Economic migration / HEALTHCARE

1 WHERE HAVE ALL THE HEALTH WORKERS GONE?
For every 100,000 people, the US has 773 nurses. Uganda has to manage with just 6.¹ The WHO minimum standard is 100 nurses and 20 doctors.

2 SITUATIONS VACANT
• The US has 100,000 vacant nursing posts.² By 2010 one million more nurses will be needed to meet the needs of an ageing population.³

• Malawi was able to fill only 28% of its nursing positions in 2003.⁴

• Canada predicts a shortfall of 78,000 nurses by 2011, and Australia 40,000 by 2010.¹

• Sub-Saharan Africa needs 620,000 more nurses now to tackle the HIV/AIDS epidemic and meet basic UN development goals.¹ Virtually every country in the world records a shortage of health staff.

3 WASTED
• The number of trained nurses who are not practising is 500,000 in the US, 35,000 in South Africa, 15,000 in Ireland.⁵

4 COMINGS & GOINGS
• South Africa loses almost half its qualified doctors to Canada, Britain and Australia. It recruits staff from poorer countries like Kenya, Malawi and Zimbabwe which now account for 80% of South Africa’s rural doctors.⁶

• The Philippines is the world’s biggest exporter of labour. It sends 14,000 nurses abroad each year – twice as many as it trains – to work in the US, Saudi Arabia, Ireland and Britain, causing a shortfall at home.³

• Britain recruits around 15,000 nurses a year and loses around 8,000 to emigration. Main destinations are Australia, US, Canada, Ireland and New Zealand/Aotearoa.⁷

5 DEPENDENCY
Rich countries rely on foreign health staff, increasingly from Asia and Africa.

• In New Zealand/Aotearoa over 50% of nurses registering are foreign trained.⁸

• In Britain 43% of nurses registering were foreign trained in 2003 compared with 10% a decade earlier.⁹

• Around 12,500 doctors and 16,000 nurses from Africa are registered to work in Britain.¹⁰

• In Queensland, Australia, 40% of the medical workforce was trained abroad.¹¹

• In 2004 some 14% of nurses registered in the US were trained abroad.¹²

• Almost 25% of doctors in Canada, Australia and the US are foreign-trained – rising to over 30% in Britain.^13,4,14

6 UNHEALTHY BALANCE
In the past decade Ghana has lost 50% of its professional nurses to Canada, Britain and the US. There are more Ghanaian doctors working outside Ghana than in the country itself.¹⁵

• Zambia’s public sector retained only 50 out of 600 physicians trained in medical school from 1978 to 1999.¹⁷

• Britain has saved $117 million in training costs by recruiting Ghanaian doctors since 1998. • In Britain 1 child in every 150 dies before the age of 5. • In Britain average per capita spend on health is $1,668.16	• Ghana has lost $63 million of its training investment in health professionals. • In Ghana 1 child in 10 dies before the age of 5. • In Ghana average per capita spend is just $11.16

7 INCOME GAP

8 REMITTANCES
Migrant workers send home around $100 billion a year – the largest source of foreign exchange for many of the poorest countries.¹⁸

• Recorded transfers to Africa totalled $12 billion in 2002 – of which $4 billion went to sub-Saharan Africa. If unofficial transfers were counted, these figures would probably double.¹⁸

• Mexico receives $15 billion in remittances a year – second only to oil revenues. Other major recipients are India, Philippines, China, Morocco, Bangladesh, Colombia, Egypt and Turkey.¹⁸

• After the US, the top sources of remittances are Saudi Arabia, Switzerland, Germany and France.¹⁸

Sources:
1 James Buchan and Lynn Calman, The Global Shortage of registered nurses: an overview of issues and action, International Council of Nurses, 2005.
2 Kathy Quan, ‘Nursing shortage worldwide’, 2005, http://nursing.about.com
3 Melissa Howell, ‘Doctors leaving Philippines to become nurses’, 2003 www.sfgate.com
4 Dr Kimberly Hamilton and Jennifer Yau, ‘The Global Tug-of-War for Health Care Workers’, Migration Policy Institute, 1 December 2004. http://migrationinformation.org
5 International Council of Nurses, 2004.
6 Dr PN Govender, South African Medical Association, May 2004.
7 UK Central Council for Nursing and Midwifery, 2005.
8 New Zealand Nurses Organization, 5 August 2004 www.nzno.org.nz
9 James Buchan, Renu Jobanputra, Pippa Gough, London Calling? The international recruitment of health workers to the capital, Kings Fund, July 2004, www.kingsfund.org.uk
10 British Medical Association quoted in PA News, Andrew Woodcock, ‘NHS Reliance on Foreign Doctors Immoral’, 15 March 2005, www.wews.scotsman.com
11 Mark L Scott et al, ‘Brain-drain or ethical recruitment?’, The Profession, MJA 2004 vol 180, School of Public Health and Community Medicine, University of NSW. www.mja.com.au.
12 Marko Vujiicik et al, ‘The role of wages in the migration of health care professionals from developing countries’, Human Resources for Health, Department of Human Resources for Health, WHO, 28 April 2004.
13 Canada and the World Backgrounder, ‘Losing the best and the brightest’, 2002, www.findarticle.com
14 UK Department of Health statistics, 2005.
15 World Health Organisation, Bulletin, 2005.
16 MedAct/Save the Children report, Whose Charity? Africa’s aid to the NHS, 2005.
17 Public Services International, ‘Southern Africa: lack of health workers hampers AIDS treatment’, http://www.world-psi.org
18 IMF, April 2005.