The World Health Organization (WHO)(2010) points out that migration of professionals in the healthcare sector has increased in recent decades and that this may result in increased inequitable access to health care services. The causes for migration generally fall into two categories: the need for better employment opportunities and the need for better working conditions. The term used in research for describing the motives for migration is “push factors” (WHO, 2010). As indicated by WHO, the most frequent “push factors” are: poor working conditions, low salaries, limited career development opportunities, concerns regarding safety, and lack of management and support. Walton-Roberts et al. (2017) have also explored the causes and consequences of, and policy responses for, the migration of health workforces. Their study reports results referring to India, one of the four countries described by the scholars as a renowned source for medical workforce. This empirical research revealed that the main causes for health workforce migration in India are: income, cost of living, the opportunity for individuals in the medical system to find the jobs they want, the safety of their families, opportunities for professional development. In respect to the jobs they sought, respondents in Walton-Roberts’ study mentioned not only salaries, but also the location of the job, the nature of the work entailed by the job, the working conditions, the respect and dignity associated with their position in other locations/countries. Regarding opportunities for professional development, respondents noted the availability of opportunities for specialist training, and for future professional development. These findings are consistent with those reported in the literature regarding the global health workforce looked at from a broader perspective (WHO, 2010).
As may be seen, the causes for migration stretch beyond the limits of the medical system and include aspects relating to general safety, cost of living, educational opportunities etc. It is for this reason that addressing these causes should entail the collaborative efforts of cross-sectorial stakeholders at both a national and global level. The code of practice regarding the international recruitment of health personnel may be presented as the outcome of such collaborative efforts. The WHO Code makes numerous recommendations for the member states adopting it.
These are guided by the following principles:
(1) Ethical international recruitment – developed countries should refrain from engaging in active recruitment of health personnel from developing countries which already face shortages in this sector,
(2) The development of health workforces and of sustainable health systems – countries should develop their own health workforces and retain them so as to meet their needs especially in the areas with most stringent needs,
(3) Fair treatment of migrant health workforces,
(4) International cooperation – setting up bilateral and multilateral arrangements could help ensure that benefits would be available for both source and destination countries,
(5) Providing support for developing countries – in the form of technical assistance, financial support and by reducing active recruitment practices,
(6) Data gathering – at both national and international levels,
(7) Information exchange – both within and between countries as well as with WHO, so as to facilitate the development of guidelines that would benefit all of those involved.
Advocating for equitable access of the world’s population to health and healthcare, and seeking solutions for achieving this, may be seen as interfering with the rights of those representing the medical workforce. Attempts to control migration of health workforces may result in a negative impact upon their rights to the benefit of those who would otherwise be deprived of access to medical care. One solution to this apparent paradox would be to provide flexible options for health workers. The reasons for migration as documented by research may serve as guidelines for implementing change which would control migration by abolishing the need for it. If medical sector professionals could be provided, in their own country, with the opportunities they seek in other countries, then the outflow of medical workforces would arguably be reduced. Forced control over their migration may negatively impact upon their rights but finding means to motivate them to remain within sectors where health workforces are scarce would be for the benefits of both those seeking medical care, and those providing it. This directs the discussion to the conclusions drawn by the Commission on Social Determinants of Health (CSDH), according to whom there are social determinants of health which go far beyond the medical sector, and these may only be controlled through coherent cooperative and global action. Achieving an equitable distribution of health and consequently of a health workforce without negatively impacting on the rights of any of those involved may only be achieved by improving the health of countries, and by eliminating inequalities between countries through cross-sectorial global, national and social action (CSDH, 2008).
CSDH. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organisation.
Walton-Roberts, M., Runnels, V., Rajan, S., Sood, A., Nair, S., Thomas, P., Packer, C., MacKenzie, A., Tomblin Murphy, G., Labonté, R. and Bourgeault, I. (2017). Causes, consequences, and policy responses to the migration of health workers: key findings from India. Human Resources for Health, 15(1).
WHO. (2010). User’s Guide to the WHO Global Code of Practice on the International Recruitment of Health Personnel. World health Organisation. [Online] Available at: https://apps.who.int/iris/bitstream/handle/10665/70525/WHO_HSS_HRH_HMR_2010.2_eng.pdf [Accessed 15 December 2018]