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

High Level Meeting on Migration and Mobility of Health Care Workers in the Region of the Americas
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Date: 17-18 October 2024
Location: Conference Room B, PAHO/WHO Headquarters, Washington, D.C.
Format: In person.

Objectives

  • 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.    
     

Background

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.  

Justification

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).

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 Labour 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, D.C., 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 its 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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