This commentary paper highlights changing patterns of outward migration of Zambian nurses. The aim is to discuss these pattern changes in the light of policy developments in Zambia and in receiving countries. Prior to 2000, South Africa was the most important destination for Zambian registered nurses. In 2000, new destination countries, such as the United Kingdom, became available, resulting in a substantial increase in migration from Zambia. This is attributable to the policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering voluntary separation packages. The dramatic decline in migration to the United Kingdom since 2004 is likely to be due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses are also leaving Zambia for other destination countries, a significant new development. This paper stresses the need for nurse managers and policy-makers to pay more attention to these wider nurse migration trends in Zambia, and argues that the focus of any migration strategy should be on how to retain a motivated workforce through improving working conditions and policy initiatives to encourage nurses to stay within the public sector.
Human Resources
The WHO Secretariat has redrafted the code of practice in order to take into account, as requested, the views and comments expressed by members of the Board in January 2009 and the outcome of the subsequent sessions of the regional committees. Two core themes identified by the regional committees and incorporated in the revised draft code were that member states should strive to achieve a balance between the rights, obligations and expectations of source countries, destination countries and migrant health personnel, and that international health worker migration should have a net positive impact on the health system of developing countries and countries with economies in transition. The revised draft text emphasises that international health personnel should be recruited in a way that seeks to prevent a drain on valuable human resources for health. It also recommends that countries should abstain from active international recruitment of health personnel unless equitable bilateral, regional, or multilateral agreement(s) exist to support such recruitment activities.
This report is a summary of six years of investigation into migration policy and practice. Its findings indicate that, for migration to have its full developmental impact, the most beneficial policy change would be to reduce barriers to migration, at all levels and particularly for the poorest. This paper examines the changing dynamics of migration, impacts of migration on poverty and livelihoods, new initiatives in international migration, and how the findings in relation to the development of policy on migration. It found that poor people are more likely to move over shorter distances, either within or between poor countries, and where poor people have a greater choice in terms of migration destinations, the net effect on inequality is more likely to be positive. In addition, skilled migration is largely a symptom, not a cause, of underdevelopment. Diaspora engagement can contribute to the development of countries of origin, but this is a highly politicised arena.
This paper found that, until recently, researchers and policymakers paid little attention to the role of health workers in developing countries but a new generation of studies are providing a fuller understanding of these issues using more sophisticated data and research tools. Recent research highlights the value of viewing health workers as active agents in dynamic labour markets who are faced with many competing incentives and constraints. Newer studies have provided greater insights into human resource requirements in health, the motivations and behaviours of health workers, and health worker migration. The authors note that they are encouraged by the progress but believe there is a need for even more, and higher-quality, research on this topic.
This paper contributes to the economics literature on nursing market shortages by putting forward two new models that suggest three new explanations for perceived nursing shortages. The first model focuses on hospitals hiring both permanent staff nurses and temporary contract nurses. It shows that hiring both classes of nurses can represent optimising behaviour, and that an interesting kind of perceived nursing shortage results from this dual hiring. The second model posits two classes of hospitals – premier and funds-constrained – and generates two distinct kinds of nursing shortages: economic shortages, involving unfilled, budgeted positions, and non-economic professional standards shortages. The paper argues that the perceived existence of professional standards shortages may be a significant explanation for the widespread impression of persistent shortages.
The National Organisation of Nurses and Midwives of Malawi’s position paper is a response to the proposed introduction of fees for student nurses and midwives. It has been submitted to top leadership in government, parliament, civil society organisations, media, community and religious leaders, professional organisations, trade unions and other opinion leaders. The organisation asks for ‘revision of government decision on payment of fees by students and parents towards training in nursing and midwifery. Specifically, the fees are very high costing over K1 million per student for a three-year course of study. This is prohibitive to selected candidates who aspire to study nursing/midwifery… [ ] … Existing and alternative funding options can be maximised to address funding for nurses and midwives’ training.’ It notes that civil society has a critical role in ‘complementing government efforts to develop the country socio-economically, taking it from “Poverty to Prosperity”’ and hopes to build on the economic prosperity achieved by Malawi in the past six years, referring to ‘meaningful and sustainable funding… [ ] … for the training of nurses and midwives.’
A ten-point plan to improve the nursing profession through education and training was recently agreed upon by the national Health Ministry in South Africa. Health minister, Aaron Motsoaledi, said discussions were underway between the department of Higher Education and Training, his department, the Council on Higher Education and Umalusi on the role of new quality councils in quality assurance of the diversity of health science offerings. From this discussion, an agreement emerged between the Department of Health and the Department of Higher Education and Training on the need for a diversified nursing education and training system. The next step was to revitalise the nursing colleges sector. This followed a recognition that strengthening colleges would contribute to a vibrant nursing education and training system. ‘What we need to do is work out how we can retain nurse educators, encourage nurse education as a critical career path and more generally attract young people into the profession,’ Motsoaledi said.
The findings in this report by the United Nations Development Programme (UNDP) cast new light on some common misconceptions about migration. Most migrants do not cross national borders, but instead move within their own country: 740 million people are internal migrants, almost four times the number of international migrants. Among international migrants, less than 30% move from developing to developed countries. For example, only 3% of Africans live outside their country of birth. Contrary to commonly held beliefs, migrants typically boost economic output and give more than they take. Detailed investigations show that immigration generally increases employment in host communities, does not crowd out locals from the job market and improves rates of investment in new businesses and initiatives. Overall, the impact of migrants on public finances is relatively small, while there is ample evidence of gains in other areas such as social diversity and the capacity for innovation. The gains to people who move can be enormous. Research found that migrants from the poorest countries, on average, experienced a 15-fold increase in income, a doubling of school enrolment rates and a 16-fold reduction in child mortality after moving to a developed country.
African countries, much poorer and less resourced than South Africa, are using trained mid-level health workers to perform tasks traditionally reserved for doctors, including surgery, and, in the process, are saving the lives. Presenters from Mozambique, Tanzania and Malawi at the 14th FIGO (International Federation of Gynecology & Obstetrics) World Congress of Gynecology and Obstetrics on 4 October shared details of how mid-level health workers are performing caesareans and other emergency surgical procedures in hospitals where there are simply no doctors and often no professional nurses. In Mozambique, 92% of all Caesarean sections at the district hospital level are carried out my mid-level providers – tecnicos de cirugia. In Tanzania the percentage is 84%. Studies in all three countries have shown that with the right training these mid-level providers – some trained straight after school while other have some experience of working in the health sector – have similar outcomes to doctors when providing life-saving emergency obstetric surgical care. Compared to doctors, their retention rates, especially in rural and district areas where the need is desperate, are excellent.
This survey was conducted among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. The survey shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.