University of Alberta:

Linda Ogilvie, RN, PhDJudy Mill, RN, PhDBarbara Astle, RN, PhD CandidateAnne Fanning, MD, FRCPS

University of Ghana:

Mary Opare, RN, MN

Credentialing of Internationally Educated Health Professionalsand the Nursing Exodus from

sub-Saharan Africa

Credentialing of Internationally Educated Health Professionalsand the Nursing Exodus from

sub-Saharan Africa

Africa is estimated to have 1.3% of the global health workforce and 25% of the disease burden (WHO, 2004)

Competing RightsCompeting Rights

Right to:• health

• leave one’s country to seek a better life

• work and to just and favourable conditions of work

• an adequate standard of living

• education

• nondiscrimination and equality

Canada GhanaSouth Africa

Malawi Zimbabwe

Life Expectancy

(years)

78(M)

82(F)

57(M)

60(F)

48(M)

50(F)

41(M)

42(F)

37(M)

36(F)

<5MR (probability of dying before fifth birthday per 1000)

6(M)

5(F)

99(M)

92(F)

70(M)

61(F)

182(M)

175(F)

133(M)

119(F)

MMR (probability of maternal death per 100,000 live births)

5 540 230 1800 1100

Note: MMR from 2000; other statistics from 2003

Table 1: Comparison of Life Expectancy, Under Five Mortality (<5MR), and Maternal Mortality Ratio (MMR) for Canada, Ghana, Malawi, South Africa, and Zimbabwe (WHO, 2005)

Country Malawi Zimbabwe GhanaSouth Africa

Physicians 1:30,000 1:5000 1:10,000 1:5000

Nursesnot

reported1:1000 1:2000 1:1000

Midwivesnot

reported1:2000 1:2000

not reported

Table 2: Physician, Nurse and Midwife Availability in Malawi, Zimbabwe, Ghana, and South Africa per Population around 1998 (WHO, 2002)

Brain Drain?

Brain Gain?

Brain Circulation?

Migration of Health Professionals from sub-Saharan Africa

Migration of Health Professionals from sub-Saharan Africa

Pattern

Poor data

Extent (physicians)

Extent (nurses)

Table 3: UK Licensure of Nurses from South Africa, Zimbabwe, Ghana, and Malawi from 1998-99 to 2002-03

Country 1998-99 1999-00 2000-01 2001-02 2002-03

South Africa

599 1,460 1,086 2,114 1,480

Zimbabwe 52 221 382 473 493

Ghana 40 74 140 195 255

Malawi 1 15 45 75 57

Adapted from Bach (2003) from UK Nursing and Midwifery Council data

Push-Pull Factors in International Health Professional Migration

Push-Pull Factors in International Health Professional Migration

Common in general migration literature

HIV/AIDS

Worldwide shortage, particularly of nurses

Policy Response to International Health Professional Migration

Policy Response to International Health Professional Migration

Attention to stick and stay factors within countries

High-income countries meet own needs through education and retention

Ethical recruitment practices

Financial restitution

Skill recirculation

Skill Recirculation or Brain Circulation?

Skill Recirculation or Brain Circulation?

Initiatives from the diaspora

International partnerships

Reorientation of international aid priorities

Integration of health systems

Coming Full CircleComing Full Circle

Barriers to credentialing of internationally educated health professionals are not useful as a strategy to reduce health inequities worldwide and need to be addressed only within the context of protection of the public within the receiving country