Managed migration of nurses to Europe in experiment in 4 African countries

From African Press Agency
2007-08-18
European countries set up nurse migration programme for COMESA

Port Louis (Mauritius) Mauritius is amongst four African countries chosen for a 'Temporary Nurse Migration Programme' (TNMP) which entails sending each year a group of forty qualified male and female nurses to work in four European countries for a determined set of time, a release of the Health ministry said Saturday in Port Louis.

The Commonwealth Secretariat and the Common Market for Eastern and Southern Africa (COMESA) jointly organised the programme within the framework of the General agreement on Trade in Services (GATS).

The four recruiting European countries, namely Britain, Ireland, Finland and the Netherlands, set up the 'Temporary Nurse Migration Programme .

The release writes that Mauritius, Uganda, Kenya and Malawi are the four COMESA countries chosen.

The TNMP will also give an opportunity to such nurses to get acquainted with new developments in the nursing sector in Europe, the release said.

The European countries have also proposed a financial and technical help to each of the COMESA countries to develop a strategy for the training of nurses.

The Health ministry is now in consultation with the Nursing Association to study the viability of the project.

SR/ad/APA

Nurse Shortage Issue enters American Presidential Election Campaign

The Medical News Today reported that on August 24 John Edwards, a Democrat Senator, talked during his campaign trail in New Hampshire about his commitment to add 100,000 nurses in the US health workforce within five years.

Read from his campaign website.

Below is the excerpt.

According to John Edwards:
-- Nursing shortage growing: One estimate says New Hampshire needs 672 new nurses annually until 2014 just to fill vacant positions. However, the state is only producing half that number of nursing graduates each year. By 2020 the USA will have 1 million fewer registered nurses than it needs. New Hampshire will have 27% fewer nurses than it needs. (NHDES, 2007; HRSA, 2006; CHWS, 2006; NHNA, 2006)

-- Nursing shortage undermines patient health: A patient who goes in to hospital for routine procedures is at a 31% higher risk of death if his/her hospital has a severe nursing shortage. Up to 25% of unexpected hospital deaths may be due to nursing shortages. Taking on more nurses could save 6,700 lives in hospitals and 4 million days of hospital care. Addressing nursing shortages properly would significantly reduce adverse outcomes, such as hospital-acquired pneumonia and cardiac arrest. (Aiken et al., 2002; JCAHO, 2002; Needleman et al., 2006)

-- Overworking nurses is dangerous: Several hospitals are having to make their nurses work longer and longer shifts in order to address their nursing shortage. They are also making nurses responsible for an ever-growing number of patients. Many nurses have to work shifts of 12 hours or more. (IWPR, 2006)

-- RNs leaving nursing: Almost 450,000 nurses have left the profession. They are put off by the longer hours, unsafe workplaces, low compensation and lack of respect. (HRSA, 2006; CHWS, 2006)

Retaining Nurses by Respecting the Profession

Edwards will keep skilled nurses from leaving the profession and bring back former nurses. Bringing back just 10 percent of the nurses who have left the profession will increase the number of veteran nurses serving America's patients by about 50,000. Edwards will:

• Ensure Safe Staffing Levels: High patient-to-nurse ratios have been linked to increased medical errors, worse patient outcomes and high staff turnover. Edwards believes that we need requirements that ensure safe staffing levels, determined on a unit-by-unit level, with appropriate exceptions for emergencies. He will support hospitals in finding the nurses that they need to provide high quality care. [Aiken, 2002]
• Eliminate Mandatory Overtime: When hospitals force nurses to work more than 12 hours at a time, it becomes difficult for nurses to provide top-quality care and they are more likely to quit their jobs. States like New Hampshire have begun to lead the way in restricting mandatory overtime, but we need a national solution. As president, Edwards will ban mandatory overtime for nurses, with limited, temporary exemptions for truly understaffed areas.
• Improve Workplace Safety: The simple act of doing your job should not cause you harm. Edwards strongly opposed the Bush Administration's abandonment of real ergonomics standards. As president, he will implement a broad, mandatory ergonomics rule, and appoint officials who are committed to enforcing it. He will also help improve nurses' working conditions by offering resources to hospitals that commit to major improvements in nurses' working conditions - such as offering more time off, implementing new safety standards, and giving nurses a greater voice in hospital administration. He will also instruct the Department of Health and Human Services to lead a nationwide initiative on workplace safety and establish a presidential commission to recommend improvements in the nursing workplace, including protections from pandemic flu and safe patient handling.
• Strengthen Nurses' Voices: Giving nurses a stronger voice will help keep nurses on the job. Edwards will strengthen labor laws to make it easier for nurses to organize and collectively bargain and reverse the court decision that deprived nearly 1 million of nurses and millions of other workers of the opportunity to join a union. He will also offer federal challenge grants to support responsible "magnet hospitals" that offer more training and mentoring, decent pay and benefits and give nurses a voice in hospital administration.

