Ref. :  000022938
Date :  2006-03-16
Language :  English
Home Page / The whole website
fr / es / de / po / en

"Looking for greener pastures": Nurses and doctors on the move

The global health care profession employs an estimated 100 million people, but is not attracting enough new recruits in both developed and developing countries alike. So fierce is the competition to secure scarce health care professionals, that private recruitment agencies stage promotional events and aggressive recruitment campaigns in supplying countries. A recent ILO study (Note 1) examines these shortages of health care professionals and the role played by private recruitment agencies in the flows of international migration.

Author :  OIT / ILO



LONDON (ILO Online) - Conrado, a highly qualified nurse from Asia (Note 2), was among many who were approached by a United Kingdom (UK) based company with offices in an Asian city. Interviews by agency staff and a pre-selection test cost some £200 each. They were then told that they had to pay a further £300 for the work permit and placement fee.

Having paid a total of £700 - for which no receipts were given - they were then informed that they needed to raise one month's deposit and one month's rent for their accommodation on arrival in the UK. The nurses were not told that the National Health Services Trust has a policy of giving migrant nurses an advance payment of £500 on arrival. Nor were they told that their accommodation was in fact provided for them by the agency.

"We were all drained in terms of the finances and this was the exact timing a finance company offered a loan of £1,500 … desperate to grab the opportunity we took the loan though we knew that almost nothing would be left from our salary and besides we're not in the position to decline the offer", explains Conrado.

When the nurses arrived in the UK they were given tenancy agreements to sign for accommodation not yet seen. After two months the nurses found that they were unable to pay for the accommodation and give themselves an adequate diet. "I lived on £5 worth of food a week, having an apple for breakfast, a snack in the canteen for lunch, and rice for dinner", he says.

"When describing the new nurse migration, observers often invoke the image of a global treasure hunt. The implication is that nurses will discover the treasure at the end of the hunt. That is not always the case, as Conrado's example shows", comments Susan Maybud, ILO Health Services Specialist and co-author of the study.


Brain drain, brain gain or brain waste?
The adequate supply of health care professionals has been a serious issue for developed countries in the last few decades. In the United States (US) a 20 per cent deficit in the registered nurse workforce has been forecasted by 2020 if current trends are not reversed. In the UK, 100,000 nurses are due to retire by 2010. Across the European Union, more than half of the physicians were aged over 45 in 2000; in Norway, the average age of dentists was 62.

Developing countries, on the other hand, struggle to produce and retain a sufficiently qualified health care workforce. Around 36 African countries do not meet targets of one doctor per 5,000 people and even in non-conflict affected countries such as Zambia and Ghana, there is only one doctor for more than 10,000 people.

Health care professionals who leave most often do not return. A nurse in Uganda would typically earn US$38 per month and a nurse in the Philippines would earn US$380, but in the United States the average monthly wage for nurses is about US$3,000.

"With the difficult situation in the African health system, I can't condemn doctors who leave to look for pastures greener…but I feel very sad for the poor people who are left behind without quality health care", comments an African doctor.

"Migration is embedded in the personal human right to freedom of movement, and the use of an individual's knowledge and skills to seek a better life. But the adverse effects that the international recruitment of health care workers have on strained health systems of poor countries raises moral concerns. The migration flows from poor to better-off countries increase worldwide inequities in health by jeopardizing the capacities of weak health systems to provide adequate health services in today's globalized labour markets", explains Susan Maybud.

"While remittances generated by migrants are welcome national income sources for poorer countries - US$1 in remittances generates US$2 in local economic activity - they do not compensate governments for their investment in the education and training of health care workers" she adds.


Regulating international recruitment
To deal with migration of health professionals, countries have set up national, regional and international commissions, proposed or implemented regulations, and even tried to enact bans limiting migration. Reports on unscrupulous private agencies raised calls for better regulation mechanisms. In many countries recruitment agencies have to register with government authorities. Legally registered agencies may accept admission fees from nurses and charge them for services, but the amounts involved are prescribed.

In India, only agencies with a license from the Ministry of Labour can execute overseas recruitment. Irish law requires that costs be borne by the employers and states clearly that deduction from wages by recruitment agencies was an illegal practice. The Companion Document of the Commonwealth Code of Practice recommends that governments enter "auditable" arrangements with recruitment agencies and set up monitoring mechanisms.

As an example of good practice, the study cites the Code of Practice for the International Recruitment of Healthcare Professionals for National Health Service (NHS) employers by the UK NHS. The Code recommends that employers only cooperate with agencies that apply the standards set out in the Code of Practice and states that developing countries should not be targeted for the recruitment of health care professionals. Currently, the Code applies to 178 agencies with an intention to extend coverage to 200 more from 2005 onwards.

