African Physician Migration to High-Income Nations: Diverse Motives to Emigrate (“We Are not Florence Nightingale”) or Stay in Africa (“There Is No Place Like Home”); Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

Document Type : Commentary

Authors

1 Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA

2 Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA

3 Office of the Dean, Yale School of Public Health, Yale University, New Haven, CT, USA

Abstract

Research in assessing the global and asymmetric flows of health workers in general, and international medical graduates in particular, is fraught with controversy. The complex goal of improving health status of the citizens of home nations while ensuring the right of health workers to migrate generates policy discussions and decisions that often are not adequately informed by evidence. In times of global public health crises like the current coronavirus disease 2019 (COVID-19) global pandemic, the need for equitable distribution and adequate training of health workers globally becomes even more pressing. Brugha et al report suboptimal training and working conditions among Irish and foreign medical doctors practicing in Ireland, while predicting large-scale outward migration. We comment on health personnel migration and retention based on our own experience in this area of research. Drawing from our examination of medical migration dynamics from sub-Saharan Africa, we argue for greater consideration of health workforce retention in research and policy related to resource-limited settings. The right to health suggests the need to retain healthcare providers whose education was typically subsidized by the home nation. The right to migrate may conflict with the right to health. Hence, a deeper understanding is needed as to healthcare worker motives based on interactions of psychosocial processes, economic and material determinants, and quality of work environments.

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References

  1. Giovanelli M. Foreign-Trained Doctors Kept Out of Practice in US. The World; April 14, 2011. https://www.pri.org/stories/2011-04-14/foreign-trained-doctors-kept-out-practice-us.  Accessed July 17, 2020.
  2. World Health Organization (WHO). The World Health Report 2006: Working Together for Health. Geneva: WHO; 2006.
  3. Saluja S, Rudolfson N, Massenburg BB, Meara JG, Shrime MG. The impact of physician migration on mortality in low and middle-income countries: an economic modelling study. BMJ Glob Health. 2020;5(1):e001535. doi:10.1136/bmjgh-2019-001535
  4. Brugha R, Clarke N, Hendrick L, Sweeney J. Doctor retention: a cross-sectional study of how Ireland has been losing the battle. Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.54
  5. Hunt P. The UN Special Rapporteur on the right to health: key objectives, themes, and interventions. Health Hum Rights. 2003;7(1):1-27. doi:10.2307/4065415
  6. Lofters A, Slater M, Fumakia N, Thulien N. "Brain drain" and "brain waste": experiences of international medical graduates in Ontario. Risk Manag Healthc Policy. 2014;7:81-89. doi:10.2147/rmhp.s60708
  7. Brugha R, McAleese S, Dicker P, et al. Passing through - reasons why migrant doctors in Ireland plan to stay, return home or migrate onwards to new destination countries. Hum Resour Health. 2016;14(Suppl 1):35. doi:10.1186/s12960-016-0121-z
  8. Glinos IA. Going beyond numbers: a typology of health professional mobility inside and outside the European Union. Policy and Society. 2014;33(1):25-37. doi:10.1016/j.polsoc.2014.04.001
  9. Update on Visas for Medical Professionals. US Department of State website. https://travel.state.gov/content/travel/en/News/visas-news/update-on-h-and-j-visas-for-medical-professionals.html.  Accessed July 17, 2020.
  10. Tankwanchi AS. Doctors Beyond Borders: Data Trends and Medical Migration Dynamics from Sub-Saharan Africa to the United States [dissertation]. Nashville, TN: Vanderbilt University; 2012.
  11. Tankwanchi AB, Vermund SH, Perkins DD. Monitoring Sub-Saharan African physician migration and recruitment post-adoption of the WHO code of practice: temporal and geographic patterns in the United States. PLoS One. 2015;10(4):e0124734. doi:10.1371/journal.pone.0124734
  12. Tankwanchi AS, Hagopian A, Vermund SH. International migration of health labour: monitoring the two-way flow of physicians in South Africa. BMJ Glob Health. 2019;4(5):e001566. doi:10.1136/bmjgh-2019-001566
  13. Silvestri DM, Blevins M, Wallston KA, et al. Nonacademic attributes predict medical and nursing student intentions to emigrate or to work rurally: an eight-country survey in Asia and Africa. Am J Trop Med Hyg. 2017;96(6):1512-1520. doi:10.4269/ajtmh.16-0756
  14. Tankwanchi ABS. Oppression, liberation, wellbeing, and ecology: organizing metaphors for understanding health workforce migration and other social determinants of health. Global Health. 2018;14(1):81. doi:10.1186/s12992-018-0397-y
  15. Manzo LC, Devine-Wright P. Place Attachment: Advances in Theory, Methods and Applications. New York, NY: Routledge; 2013.
International Journal of Health Policy and Management

Articles in Press, Accepted Manuscript
Available Online from 02 November 2020

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