Increasing the Number of Young People Choosing Nursing as a Career

Educating and training the next generation of health care workers is essential to meet the increased demand of a universal health care system. To add 50,000 new nurses to the profession within five years, Edwards will:

• Add New Nurses to Critical Shortage Areas: Edwards will pay up to full tuition and fees for 50,000 new students to become nurses. In return, these nurses would agree to serve for at least four years where nurses are in critical short supply, such as rural hospitals and urban public hospitals.
• Expand Educational Capacity: In addition, to ensure that schools have the resources to provide the new students with high-quality training, Edwards will invest to increase the capacity of the nation's nursing schools – including training and recruiting nursing faculty -- by 30 percent to meet the challenge of nursing shortage. He will also support distance learning initiatives– like the current partnership between UNH and Granite State College – that can help bring advanced training to rural areas. [Manchester Union-Leader, 8/6/2006]
• Create Partnerships with Hospitals: Classroom training is vital, but there is no substitute for experience. Edwards will support training partnerships of nursing schools and hospitals, like medical schools already have.
• Reach Out to High School Students: To reach a new generation of nurses, Edwards will help high schools implement career education programs in nursing that combine applied skills with rigorous academics.
• Promote Career Ladder Programs: There are hundreds of thousands of low-wage health care workers in hospitals and home care agencies across the country with the dedication and familiarity with the field to become professional nurses – but they don't have the time or money to go to nursing school. Edwards will support Career Ladder partnerships, where employers and unions help low-wage health care workers and displaced workers from other sectors move up the skills ladder with on-the-job training, time off for training and guaranteed placement. He will build on model programs like the successful workforce development labor-government partnership in Los Angeles County. [Fitzgerald, 2006]

At the UN, Gordon Brown promised more effort on health workforce

In his speech to the UN, Gordon Brown the new UK Prime Minister addressed the issue of health crisis and the shortages of health workforce. The corresponding news article by Emma Heard from Sky News, "one doctor for every 50,000 people", quotes Brown as saying: a radical overhaul of health care in Africa's poorest nations is part of the "emergency action" needed to "eradicate the great evils of our time".

Below is an excerpt of his speech:

"Weak health systems and insufficient doctors and nurses are also among the main obstacles to access to basic healthcare.

Take Malawi with 12 million people - and just 250 doctors -- one doctor for 50,000 people. And just 3800 nurses. For 20 million people in Mozambique, just 500 doctors and 4000 nurses. For 38 million people in Tanzania. Just 800 doctors and 3600 nurses.

So we should set a new objective - to match advances in drugs and treatments by advances in the capacity of healthcare systems to deliver.

Later this year we will launch a new initiative to better align finance from donors and from within countries themselves with comprehensive national health plans and provide more long term predictable financial support.

And in the next year I want the Global Alliance for Vaccines and Immunisation to have more power to use international finance to build health care systems for the future."

click for full speech

US medical workforce expansion plan criticized in the BMJ

David Goodman of Darthmouth Medical School in New Hampshire, USA wrote an editorial piece criticizing the current plan in the US to expand medical training. He argues that "expanding the medical workforce is unlikely to be cost effective or produce better outcomes for patients". He cites Jonathan Weiner of Johns Hopkins University that the cross country analysis that the current level may not be too few. According to Weiner, there are other ways to spend money more efficiently to improve health situation in the US. The use of other heatlh care cadres and the way health system is managed could play important roles.

click for: Goodman's article, Weiner's article

Summary points from Weiner's analysis based on OECD data

• Above a certain threshold, there is little evidence that more doctors add to health of population
  
• Many countries, US regions, and health maintenance organisations provide superior care with fewer doctors per person than the current US national ratio
  
• Forecasts of a future US doctor shortage do not adequately consider the availability of other clinical providers
  
• Information technology and preventive healthcare may increase productivity and decrease patient demand
  
• The billions to be spent on expanding US medical training would be better spent on meeting the needs of citizens without access to basic care

Shortages in the US

The Associate Press reports on the situation of physician shortages in many rural areas in the US . Several factors were raised including working conditions and post 9-11 visa situation. No discussion on the implications on brain drain from other countries though.

