High Level Meeting on Migration and Mobility of Health Care Workers in the Region of the Americas

• To hold a high-level dialogue on issues related to healthcare workers migration and mobility and to define strategic directions for a roadmap in alignment with WHO’s Global Code of Practice on the International Recruitment of Health Personnel.
• To agree on key policy areas to optimize the benefits of migration and mitigate its negative effects in the Region.
• To identify innovative mechanisms for fostering collaboration among countries to achieve equity and promote knowledge exchange on health workers migration and mobility, thereby facilitating the development of specific solutions for the Region of the Americas.    
   

The international mobility and migration of healthcare workers has been growing steadily over the years. Between 2008 and 2018, the number of migrant physicians and nurses in the Organization for Economic Co-operation and Development (OECD) countries increased by 60% (1). In eight high-density OECD countries, the proportion of foreign-trained physicians increased from 32% in 2010 to 36% in 2020 (2). This trend was further magnified by the COVID-19 pandemic. The economic projections concerning the demand and supply of health professionals suggest a continued rise in the global movement of health workers. Moreover, the persistent global shortage of human resources for health (HRH) is widespread but in addition not evenly distributed across regions. For example, Latin America and the Caribbean (LAC) are expected to be among the regions with the most substantial net shortages by 2030 (3).

The migration of human resources for health (HRH) from low- and middle-income countries (LMICs) is a global health issue with significant implications for both source and receiving countries, shaped by a complex interrelation of push and pull factors at the individual and systemic levels. At the individual level, better job opportunities, improved working conditions, higher salaries and better career prospects are drivers (pull factors) for migration. At the systemic level, the deficit of health personnel in receiving countries and weak health systems, poor working condition, limited professional development opportunities, political instability and poor governance in the countries of origin, can push HRH to seek employment elsewhere. Additionally, the global distribution of health workers is influenced by macro-level factors such as economic globalization, international trade agreements, rigid supply systems and aging populations in high-income countries, driving up demand and intensifying workforce migration from LMICs (4). 

In the Region of the Americas, migration and mobility of healthcare workers is not a recent phenomenon, but it has become a pressing issue over the last years due to significant shortages of health personnel in LMICs. In the case of Central America and the Caribbean, it has compromised their health systems’ ability to respond to public health emergencies and to provide essential health services to meet the population’s health needs. The migration flow has been further exacerbated by private, for-profit recruitment firms that are increasingly entering this market and shaping migration patterns. 

A study conducted in 2023 by PAHO and the Human Resources for Health Caribbean Commission (5), showed that main push factors for migration were inadequate remuneration, limited professional development opportunities, and stressful working conditions. The perspective of better salaries seems to be a strong motivator for migration in the Caribbean Subregion. A study published in 2019 (6), on salary disparities between health workers working in the Caribbean and selected destination countries, showcased the purchasing power parity (PPP) for adjusted HRH salaries in three selected destination countries (Canada, United Kingdom-UK and United States) were much higher than those of comparable HRH working in selected Caribbean countries (Dominica, Grenada, Jamaica and St Lucia and). This may account for the continued tendency of health workers trained and employed in the Caribbean subregion to migrate due to financial incentives. 

The proposal for a Human Resources for Health Roadmap in Central America and the Dominican Republic, spearheaded by Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) in 2023, underscores the urgent necessity of addressing high rates of migration and mobility among healthcare workers (7). Priorities include ensuring decent working conditions and the protection of health workers. Measures such as improving the labor market, security conditions, and fostering bilateral agreements have also been identified as crucial for addressing this issue. 

In some countries, insecurity and political instability play a pivotal role in migration, including that of health workers as they tend to seek better opportunities out and within the Region of the Americas as well. 

OECD data from 2017 to 2021 indicates that the countries with the highest number of foreign-trained physicians from Latin America are Canada, Chile, and Germany. The majority of these physicians originate from Colombia, Ecuador, and Venezuela. A large number of foreign-trained nurses from the English Caribbean migrate to Canada and the UK; most nurses are from Barbados, Guyana, Jamaica and Trinidad & Tobago (8). There is also an important socio-economic push factor that affect nurses, who are mostly women, who earn 20% less than men, have limited access to leadership positions, and are underrepresented in senior positions, both in health systems and in politics (9).
By 2030, the shortage of health professionals in the Americas will be at a minimum around 600 thousand and up to 2 million (10-12) in LAC, unevenly distributed within and among countries. The migration of health-care professionals represents an important modality of brain drain from the most affected subregions and countries, which will bear the brunt of the projected HRH deficit by 2030. Furthermore, the dearth is already the highest in rural and underserved areas, leading to pronounced healthcare disparities (4). 

