st VENUE: ENASHIPAI RESORT and SPA - NAIVASHA TOPIC:...

KENYA ASSOCIATION OF PHYSICIANS 16TH ANNUAL SCIENTIFIC CONFERENCE

21st - 24th March,2012 VENUE: ENASHIPAI RESORT and SPA - NAIVASHA

TOPIC: LOCAL AND INTERNATIONAL MIGRATION OF HEALTH CARE PERSONNEL WITH EMPHASIS ON NURSING SHORTAGE FROM SUB SAHARAN AFRICA

AUTHORS Sr. Rebecca Waasula DR. GORDON PETER YOSSA MBCHB. DPH – Makerere

Critical Care link nurse Aga Khan Hospital – Msa(GMC)

Coast Cardiac Nurse Bomu and Pandya M Hospitals

P.O.BOX 83911 – 80100 P.O.BOX 83911 – 80100

Email: waasul@yahoo.com E-mail gp.yossa@yahoo.com, kmamsa@wananchi.com

0722 988809 0721 207 856

BACKGROUND •Sub-Saharan Africa has 25% of the worlds disease burden but only 1.3%of the trained health workforce (WHO 2004) with certainty, the health related MDGs will not be met and the workforce shortages will be a factor in missing these targets. •The migration of nurses and other health professionals to developed countries is considered a major contribution to health crises now and to be in SSA •Nurses constitute 45-60% of entire workforce spending the largest time with patients and now running managerial positions. Hence emphasis on nursing shortage will unveil all factors affecting health workforce

OBJECTIVE

• Highlight the critical role of the nurse and other healthcare personnel in achieving the health related MDGs.

• Mitigation of the negative socio economic, ethical factors of migration on the person source and the recipient country

Methodology

• Literature searches – existing publications and country documents on health workforce for health report, WHO – (AFRO) synthesis on migration, international council of nurses series on global nursing section – health services research (analysis/summarries), common wealth secretariat, neon classified wikipedia – free encyclopedia, unpublished materials- roles in training, mentorship and administration

Findings • Push and pull factors

• Push – from source country and facilitate a potential migrants decision to care

• Pull – factors in recipient country that creates the demand or encourages the potential migrant to leave home

• Factors include – Income renumeration

– Job satisfaction

– Perception of work environment

– Clinical freedom- ability to utilize ones professional skills

– Career opportunities

– Trust in management of health service – political/administrative governance

– Occupational risk (HIV/AIDS)

– Welfare/retirement benefits

Mitigation factors- “stick factors”

• Family ties

• Psycho social links

• Potential coast to be incurred

NURSE MIGRATION(SUB SAHARAN AFRICA)

• SSA with very low concentration of nurses 0.3 – 4 nurses /1000 population are supplying nurses to countries in other region with better ratios 7 – 15 nurses /1000 popn

• Anglophone African countries observe more departures vs eg. Portuguese/speaking or Non English countries. In UK. 2001 – 2008. 34% of all nurses foreign – 21.2% from SSA

TROUBLING DATA

• 1999 – 2001 - 114 Nurses – 60% workforce left a single hospital in Malawi

• 2000 – 500 nurses left Ghana(double number of graduates in the country)

• Wage differences a “Push Factor” – most important factor in health worker migration eg. Purchase Party Pay for nurses in Australia/Canada x 14 – for Ghana, x25 for Zambia, x2 for South Africa

LOW LEVEL SUPPLY OF NURSES

• Likely to persist as “economic – fiscal restrictions imposed "and effects of HIV/AIDS

• Further deficit internationally from Public section with Private/NGO – better funded programmes eg. TB(WHO 2004)

• Africa operating at an average of one trained health worker per 1,000 population compared with world average 4 per 1000, estimated minimum required to sustain coverage of basic health services 2.5/1000 (JLI 2004 report

• Minor losses magnifies existing shortages

IMPACT OF MIGRATION

• Paucity of data and hence difficult

• Poor delivery of critical services with shortages (Buchan &Cholski 2004) eg. Recruitment of 2 specialised anaesthetist led to a closure of spinal injury centre in South Africa serving several countries(Martinew and Deeke 2002)

• Ghana – new Nursing Schools opened

ECONOMIC EFFECTS ON SOME COUNTRIES

• Lost investments

• Loss to gross domestic product – from departed high professional

HIV/AIDS PANDEMIC and NURSE MIGRATION

• HIV impact has been linked to STRESS, BURNOUT, ABSENTISM, decline in Quality (Kinoti -2003, JLI Africa Group 2004, Shisana etc 2004)

• South Africa – 16.2% - stress related illnesses

2/3 took sick leave( Shisana 2001)

• Over 50% staff – worried about contracting HIV – work related

DISCUSSION

NURSING SHORTAGE • Demand for nursing professionals exceeds supply either

locally within a given health care facility, nationally or globally

• Potential factors – lack of adequate staffing ratios in hospitals and other

health care facilities, lack of placement programmes for newly trained nurses, inadequate work retention incentives

