114/09/2007 Third Global Forum on International QA, Accreditation and the Recognition of Qualifications in Higher Education, UNESCO; Dar es Salaam

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Migration intentions of pharmacy students A global study of root drivers

Tana WulijiProject Coordinator, FIP; Chair Moving On III Project IPSF

Ian Bates, David Taylor, Sarah CarterSchool of Pharmacy, University of London

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Migration is a symptom

Migration is a form of attrition

Migration is not a new phenomena

Migration is not generic

Migration is complex

Migration is not ‘brain drain’

Points to need for workforce, social, policy, education development

Migration is not only about money

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Overview

• Migration• Migration is a symptom, not the cause• Workforce trends• Migration intention study• Questions for higher education providers

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Migration is a symptom, NOT the cause

“Results suggest that Africa's generally low staffing levels and poor public health conditions are the result of factors entirely unrelated to international movements of health professionals.”M Clemens, Centre for Global Development, Do Visas Kill? 2007.

Workforce distribution, skill mix, performance incentives

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Migration is a symptom, NOT the cause

“International migration is neither the main cause nor would its reduction be the solution to the worldwide health human resources crisis.”J Dumont, P Zurn. OECD. Immigrant health workers in OECD countries in the broader context of highly skilled migration. 2007.

Training capacity, employment opportunities, workforce distribution,

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Migration is a symptom, NOT the cause

“Attitudes towards professional practice, social and political environment at home coupled with perception of opportunities for economic and professional development abroad drive migration intentions”IPSF, FIP, School of Pharmacy University of London, 2007

Quality of education, working environment, learning and professional opportunities, social

development

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Migration: Flag pole or flag?

Migration

Workforce and education

Workforce and education

Entry

Retention

Attrition

Planning

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Health workforce crisis

• Critical shortage < 2.5 health workers per 1000 population (doctors, midwives, nurses)– WHO Global Atlas: www.who.int/globalatlas

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Pharmacy Workforce Trends

• Shortages• Workforce distribution

imbalance – rural/urban, public/private

• Practice role development• Increasing migration

(within and between countries)

• Poor utilisation

2006 FIP Global Pharmacy Workforce and Migration Report www.fip.org/hr

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Drivers of migration

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Foreign born health workforce in OECD

J Dumont, P Zurn. OECD. Immigrant health workers in OECD countries in the broader context of highly skilled migration. 2007.

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Pharmacist migration trends

• Foreign pharmacist registrations per year in Canada 1995 -2005

– FIP Global Pharmacy Workforce and Migration Report 2006

0

50

100

150

200

250

300

350

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Num

ber o

f for

eign

pha

rmac

ists

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Pharmacist migration trends

• Number of foreign pharmacists registering in Australia

– FIP Global Pharmacy Workforce and Migration Report 2006

020406080100120140160

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

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Pharmacist migration trends

• Number of pharmacists intending to leave Ghana– Letters of good standing requested per year– FIP Global Pharmacy Workforce and Migration Report 2006

0

20

40

60

80

100

1995 1996 1997 1998 1999 2000 2001 2002 2003

Num

ber o

f pha

rmac

ists

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Migration theories

Sociological

Unifying

GeographicalEconomic

Push-pull factors

Migrant networks

Labour and income differentials and demand

Micro- and macro- levels

Spatial interactions Mobility

transition

Migration systems

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Push-pull theories

Sending country Receiving country

Push:Workforce surplus

Lack of CPD/training opportunities and career opportunities

Poor remuneration and work conditions

Political/social instability

Pull:Workforce shortage

Opportunities for CPD/training and career development

Greater financial rewards and improved working and living conditions

Stick factors Stay factors

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Pharmacy students and their intention to migrate – pilot study

• Collaborative research– FIP, International Pharmaceutical Students’ Federation (IPSF) and School of

Pharmacy, University of London– Research Group (Moving on III)– Input from WHO, OECD, IOM

• Nine countries: Australia, Bangladesh, Croatia, Egypt, Nepal, Portugal, Singapore, Slovenia, Zimbabwe

