International migration and
recruitment of nurses
Prof. James Buchan
[email protected]
International migration and
recruitment of nurses
•
•
•
•
•
Active recruitment
UK Case study
Code of Conduct
EU
Ghana case study
“Active recruitment”:
recent initiatives in other
“importer” countries
N orw ay
L an gu ag e skills train ing/
govt agreem ents w ith
P oland, B altic S tates
Ireland
N ation al co -ord in atio n of
clinical placem en ts
U SA
O pportun ity to sit
licensing ex am inatio n in
ho m e co untry
% of new nurse registrants from EEA,
UK and “other” countries 1993-2003
100%
80%
Other
%
60%
UK
40%
EU
20%
0%
4
/9
93
5
/9
94
6
/9
95
7
/9
96
8
/9
97
9
/9
98
0
/0
99
1
/0
0
0
20
2
/0
1
0
20
/3
02
0
2
UK: Total “outflow” of nurses /
to USA
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
2/
3
20
0
2
/0
20
01
01
00
/
00
99
/
99
98
/
98
97
/
97
96
/
96
95
/
95
94
/
93
/
94
OTHER
USA
Net flow of nurses to/ from UK (NMC
registrations)
12000
10000
8000
6000
4000
2000
0
93/94
94/95
95/96
96/97
97/98
98/99
-2000
-4000
Year
99/00
2000/01 2001/02 2002/03
Ireland: Home, EU and non EU
nurse registrants
2,000
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
1990
1991
1992
1993
Ireland
1994
1995
1996
1997
European Union (EU)
1998
Non-EU
1999
2000
2001
EU accession:
Physicians intent to move
(Source Open Society,2003)
70
60
%
50
40
Intent
Definite
30
20
10
0
Lith.
Hung.
Pol.
Czech.
Department of Health (England)
Code
• Requires NHS employers not to “actively” recruit
from developing countries, unless govt. to govt.
agreement (India, Philippines, Indonesia)
• List of “preferred provider” recruitment agencies
• Issued Nov 2001 (but list of countries only
available Jan 2003)
• Compliance difficult to monitor- NHS does not
record international nurses
• Private sector (25% of workforce) not covered by
Code
Annual no. of new entrants to UK nursing
register, from selected sub Saharan African
countries, 1998-2003
500
450
400
350
300
250
200
150
100
50
0
1998/99
1999/00
2000/01
2001/02
Nigeria
Ghana
Zambia
Malawi
Kenya
Botswana
2002/3
Zimbabwe
“Outflow” of nurses from Ghana
(Ghana Nurses Council verifications)
1000
900
800
700
600
500
400
300
200
100
0
rt
ia
l)
03
(p
a
20
20
02
20
01
20
00
19
99
19
98
OTHER
USA
UK
Vacancy rates, Ghana Health
Services, 1998 and 2002
60
50
%
40
Nurses
Doctors
30
20
10
0
1998
2002
Impact on source countries
•
•
•
•
•
Understaffing / loss of skills
Decreased capacity in health services
Increased costs of recruitment and retention
possible compromises in quality of care
Low morale- remaining nurses and
consumers
(sources : DENOSA/ Caribbean, PAHO)
Inflow of nurses to developed countries,
by World Bank status of source countries
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
UK 2001/02
Norw ay
2002
Ire land
2001
Victoria
State , Aus
2002
High Income/High Middle Income
Lower Middle Income
Low Income
Unite d
State s 2002
Challenges and Opportunties
Destination
countries
OPPORTUNITIES
CHALLENGES
Solve skills
shortages
Efficient (and
ethical?)
recruitment
Outflow causes
skills shortages
Source countries (Remittances)
Upskilled returners
Mobile nurses
Improve pay, career
prospects
Static nurses
(if oversupply)improved job
opportunities
Achieving equal
opportunities
destination country
Increased
workload,
decreased morale
Policy Issues
• High level of reliance on international
recruitment- necessary/ desirable/
sustainable?
• UK (DH England) Code- how effective?
can it be strengthened?
• Bilateral agreements / managed migration:
desirable?/ effective?
• “Ethical” frameworks / international
monitoring: whose responsibility?
References
• Buchan J, Dovlo D 2004. International
Recruitment of Health workers: a report
fro DFID.
http://www.dfidhealthrc.org/Shared/public
ations/reports/int_rec/int-rec-main.pdf
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UK- % of new home trained and overseas registrants