Adopted in 1977, ILO Recommendation 157 tries to facilitate the harmonization of education, training and practice regulations, as well as the mutual recognition of qualifications and nursing personnel exchange programmes on the basis of bilateral and multilateral agreements for migrating nursing personnel.

"Governments are responsible for ensuring adequate workforce planning and development in the health sector; employers and recruiters are critical for implementing international recruitment according to quality standards; unions and professional associations have an important role in preventing migrant worker exploitation by disseminating information and giving support to victims of abuse", concludes Maybud.




Note 1 - "Care trade": The international brokering of health care professionals, by Susan Maybud and Christiane Wiskow, in: Merchants of Labour, edited by Christiane Kuptsch, International Institute for Labour Studies, ILO, Geneva, 2006.

Note 2 - Example taken from Anderson, B. and Rogaly B., "Forced Labour and Migration to the UK", Centre on Migration, Policy and Society, Oxford University and Trade Union Congress, 2005.


Rate this content
 
 
 
Average of 106 ratings 
Rating 2.37 / 4 MoyenMoyenMoyenMoyen
Same author:
 flechePoor working conditions are main global employment challenge
 flecheRecognizing the rights of domestic workers
 flecheNew ILO figures show 150 million migrants in the global workforce
 flecheThe future of work depends on the future of women at work
 flecheMore than half of the world’s older persons lack quality long-term care
 flecheG20 starts to tackle inequality
 flecheGrow the economy with a well-balanced diet
 flecheG20 caught in weak economic and jobs recovery spiral
 fleche2030 development agenda: Major breakthrough for world of work
 flecheCutting back workers' protection does not lead to stronger growth
 flecheNew ILO study points to the long-term impact of child labour
 flecheInformally employed Syrian refugees, working under harsh conditions, further strain Jordanian labour market
 flecheRana Plaza: Never again
 flecheTechnology lightens the load for factory inspector
 flecheWhere has inequality gone up and where has it gone down?
 flecheMembers of g7+ to discuss creating jobs for peace through Fragile-to-Fragile Cooperation
 flecheGlobal survey shows rising women’s participation in cooperatives
 flecheProgress on gender equality at work remains inadequate
 flechePrivate sector services and the care economy, key engines of job creation
 flecheUnemployment on the rise over next five years as inequality persists
 flecheGlobal momentum means more women move into management
 flecheLack of higher education leaves millions of young people out of decent work in developing countries
 flecheGlobal health protection crisis leaves almost 40% of the world’s population without any coverage
 flecheGreece needs to address risk of a prolonged social crisis
 flecheCooperatives’ considerable clout in the fight against child labour
 flecheGlobal Employment Trends 2014: Risk of a jobless recovery?
 flecheMore than 70 per cent of the world population lacks proper social protection
 flecheWorld Day Against Child Labour
 flecheSeasonal work brings year-round benefits
 flecheGlobal Employment Trends 2014: The risk of a jobless recovery
 flecheGlobal Employment Trends 2014: The risk of a jobless recovery
 flecheGlobal Employment Trends 2014: The risk of a jobless recovery
 flecheWorking poverty reduction stalled
 flecheThe pride of working women
 flecheHow can sports help to promote youth employment?
 flecheAn unprecedented gathering deep in the Amazon jungle
 flecheIs small still beautiful?
 flecheWork sharing can save jobs in times of crisis
 flecheA strategic alliance for youth employment
 flecheRise of middle-class jobs in the developing world could spur growth
 flecheLabour market gender gap: Two steps forward, one step back
 flecheMore than 70 per cent of workers lack unemployment protection
 flecheYouth unemployment getting even worse
 flecheWage cuts may hurt growth
 flecheILO: Greater gender equality in politics is good news for the world of work
 flecheTransition to green economy could yield up to 60 million jobs, ILO says
 flecheStepping up the fight against child labour
 flecheILO chief on world economy: Too much focus on finance, too little on society
 flecheYouth employment
 flecheILO study says workplace inequality in Europe has increased significantly since start of financial crisis
 flecheILO warns youth job crisis threatens social cohesion, calls for more and better jobs for youth
 flecheShort term indicators of the labour market
 flecheVoices on Social Justice
 flecheGlobal Employment Trends 2012: Preventing a deeper jobs crisis
 flecheShort-term employment and labour market outlook and key challenges in G20 countries
 flecheSocial protection floor key to addressing crises and social instability
 flecheWorld of Work Report 2011- ILO says world heading for a new and deeper jobs recession, warns of more social unrest
 flecheQuestions and Answers on global trends and challenges on occupational safety and health
 flecheXIX World Congress on Safety and Health at Work
(11-15 September 2011, Istanbul - Turkey)