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Methods

Focus group workshopAugust 2005

Questionnaire development and reviewJanuary – April 2006

Questionnaire distributed via MO III GroupApril 2006

Data collectionApril – May 2006

AnalysisJuly 2006 – March 2007

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Results

• 791 final year pharmacy student respondents• 9 countries:

– Australia (336), Croatia (96), Singapore (60), Portugal (55), Zimbabwe (37), Bangladesh (58), Nepal (31), Egypt (103), Slovenia (25)

• Mean age: 22 years• 61% respondents female• Top destination countries: UK, USA, Australia

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Intention to migrate

• 52% respondents plan to migrate– 2/3 plan long-term migration (> 2 years)

• 80% of international students plan to migrate– 80% plan long-term migration– Implications for cross-border education?

• Students with past experience abroad are more likely to migrate (79% vs 49%, p<0.001).

• Variation in % planning to migrate between and within countries – 13% (Croatia) – 90% (Bangladesh)– Influence of education on attitudes & intention?

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Drivers of Migration

• Factor 1: professional practice environment and status in own country– 10 items, α= 0.8

• Factor 2: opportunity to develop career and resources abroad– 4 items, α= 0.7

• Factor 3: social and political environment in own country – 5 items, α= 0.7

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Factors in migration decisions

-0.4

-0.3

-0.2

-0.1

0

0.1

0.2

0.3

Mea

n z-

scor

e

yes no

Differences in scores between students who plan and do not plan to migrate

Factor 1Factor 2Factor 3

Negative perceptions of own country

Positive perceptions of other countries

p<0.001

N = 791

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Factors in migration decisions

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

Mea

n z-

scor

es

Temporary Long-term

Temporary vs long-term migration

Factor 1

Factor 2

Factor 3

Negative perceptions of own country

Positive perceptions of other countries

p<0.001

N = 791

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Country differences

NoYes

Plan to go abroad within 5 years

1.5

1.0

0.5

0.0

-0.5

-1.0

-1.5

-2.0

NoYes NoYes NoYes NoYes NoYes NoYes NoYes NoYes

AustraliaEgyptBangladeshZimbabweSloveniaSingaporeNepalPortugalCroatia

Factor 3

Factor 2

Factor 1

p<0.001

Mea

n Zs

core

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Factors and the intention to migrate

Intention to migrate long-term

ConnectionsProfessional environmentOpportunities abroadSocial and political environmentGenderResidence statusMigration intentionPast international experience

Multiple Correspondence Analysis

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Opportunities for workforce development?Career development pathways

Improve interprofessional relationships

Practice environment

Social development Recognition of

pharmacist roles

Supportive policy

Levels of practice

Utilisation of pharmacist skills

Fair recruitment and employment terms

Pharmacy education

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Questions for higher education

What is the influence of the quality of education on attitudes that drive the intention to migrate?

What is the responsibility of higher education providers to produce and support a workforce catered for local needs?

What is the role of life long learning and local post-graduate learning opportunities?

Migration = attrition

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Stepping up global and national action

• Drivers of migration study (20+ countries)• 2007 pharmacy workforce study (2008 report)• FIP-WHO Pharmacy Education Taskforce

– Global Pharmacy Education Consultation (2007)– Competency, academic workforce, quality

• FIP Global Conference on the Future of Hospital Pharmacy – workshop on HRH

• Global Health Workforce Alliance – scaling up education and training, migration

• Country case study and pharmacy human resource policy development – Zambia

• And more…….

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More information• FIP Human Resources for Health: www.fip.org/hr• WHO World Health Report 2006: www.who.int/whr/2006/en• Global Atlas of the Health Workforce: www.who.int/globalatlas• Human Resources for Health Journal: www.human-resources-

health.com• International Organization for Migration: www.iom.int• HRH Global Resource Center: http://www.hrhresourcecenter.org

Acknowledgements:

• IPSF Moving On III Research Group and Executive• Mr Ton Hoek, CEO and General Secretary, FIP• Mr Xuan Hao Chan, Project Coordinator, FIP• Prof Hugo Mercer, HRH Department, WHO

www.fip.org/hr

tana@fip.org