When NRM last looked
at the issue of "poaching" caregivers from poor countries
(see "MD recruiting
without borders," page 1, Vol 1 No 18) we focused
on the plight of the countries who were experiencing the
healthcare brain drain. Now we'd like to turn the spotlight
on the doctors who flee their homeland and head for Canada.
If you thought they're just here to chase our rainbow-hued
currency, you'd be dead wrong.
A recent World Health Organization
(WHO) report entitled "The role of wages in the migration
of healthcare professionals from developing countries,"
finds money doesn't typically drive a caregiver's decision
to work abroad. This is especially true for Africa.
"Healthcare wage increases in source countries � unless
substantial � will not decrease the willingness of healthcare
professionals to migrate from these developing countries,"
the authors conclude. In fact, money isn't even usually
a deciding factor in where they'll end up. The report
finds caregivers are more influenced by factors like
how easy it is to get accredited in the destination
country and whether or not there's a shortage in their
field.
NO
RESPECT
Dr Imran Ahmad, an oncologist who graduated from medical
school in Pakistan and practises at the Saskatoon Cancer
Centre, believes that the source countries have a lot
of work to do before they can expect to lure doctors
back. "I left Pakistan first because there was no training
in medical oncology available there at the time," he
says, "but also because I disliked the corruption and
lack of respect for merit in the medical system there."
Dr Ahmad believes, above all, that
doctors leave because they don't want to live and work
in a non-democratic society. "It's not that people don't
want to go back," he says. "A lot of my friends have
gone back, but they find that nobody respects them or
appreciates them, and they come back here." He feels
that given the right offer, about a quarter of Pakistani
physicians working abroad would consider returning.
"It would be good for the country," he says. "But what
is good for the country must be realized at the very
top level of government and has to be discussed there."
Dr Ahmad is one of four Pakistani doctors working at
the Saskatoon Cancer Centre.
Marko Vujicic has been part of
a WHO team that has spent the past few years trying
to get a handle on the extent of and causes behind the
caregiver shortages in developing countries. "At major
health summits," he says, "ministers from developing
nations, especially in Africa, are identifying a lack
of human health resources as the major constraint in
achieving goals for health set out by the WHO." Mr Vujicic
led WHO research on the migration plans of African physicians
and nurses. He thinks attitudes are changing about international
caregiver poaching. "Two years ago the debate was how
do we stop this," he says. "Today the question is how
do we manage this and minimize losses to developing
nations."
And the loss is significant, not
just in terms of labour, but also education funding.
Many developing countries subsidize or cover the costs
of medical education only to see graduates head straight
from their convocation to the airport. Fully 68% of
healthcare workers in Zimbabwe intend to leave, according
to WHO data, as do 62% from Ghana and 58% from South
Africa.
Some recent developments hint that
the international community is starting to get serious
about caregiver poaching. The latest World Health Assembly
(WHA) passed a resolution aimed at levelling the playing
field for poor countries. The resolution calls on rich
countries to pay compensation to the countries that
they're poaching from. A finder's fee would be levied
for each worker poached � money that would be used to
fund healthcare education.
The International Organization
for Migration is approaching the same problem in a very
different way. The group has a plan in the works to
recruit healthcare professionals who have emigrated
and set up exchange programs where they can return to
their home country to work for three or four years.
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