 flecheQuestions and answers on the ILO response to challenges in the Arab World
 fleche100th ILO annual Conference decides to bring an estimated 53 to 100 million domestic workers worldwide under the realm of labour standards
 flecheMain findings of the ILO study 'The Global Crisis: Causes, responses and challenges'
 flecheGlobal economic crisis opens up new space for discrimination at work, ILO says
 flecheILO: learning lessons from success key to economic improvement for the Least Developed Countries
 flecheILO says fair and equitable policies are key to sustainable economic recovery
 flecheILO report warns weak jobs recovery to continue through 2011 - youth employment a world priority
 flecheSocial security plays critical role in times of crisis, but still eludes much of the world
 flecheOslo Conference calls for commitment to recovery focused on jobs
 flecheWorld economic crisis has spurred a record increase in youth unemployment says ILO
 flecheYouth employment in crisis: Questions and answers on the situation of youth on the labour market
 flecheThe State of Child Labour Today
 flecheILO says 21 million jobs in G20 saved by crisis response policies, but labour market slack remains high
 flecheUnemployment reached highest level on record in 2009: Somavia calls for the same policy decisiveness that saved banks to save and create jobs
 flecheILO warns “early exit” from stimulus measures could prolong jobs crisis
 flecheILO report says temporary workers among the worst hit by the economic crisis, urges balance between flexible labour markets and workers’ protection
 flecheDespite continued rise in unemployment, measures taken by G20 governments will save up to 11 million jobs in 2009, ILO says
 flecheFacing the global jobs crisis: Migrant workers, a population at risk
 flecheCommunity tourism: respecting nature, local culture and indigenous peoples’ rights while on vacation
 flecheILO welcomes new support for the Global Jobs Pact from the UN Economic and Social Council
 flecheILO adopts “Global Jobs Pact” aimed at creating jobs, protecting workers and stimulating economic recovery
 flecheILO says crisis increases risk of girls becoming child labourers
 flecheHeads of State, government and leaders from the world of work tackle the global jobs crisis
 flecheILO says job losses are increasing due to economic crisis
 flecheNew ILO report says “cost of coercion” to workers in forced labour surpasses USD 20 billion per year
 flecheILO marks its 90th anniversary with global dialogue for decent work and a fair globalization
 flecheThe ILO and the quest for social justice : 90 years of ILO history
 flecheILO calls for urgent global jobs pact to forestall "prolonged and severe" employment crisis
 flecheILO warns economic crisis could generate up to 22 million more unemployed women in 2009, jeopardize equality gains at work and at home
 flecheMicrofinance and the real economy: impacts and outcomes of the global economic crisis
 flecheILO meeting to discuss employment crunch in the financial sector
 flecheUnemployment, working poor and vulnerable employment to increase dramatically due to global economic crisis
 flecheWorld of Work Report 2008: Income inequalities in the age of financial globalization
 flecheWorld of Work Report 2008 - Global income inequality gap is vast and growing
 flecheLandmark new report says emerging green economy could create tens of millions of new “Green Jobs”
 flecheWomen migrant workers: seizing opportunities, upholding rights
 flecheILO Declaration on Social Justice for a Fair Globalization
 flecheInternational Day of Cooperatives - Cooperating in times of crisis
 flecheHigh-level meeting in Turin from 1 to 3 July on “The European social model in the context of globalization”
 flecheWorld Day Against Child Labour 2008 ─ ILO says education is the “right response” to child labour
 flecheILO sees a significant improvement in Workplace attitudes to HIV/AIDS
 flecheILO Director-General calls for new multilateral consensus to head off global slowdown and recession
 flecheGlobal Employment Trends for Women 2008
 flecheGlobal Employment Trends for Women 2008: more women enter the workforce, but more than half of all working women are in vulnerable jobs
 flecheThe challenge to make chocolate child labour free
 flecheILO projects global economic turbulence could generate five million more unemployed in 2008
 flecheILO calls for new efforts to support people with disabilities in the world of work
 flecheTrade unions and globalisation: trends, challenges and responses
 flecheGreen jobs and global warming: ILO to discuss new initiatives for tackling climate change in the world of work
 flecheKey Indicators of the Labour Market - Executive summary
 flecheNew ILO report says US leads the world in labour productivity, some regions are catching up, most lag behind
 flecheILO says Asia and the Pacific labour forces expected to grow by over 200 million by 2015
 flecheThe Decent Work Agenda in Africa: 2007–2015
 flecheWhen global leaders discuss business and labour principles - Global Compact Leaders Summit 2007
 flecheNew ILO Global Report on Equality at Work 2007
 flecheEmployment and working conditions in Europe: How much can one work?
 flecheILO study warns on the feminization of working poverty
 flecheILO and WTO issue new joint study on "Trade and employment: Challenges and policy research"
 flecheILO, UNDP join forces to promote growth for decent jobs
 flecheGlobal Employment Trends 2007
 flecheReversing the brain drain in China: the return of the 'sea turtles'
 flecheNew ILO study says youth unemployment rising, with hundreds of millions more working but living in poverty
 flecheILO Director-General lauds formation of new global union federation representing 166 million workers
 flecheThe global jobs crisis:
Address the growing imbalance between growth and jobs creation