Excerpt:

"The government estimates that more than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, according to the American Medical Association. And the gap is expected to widen dramatically over the next several years, reaching 24,000 in 2020 by one government estimate. A 2005 study in the journal Health Affairs said it could hit an astonishing 200,000 by then, based on a rising population and an aging work force."

"J-1 visa waivers allow foreign doctors to work in underserved areas for three to five years, with a shot at eventually obtaining permanent residency. Over each of the past three years, about 1,000 practicing physicians have come to the U.S. on J-1 visa waivers. Many of them are from unstable or undeveloped countries and come here in search of better training, working conditions and pay. Yet, since 9-11, the federal government has made it more difficult to qualify for the special visas and to obtain permanent residency."

Another news piece on physician migration and shortages

Another piece on physician shortage from the Associated Press.

Excerpt from http://www.iht.com/articles/ap/2007/07/20/america/NA-GEN-US-Doctor-Drain.php

"Dr. Fitzhugh Mullan of George Washington University believes the U.S. — which is facing a shortage of doctors — must stop looking elsewhere to fix its problems. He compares the practice to "poaching" and said it amounts to poor citizenship in the world community.

Every doctor drawn to the U.S, Britain, Australia and Canada from poorer nations leaves a hole that likely will not be filled, he said.

Mullan's research shows that areas such as sub-Saharan Africa (13.9 percent), the Indian subcontinent (10.7 percent) and the Caribbean (8.4 percent) lose large numbers of doctors to the big four nations. But there is little reciprocation. The U.S. exports less than one-tenth of 1 percent of its doctors abroad, for example.

"That creates enormous problems for the (source) country and for the educational and health leaders in the country who are attempting to provide healers," he said."

The loss of doctors in Africa, where millions have been infected with HIV and AIDS, is especially acute.

Dr. Kgosi Letlape, president of the South African Medical Association, said doctor migration creates a trickle-up effect, of sorts.

"What goes around comes around," he said. "We are in a continuum. What South Africa loses to the developed world, to the United States say, we gain from Uganda."

UNCTAD emphasizes needs to address braindrain

The UN Conference on Trade And Development (UNCTAD) Secretariat released the "Least Developed Countries Report 2007" highlighting the role of knowledge and technology in trade and development. The report also addresses the issue of braindrain and proposes a number of policy actions for destination and home countries and donors.

For destination countries:
• Favouring temporary entrance rather than permanent immigration;
• Establishing development assistance programmes that help LDCs to retain their professionals;
• Creating programmes of assistance for skilled emigrants returning to their home countries; and
• Refraining from recruiting LDC professionals with clear negative consequences for home countries.

For home countries:
• Retention - offer job opportunities, better working conditions and career paths
• Return - focus more on the short-term return of emigrants which can eventually lead to permanent return.
• Diaspora - maintaining contact with them and attracting them to specific activities and projects

For donors, international organizations:
• Supporting LDCs in attracting back emigrants;
• Providing assistance to LDCs in enhancing the gains from diaspora links; and
• Establishing regional initiatives that facilitate temporary movement of professionals so as to enable LDCs to benefit from brain circulation.

Click here for full report
Click here for Chapter 4 on International Emigration

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The Guardian Unlimited (UK) also published an article on this report". Excerpt from the newspaper below:

"Seeking health care in Ethiopia can be a difficult task. For every hundred thousand people, only two doctors are available as many of the country's physicians flock to the west.

Many of the world's least developed countries are losing large parts of their already shallow pool of skilled professionals to western countries - hindering their ability to pull themselves out of poverty, a report by the UN said today.

The UN's development arm warned that countries such as Ethiopia could see their long-term growth prospects damaged if the "brain drain" is not addressed

....

The health sector, in particular, has suffered from a large loss of trained workers, which UNCTAD said often had a severe impact on the standard of service available to the poor.

In Bangladesh, 65% of all newly graduated doctors seek jobs abroad and the country loses 200 doctors from the government sector each year."