495 – 2005)● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007
Human Resources for Health
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● Shortages and Vacancies (2006)– 6.5 % PHCs without Doctor – 4.7 % of SCs without HW(F)– 39.2 % of SCs without HW (M)– Short fall of 19,311 MPW (F)– Shortfall of 64,211 MPW(M)– Shortfall of 4,214 LHV/HA– Shorfall of 5290 HA(M)– 4.8% MPW(F) posts vacant– 24.1 %MPW(M) Vacant– 13.2 % LHV/HA Vacant– 25.4 % HA(M) Vacant– 17.5 % Doctors at PHCs Vacant
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
Human Resources for Health
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● Migration of Health Personnel● Estimation 50% of AIIMS students migrated
to overseas or to the private sector● Around 1,00,000 doctors of Indian origin
settled in the USA and UK alone(WHO 2007) ● Around 81,091 nurses migrated to USA from
India● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007
Human Resources for Health
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Migration● Movement of people from one place to another
has shaped today's political, social and economic wourld and major influence on society.(Stilwell et. al)
● In 2000 almost 175 million people or 2.9% of world population, were living outside their country of birth for longer than one year.
● Of these, 65 million are economically active● It is significant for many resource poor countries as
they lose their better education nationals to richer countries
● 65% of all economically active migrants who have moved to developed countries are classified as 'highly skilled'
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Migration in Health Sector
● In health, this refers to physicians, nurses, dentists, and pharmacists
● Nurses are in high demand● USA and UK have shortfall of nurses in 10-
20 years time. They pay high compensation to attract
● There is an international concern expressed about the loss of skilled health professionals from health-care systems in poorer coun-tries that are already weak.
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● For policy options for managing migration, evidence of the magnitude of the problem and an understanding of the context of the labour markets is needed(Stilwell et.al.2004)
● health workers migration● Migration of health professionals not been
studied extensively● Last study was in 1970s● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
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Portuguese speaking African countries to Portugal
migration
No of Physicians No of Nurses Source country In Portugal In Source Country In Portugal In Source CountryAngola 820 961 383 14288Guinea-Bissau 358 197 253 1299Sao Tome and Principe 238 67 84 183Cape Verde 231 71 40 232
Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
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● Migration of health workers is primarily demand led
● Especially to UK and USA● Increase in number of nurses leaving the
Philippines and certain African countries influenced by high rates of nursing vacancies in Canada, USA, UK
● Disparities in working conditions and pay are "pull" factors
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
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● Survey on African countries found the factors affecting migration
● In Cameroon● lack of promotion opportunities, working
conditions, and desire to gain experience were reasons for migration
● In Uganda and Zimbabwe, wages were the most important factor
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz, "Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
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● Factors affecting health professionals' decision to migrage from five African countries were
● Desire to work in better managed health system
● Desire to continue education or taining● Want a more conducive working environment● Desire for better or more realistic
remuneration● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management" Bulletin of the World Health Organization August 2004, 82 (8)
●
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In India● A Case study● The reasons for medical professionals want to
go abroad mainly to gain professional experience- higly valued in India when they come back
● Other attraction - higher earnings, perks, high quality of life
● Nurses want to settle down abroad permanently - career prospects are not bright in India
● Doctors some settle abroad● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Health workers
● Health workers● Out-migration of health workers● Dr.s and nurses from India to developed
economies● Foreign educated (mainly Russia) returning
doctors ● the official recognition of their educational
credentials for practicing medicine in India● AIIMS - 56% of graduating doctors migrated
between 1956 - 80 - 1992 study● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Intended reasons for out migration
● The purpose of intended(reasons) out migration of doctors- quoted by Khadaria study is
● to get jobjs with better training opportunities● to ensure rapid progress in the medical profession● to obtain a specific kind of training not easily
available in India● to move abroad for getting god employment
opportunities● medical experience not easily available in Inda● to get a job with better training opportunities
overseas● to progress at a comparale faster pace in the
professional career● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals",
OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Motivating factors
● Motivating factors for out-migration of doctors● Better education institutions for children in host
country● Relatives in the host country● Easy access to communication facilities overseas● scope for self employment / entrepreneurship● Conducing immigration and settlement policies of
the host country● proficiency in English language● Satisfactory health facilities overseas ● Comparatively lower real earnings in India● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Motivating factors
● Bleak employment prospects in India● Better professional infrastructure overseas● Increasing employment opportunities
overseas● To get experience that will later be highly
valued in India● Quality of day-to-day life in host country● Better income prospects overseas● Availability of experts in the host country● Higher education in the host country● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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● Faourite destinations● USA - for medical professionals● UK - second preferred destination● Australia - third preferred destination● then Canada, Kuwait, New Zealand,
Germany● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Specialisations● Cardiology and internal medicine are the most
preferred specialisation for the prospective migrant doctors for those with the USA as destination
● internal medicine was the most preferred specialisation for those intending to go to the United Kingdom, and surgery was the preferred specalisation
● Majority reported 4-6 years as intended duration of stay overseas after their planned migration
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Doctors' perceptions
Doctors' perceptions about the Quality of medical education and training in India
● Majority felt they were moderately satisfied
Level of satisfaction with present salary in India
● Many reported dissatisfied followed by moderately satisfied
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Nurses case study
● Majority of nurses are married - 88 %● Half are from Kerala● Most completed diploma in nursing● Majority 27/36 planning for one to two years
to overseas● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Source of inspiration
Source of inspiration for emigration for nurses ( in order)
● self● friends overseas● family● friends in Indi● Relatives● Mentor/ Teacher / Senior doctors● Career counselor● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Purpose of out-migration
Purpose of intended out-migration of nurses● better training opportunities● obtain a specific kind of training● Progress faster in medical profession● get employment● permanent settlement in host country ● research assignments● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Motivating factors
Motivating factors for out-migration of nurses● Better income prospects overseas● Quality of day-to-day life overseas● Better infrastructure overseas● Better education institutions for children● Get valuable experience● Higher education overseas● Increasing employment opportunities
overseas● Relatives in the host country● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Motivating factors
● Proficiency in English language● Lower real earning in India● Bleak employment prospects in India● Satisfactory health facilities● Conducive immigration and settlement
policies● scope for self employment entreprneurship● availability of experts in host country● easy access to communication facilities● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Preferred destination
Preferred destination countries for out-migration of nurses( In order)
● USA● UK● Australia● Canada● African Countries● Gulf Countries● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Level of satisfaction with education in India
Level of satisfactor with education, training, and experience in India
● Majority were Moderately satisfied● Level of satisfaction with present salary in
India● Majority said moderately satisfied
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
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Mobility or Migration Management