 flecheRealizing decent work in Asia
 flecheAsia and Pacific region faces massive jobs gap
 flecheILO to hold Asia and Pacific Regional Meeting in Busan, Republic of Korea
 flecheRussia needs migrant workers to support economic growth
 flecheSaving lives, protecting jobs: Strategic HIV/AIDS responses by enterprises (SHARE)
 flecheRecognizing the rights of the guardians of the forest: "pygmies" in Cameroon
 flecheGATS, Migration, and Labor Standards
 flecheILO hails new UN Declaration on strengthening global efforts to promote Decent Work for poverty reduction and sustainable development
 flecheGiving a fair deal to the world's 86 million migrant workers
 flecheNew ILO Report shows marked decline in child labour worldwide
 flecheILO annual jobs report says global unemployment continues to grow, youth now make up half those out of work
 flecheIs the rising international integration of products and services good for labour markets in the developed world?
 flecheILO adopts sweeping new charter for maritime sector
 flecheLabour migration in the twenty-first century: E Pluribus, Unum?

 flecheILO annual jobs report says global unemployment continues to grow, youth now make up half those out of work
 flecheGlobalization failing to create new, quality jobs or reduce poverty
 flecheTripartite Meeting on Promoting Fair Globalization in Textiles and Clothing in a Post-MFA Environment
 flecheVocational Education and Training
 flecheInternational Conference: Fair Globalization - Safe Workplace - Policies, Strategies and Practices for Sustainable Development
 flecheMicrofinance is our business – Cooperating out of Poverty
 flechePresident Abdelaziz Bouteflika calls for a social dimension of globalization
 fleche93rd annual Conference of the ILO - Delegates pave the way for urgent action on key labour concerns

 flecheILO urges ban on child labour in small-scale mines and quarries
 flecheSituation of workers in occupied Arab territories continues to deteriorate
 flecheGlobal Report 2005: A global alliance against forced labour
 flecheILO Regional Meeting expands social agenda for Europe and Central Asia
 flecheThe report: "A fair globalization - Creating opportunities for all"
 flecheNew ILO report sees weak global job growth in 2004 - Says European job growth remains static
 flecheNew UN decision makes fair globalization a core issue of the world agenda in 2005
 flecheKöhler, Horst
 flecheSomavia, Juan
 flecheUN General Assembly adopts resolution on world commission report on fair globalization
 flecheHalf the world's workers living below US$2 a day poverty line
 flecheMicrofinance paves the way to decent work
 flecheNew ILO book explores "Decent Working Time Deficit" in the industrialized countries
 flecheNew ILO report examines future of work and quality in the media, culture and graphical sector
 flecheNew ILO programme to tackle discrimination, integration of migrant workers in Europe
 flechePreparatory Technical Maritime Conference concludes successfully. Delegates forge new Convention for the maritime industry
 flecheLeaders from North and South join forces for a fair globalization
 flecheILO Director-General Addresses Extraordinary Summit of African Union says, " good national governance will not succeed unless we have good global governance"
 flecheEconomic security strengthens tolerance and happiness as well as growth and development
 flecheYouth unemployment at all time high, new ILO report says half the world's jobless are under 24
 flecheILO issues first global analysis of HIV/AIDS impact on the world of work estimates 36.5 million working age persons now have HIV, 28 million lost to world labour force by 2005
 fleche92nd annual Conference of the ILO concludes its work
 flecheWorld Commission says globalization can and must change, calls for urgent rethink of global governance
 flecheWorld Commission says globalization can and must change, calls for urgent rethink of global governance
 flecheGlobal unemployment remains at record levels in 2003 but annual ILO jobs report sees signs of recovery
 flecheEn Indonésie, la mondialisation remet en question l'ébénisterie traditionnelle
 flecheDelegates to examine how to fight poverty, create jobs
 flecheWorking out of poverty
 flecheQuatrième réunion de la Commission mondiale sur la dimension sociale de la mondialisation
13
SEARCH
Keywords   go
in 
Translate this page Traduire par Google Translate
Share

Share on Facebook
FACEBOOK
Partager sur Twitter
TWITTER
Share on Google+Google + Share on LinkedInLinkedIn
Partager sur MessengerMessenger Partager sur BloggerBlogger