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Causes, consequences, and policy responses to the migration of health workers: key findings from India

View Article: PubMed Central - PubMed

ABSTRACT

Background: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries—Jamaica, India, the Philippines, and South Africa—that have historically been “sources” of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study.

Methods: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically.

Results: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration.

Conclusions: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

No MeSH data available.


How would government policy effect your migration decisions? (Source Health Professional Migration Survey) n = 1719 each question
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Fig7: How would government policy effect your migration decisions? (Source Health Professional Migration Survey) n = 1719 each question

Mentions: In the case of nursing, private sector employers had reportedly been confiscating nurses’ registration certificates and/or insisting on a bond period in order to retain their services (P49, Nursing Association). This practice was ruled illegal by the Supreme Court of India (ruling no. 527) in 2011. The Trained Nurses Association of India (TNAI) proposed a bill on nursing service conditions that would ban this practice and other types of service conditions. Policies that ensure mandatory national return of service were nonetheless seen by some stakeholders as necessary and justified: “We are spending so much on training. Those who are migrating must give an undertaking that they will come back and put at least some minimum years of service in India” (P17, Pharmacy Association Representative) (see Fig. 6). On the other hand, the majority of health workers surveyed indicated that such policy actions would make no difference to their migration decisions. However, the second highest level of health worker survey response does suggest policy actions to manage health worker migration might make some less likely to migrate, therefore achieving the presumed policy goal (see Fig. 7).Fig. 6


Causes, consequences, and policy responses to the migration of health workers: key findings from India
How would government policy effect your migration decisions? (Source Health Professional Migration Survey) n = 1719 each question
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382411&req=5

Fig7: How would government policy effect your migration decisions? (Source Health Professional Migration Survey) n = 1719 each question
Mentions: In the case of nursing, private sector employers had reportedly been confiscating nurses’ registration certificates and/or insisting on a bond period in order to retain their services (P49, Nursing Association). This practice was ruled illegal by the Supreme Court of India (ruling no. 527) in 2011. The Trained Nurses Association of India (TNAI) proposed a bill on nursing service conditions that would ban this practice and other types of service conditions. Policies that ensure mandatory national return of service were nonetheless seen by some stakeholders as necessary and justified: “We are spending so much on training. Those who are migrating must give an undertaking that they will come back and put at least some minimum years of service in India” (P17, Pharmacy Association Representative) (see Fig. 6). On the other hand, the majority of health workers surveyed indicated that such policy actions would make no difference to their migration decisions. However, the second highest level of health worker survey response does suggest policy actions to manage health worker migration might make some less likely to migrate, therefore achieving the presumed policy goal (see Fig. 7).Fig. 6

View Article: PubMed Central - PubMed

ABSTRACT

Background: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries—Jamaica, India, the Philippines, and South Africa—that have historically been “sources” of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study.

Methods: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically.

Results: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration.

Conclusions: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

No MeSH data available.