The movement of people across and within borders has characterised the development of most global regions, resulting in a rich intermingling of cultures. Such movement is often motivated by the desire for a better life, whether this entails finding new land to cultivate or money making opportunities. In recent years, the process of movement has itself been simplified, opportunities for work in services and industry have boomed and globally, numbers of migrants have increased dramatically . In response, an increasing number of studies are emphasising the impacts of migration, particularly for developing countries, in the form of remittances - money sent by migrant workers back to communities and households. This key issues page looks at some of these perceived impacts, and provides recommendations for further reading on the subject of migration and remittances.
Human Resources
Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
Insufficient progress is being made towards the Millennium Development Goals, including those dealing with child and maternal mortality. At the current rate of progress in sub-Saharan Africa, the target of a two-thirds reduction in child mortality by 2015 will only be reached in 2165. Renewed interest in the potential contribution of community health workers may be timely. Evidence suggests that over sixty percent of deaths in children under-five years could be prevented by interventions already in existence. Studies show that 41–72 percent of deaths in newborns are preventable using available interventions if there is high coverage, and about half of this reduction may be possible using community-based interventions. This study reviews the literature for evidence of whether community health workers are capable of carrying out the tasks required of them as part of a sustainable workforce. It concluded that several factors influence programme impact and sustainability and determine whether child death reductions can be realised on a national scale: national socio-economic and political factors, community factors, health system factors and international factors. For instance, particularly if the political context is not a participatory democracy, support within the community for community health workers may be undermined by social class and caste divisions.
Speakers at a two-day international conference in Africa on midwifery have called for more incentives to attract young people into the midwifery profession. They said the midwives of today were fast ageing and that unless immediate measures were put in place to attract more young ones into the profession, the fight for the reduction in maternal and infant mortality and morbidity would be a mirage. The speakers made the call at a two-day international conference of midwives on the theme, "African Midwives: Uniting to address the reduction of maternal and infant mortality and morbidity".
Dr Tshabala-Msimang said for Africa to scale up health work-force training, there is a need to mobilise adequate resources. She appealed to the developed world which has largely benefited from this exodus of health workers, to consider financially supporting Africa to train more health workers. Additional resources will also be required to rebuild the health infrastructure in some instances as well as training our lecturers, tutors and researchers.
In responding to the goal of rapidly increasing access to antiretroviral treatment (ART), the government of Botswana undertook a major review of its health systems options to increase access to human resources, one of the major bottlenecks preventing people from receiving treatment. In mid-2004, a team of government and World Health Organization (WHO) staff reviewed the situation and identified a number of public sector scale up options. The team also reviewed the capacity of private practitioners to participate in the provision of ART. Subsequently, the government created a mechanism to include private practitioners in rolling out ART. At the end of 2006, more than 4500 patients had been transferred to the private sector for routine follow up. It is estimated that the cooperation reduced the immediate need for recruiting up to 40 medically qualified staff into the public sector over the coming years, depending on the development of the national standard for the number and duration of patient visits to a doctor per year. Thus welcome relief was brought, while at the same time not exercising a pull factor on human resources for health in the sub-Saharan region.
The School of Medicine at Muhimbili is the main doctor-training institution in the country. It runs a five-year MD programme taking 200 students annually. As for many schools in low-income countries, the majority of teachers have no formal training in educational theory. The learning environment at the school has some strengths that should to be amplified, and numerous weaknesses that need to be corrected in order to make the environment more conducive to teaching and learning.
Africa is losing its brightest to the First World. Less than 10% of doctors trained in Zambia since its independence in 1964 are still in the country: the other 90% have migrated, mainly to Europe and the United States. No less staggeringly, there are more Sierra Leonean-trained doctors in Chicago alone than in the country itself. These medical examples are merely one facet of the massive loss of skills Africa as a whole continues to suffer. In effect, one-third of the continent’s university resources are serving the manpower needs of Western nations and not those of Africa itself. United Nations estimates suggest that Africa is spending a staggering $4-billion a year training professionals for developed countries. Why this is happening, and what African universities need to do to counter the problem, came under the spotlight in the Libyan capital of Tripoli, which hosted the Association of African Universities’ (AAU) two-yearly conference of rectors, vice-chancellors and university presidents.
This paper analyses the relationship between physician migration from developing source countries to more developed host countries (brain drain) and the developmental and global health profiles of source countries. Source countries with better human resources for health, more economic and developmental progress, and better health status appear to lose proportionately more physicians than the more disadvantaged countries. Higher physician migration density is associated with higher current physician and public health workforce densities and more medical schools. Policymakers should realize that physician migration is positively related to better health systems and development in source countries. In view of the "train, retain, and sustain" perspective of public health workforce policies, physician retention should become even more important to countries growing richer, whereas poorer countries must invest more in training policies.
This paper discusses gender issues manifested within health occupations and across them. It examines gender dynamics in medicine, nursing, community health workers and home carers and explores from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. Gender plays a critical role in determining the structural location of women and men in the health labour force and their subjective experience of that location. The paper shows that woman are overrepresented in caring, informal, part-time, unskilled and unpaid work and within occupations there are significant gender differences in terms of employment security, promotion, remuneration.