Additionally, migration and mobility of healthcare workers constitute issues that are highly relevant to the labor market. Considering that the health sector is one of the main employers in many countries, these issues have an impact on areas overseen not only by the Ministry of Health, but also by the Ministry of Labor, the Ministry of Education and Ministry of the Economy. The impact of workforce migration is not only seen within the health sector, but across other social development sectors, and the economy more broadly.  

Although the situation has been acknowledged and addressed by many countries in the Region of the Americas, as evidenced by initiatives such as the Caribbean Roadmap on Human Resources for Universal Health (2018-2022) and COMISCA’s 2023 proposal for a Human Resources for Health Roadmap in Central America and the Dominican Republic, there is still a need to broaden and foster an open dialogue among countries, both within the region of the Americas and in Europe, in order to agree on specific interventions aligned to WHO’s Global Code of Practice on the International Recruitment of Health Personnel (13) and bilateral agreements. There is also a need to gather more information around issues such as equity regarding the gender salary-gap and the relationship between health professionals and low-wage health care workers who are crucial for the provision of care (i.e. nursing assistants, cleaning and food preparation workers who work in health facilities and providers of long-term care for elderly adults with disabilities), considering that these jobs are overwhelmingly held by women and migrant health workers (14).

9:00 - 9:10 am

Bienvenida Welcoming & Opening Remarks  

PAHO, Jarbas Barbosa Junior da Silva, Director

9:10 - 9:15 am

Remarks 

WHO/EURO, Hans Henri P. Kluge, Hans Henri P. Kluge, WHO Regional Director for Europe

9:15 - 10:00 am

Panel 1: Global Health Workforce Dynamics: Migration, Recruitment, Retention, and Policy Perspectives:
- WHO Code of Practice, status and perspectives
- Healthcare workforce migration in the Americas: challenges and opportunities
- Healthcare workforce migration in WHO European Region: challenges and opportunities 

Moderator: PAHO, Mary Luo Valdez, Deputy Director
Speakers:
- James Campbell, WHO-HWF, Director Health Workforce     
- Benjamín Puertas, PAHO, Chief, Human Resources for Health Unit  
- Tomás Zapata, WHO/EURO, Regional advisor, Health Workforce and Service Delivery
 

10:00 - 10:15 am

Q&A: Open Discussion on panel 1

All participants 

10:15 - 10:35 am

Coffee Break

Official picture

10:35 - 10:45 am

Video and testimonies from health care workers on migration and mobility in the Region of the Americas

Special guests

10:45 - 12:00 m

Panel 2: Health worker migration in the destination countries: Experiences and future prospects for collaboration

Moderator: WHO/EURO (RA HRH), Tomás Zapata
- Country delegation panel: Chile, Germany, Ireland, Spain, Portugal, and USA 

12:00 - 12:20 pm

Q&A: Open Discussion on panel 2

All participants 

12:20 - 1:30 pm

Panel 3: Strengthening retention and return strategies within countries and regions: best practices and lessons learned. 

Moderator: MoH-Brazil, Isabela Pinto Cardoso
- Country delegation panel: Barbados, Ecuador, Grenada, Guyana, and Honduras

1:30 - 1:50 pm

Q&A: Open Discussion on panel 3 

All participants 

1:50 - 3:05 pm 

Break

Lunch

3:05 - 4:20 pm

Panel 4: Strategies for ethical and equitable recruitment of HCW

Moderator: ILO, Noortje Denkers
- Country delegation panel: Brazil, Canada, El Salvador, Jamaica, Germany, Paraguay, and Spain  

4:20 - 4:40 pm

Q&A: Open Discussion on panel 4 

All participants  

4:40 - 4:50 pm 

Day 1: Closing 

PAHO HSS/HR, Benjamín Puertas

9:00 - 9:10 am

Welcoming & Introduction: Summary from Day 1 and Expected Results for Day 2 

PAHO HSS/HR, Gisele Almeida

9:10 - 9:30 am

Strategic orientations for a preliminary roadmap to address challenges in migration and mobility of health workers in the Americas.

PAHO HSS, James Fitzgerald, Director, Health Systems and Services

9:30 - 10:30 am

Q&A: Open discussion 

All participants  

10:30 - 10:50 am 

Coffee Break

10:50 - 11:20 am

Agreement on the strategic lines for a roadmap in migration and mobility of health workers in the Americas.

PAHO HSS/HR, Benjamín Puertas

11:20 - 12:20 pm

Next Steps 

PAHO. Country Delegates (LAC) 

12:20 - 12:30 pm

Closing Remarks  

WHO HWF. James Campbell, Director Health Workforce
WHO EURO. Natasha Azzopardi-Muscat, Director Country Policies and Systems 
PAHO. James Fitzgerald, Director, Health Systems and Services

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