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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: [email protected] E-mail [email protected], [email protected]
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services research (analysis/summarries), common wealth secretariat, neon classified wikipedia – free encyclopedia, unpublished materials- roles in training, mentorship and administration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