ETHICAL CONCERNS

• Scholars and media often keep silence

• Fraudulently obtained visas used to employ registered nurses as nurse aids

• Remuneration – staff disposition profile is exploitative

•

GLOBAL SHORTAGE AND INTERNATIONAL RECRUITMENT

NURSING SHORTAGE

• Operates at global scale affecting major development nations – UK, USA, Netherland, Saudi Arabia ,Canada

- 2002- Netherland had to fill 7,000 nursing positions

- England – 22,000 positions

- Canada – 200 and 10,000 graduates by 2011

SHORTAGE BY COUNTRY

USA

- Population projected to grow at least 18% over 2 decades into 21st Century

- Population of 65years and older expected to increase(x 3)

- Current shortfall of nurses projected at one million by year 2020

- Demand for HEALTHCARE PROFESSIONALS will continue to increase

- 1994- Rate of employment for nurses slowed down

SHORTAGE BY COUNTRY cont----

As hospitals incorporated less skilled nurse substitute

• 2009 – Economic Crisis reduced demand for nurses

• Patching up Shortage - However emergency Acute Care Nurses remain in

high demand

- Retention and recruitment are important method s to achieve solutions to shortage

- Obama Health Care reform – to have every American insured poses even greater need for nurses

- To translate into more jobs, number of positions in US hospital need to be correspondingly increased. Underserved areas benefit most easily from recruitment,

However H-IC visa – stopped by US Homeland Security . This was specifically meant for international recruitment for nurses. Alternative now – priority to US residents through “”Workforce development programme

?Use of foreign nurses prolongs issues Nursing shortage. US licensed Nurses in thousands remain unemployed,

SHORTAGE BY COUNTRY

PHILLIPINES – largest exporter of nurses -25% of all overseas Nurses 85% Filipino nurses working overseas

Government supports exportation

US Nurse salary $ 4,000p.m while in Philippines $ 200 They support entire families at home.

Migrant nurses are normally the best and leave huge gaps in professional care at home. Rural communities suffer the brunt with increasing mortality/morbidity despite advances in technology and medicine

DOCTORS TURNED NURSES – MD - RNS

- Drs usually passively recruited – look for jobs themselves. Nurses are actively recruited by agents – at times for a fee ( Dorho 2006. Mersal., Macknitosh, Henry 2005)

- Staff retrenchment in public sector a factor in reports of unemployed health workers Kenya/Uganda

- Salary differentials a Push less of a factor in Uganda as compared to Ghana – as a motivation to migrate (Emerging from war situation) – Amasese et al 2004

- GTZ studies – financial and nonfinancial incentives were effective in addresing motivation

MARKET PHILOSOPHY IN THE HEALTH CARE SYSTEM

LIMITATIONS TO COMPREHENSIVE CARE

-Nurses overloaded with number of assigned patients

- Massive paper work for billing purpose

- Short staffing to cut cost

- No consultation for health care reform

- Nursing failure to attract young generation with even over half of working nurses not recommending nursing to their children as a career.

- As a business - matters of patients care of secondary importance (John Buchanon et al Australian Nursing Research

WHO – 2010 – WORLD HEALTH ASSEMBLY

Adopted the Globe Code of Practice on International Recruitment of Health Personel

A policy framework for all countries

PHILLIPINE HEALTH CARE WORKERS – on the fore front

• Doctors training as nurses to migrate

• Since 2000 – 3500 Filipino Doctors taking up MD – RN abroad

• 80% of all Government Doctors become nurses , 5000 of 9000 MD – RN overseas

• Preventable deaths have increased with hospitals closing down, greatest brunt in the rural region

• No permanency in Nursing hierachy

CONCLUSION/RECOMMEDATIONS

• Health workforce Crisis in Africa has elicited a high level International attention with a number of policy decla ration in place( Commonwealth, ICN, UK NHS WHO) Reparation/ Compensation for source countries

• Urgent increase in workforce - Community profile

eg. – Health Extension Workers – Ethiopia

- Community Health Officers/Nurse – Ghana

• Address- Recruitment with Retention and Retraining - Incentives in Ghana (WHO 2004_

CONCLUSION/RECOMMENDATIONS cont-------

• Health Workforce Information System – to monitor policy and strategic plan ( Kenya Nursing Workforce Project 2004)

• Regional/International Corporation, Public – Private Partnership

References

- NNAK Annual Scientific Conference & 54th AGM (5-7) Oct,2011

- HEALTH SERVICES RESEARCH

Economic Impact in Nursing Trends

Migration of Nurses from Sub Saharan Africa

A review of issues and challenges( Dr Delanyo

Dorho - Switzerland

- Nursing Shortage – Wikipedia - the free Encyclopedia

ACKNOWLEDGEMENT

• NATIONAL NURSES ASSOCIATION OF KENYA

• THE AGA KHAN HOSPITAL, MOMBASA

THANK YOU