a comprehensive package
The migration of health workers and pharmacists in particular is seen as a problem with no easy solution. It is not simply a matter of difference in salary, but also in training and career progression opportunities and a conducive practice environment. A comprehensive package which offers a range of incentives is the best way forward.
2006 World Health Day in Zambia
Tana Wuliji reports.
The migration of health workers has many catchy labels – some call it brain drain, others call it brain gain or even brain circulation, but for Ruth* – a final year pharmacy student from Zimbabwe – migrating abroad is a life changing decision which is not taken lightly. Over the past ten years, the migration of pharmacists to countries such as the UK, Australia and Ireland has increased. Half of all final year pharmacy students like Ruth, surveyed across nine countries worldwide including Nepal, Bangladesh and Zimbabwe, planned to migrate within five years. More than half of these planned to remain abroad long term.
Such figures are perhaps not surprising, but may be a cause for concern for any country which invests in the development of its own health workforce. In order for policies to be effective in maximising the gains and minimising the risks from migration, there is a need to take the underlying factors influencing migration intentions into account. In the case of pharmacists, it seems to be as much a reflection of the individual’s perception of the home environment as it is of the perception of opportunities abroad.
It is tempting to simplify the problem of migration to a matter of differences in salaries between countries. However, retaining health workers requires a more holistic understanding of the factors that influence migration intentions.
Ruth’s perception of opportunities to develop her career and financial situation abroad are just one set of factors she will take into consideration. The issue of salaries cannot be separated from professional development and both need to be addressed. For example in Australia, the rural workforce recruitment and retention programme offers packages to offset disincentives for working in remote and rural areas, like offering allowances and supporting continuing education. As a result, over the last six years, the number of pharmacists in the rural community has grown by 12 per cent.
However, salary and career are not the only considerations. Ruth’s attitudes towards the local practice and professional environment, and social and political environment will also shape her migration intentions. The latter may be outside the health sector’s zone of influence.
Those who plan to migrate long term also have negative perceptions of the professional status and practice environment within their home countries compared to those that do not plan to migrate. To ensure job satisfaction, Ruth needs to feel that her services are valued by her colleagues, members of other health care professions and patients. The work environment should also be felt to be conducive for her performance, with policies that support the services that she will provide.
Interestingly, an average of 20 per cent of final year pharmacy students plan to migrate on a short term basis. There is no difference in the attitudes of these students compared to those that do not wish to migrate at all; both view the home environment positively, in contrast to those planning long term migration. This means that it is very important to know the difference between those who plan to migrate on a short term basis and those planning to migrate on a long term basis as these groups have completely different attitudes and perspectives. Short term migrants are more likely to return home, hold positive perceptions about their home environment and facilitate mutual gains from migration abroad. Those planning long term migration will be the most difficult group to retain and least likely to return from abroad.
In packing away the labels for migration which oversimplify a complex issue, strategies that aim to retain pharmacists like Ruth are more likely to be successful with a comprehensive package of interventions that satisfy her needs. In addressing the underlying factors that influence migration, retention across the health system can be improved; the very same factors not only shape the movement of health workers between countries, but within as well.
*Pseudonym
Tana Wuliji, Editor of the 2009 International Pharmaceutical Federation (FIP) Global Pharmacy Workforce Report (www.fip.org/hr).
For further information: http://www.human-resources-health.com/content/7/1/32
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Filed under: Prioritising our health workforce
Nice Article Tana! Do you think i can do some interviews with some pharmacists and other health professionals who have emigrated to Namibia from all over to hear their side of the story?
Hi Tana, I agree perfectly with your last comments. Sometimes issues about migration go beyond what Health care organisations can address. We still need to study the patterns of migration further. rebecca
Hi Chaka,
Great to get your comments. Good idea to interview pharmacists who have emigrated to Namibia. Qualitative work in this area may give some further insights. However, it would be even more interesting to know what changes would make them wish to return to their home country and how long they plan to stay in Namibia.
Hi Rebecca,
Indeed. A conducive social and political development is critical, and in many cases could be a major driving force for migration. However the health sector can do more to improve the social and political environment particularly with regards to healthcare management, human resource management and the working environment.
Dear Tana,
It goes without doubt that WHO-UNESCO-FIP education task force is working alot on Pharmacy related human resource development. I had a chance to attend task force meeting in Turkey where African case studies were presented as well. To me there are three major components of human resource development after assessing the current needs and future demands of a particular community
1. Sustainable Production of skilled human resource
2. Quality Assurance and Continuous Professional Education
3. Retention of Human Resourse
Unfortunately, if we look through the health care policy of countries across the globe especially developing and underdeveloped countries, we will find out the policy is deficient in at least one of the above stated components.
Political and Socioeconomic stability is a must to prevent brain drain. To me, there are the two main drivers of brain drain from developing countries especially from Africa. Political will and economic stability is required to prevent this.
I, myself being an immigrant lecturer (Pakistan to Malaysia) can see the major problems Pharmacists are facing.
Muhammad Abdul Hadi, BPharm, MPharm (Clinical)
Lecturer in Clinical Pharmacy
Universiti Teknologi MARA
42300 Puncak Alam, Malaysia
Dear Muhammad,
Thanks for your message. Yes I agree with you that the political environment and economic development are major factors which influences intentions to migrate. There are no easy or short answers and political will is very much required over the long term to bring about changes to ensure sustainable human resource development in the health sector.
However, despite these restraints, changes at grass roots levels to improve the working environment, support to practitioners and information about the health workforce can be put in place to generate improvements. There are many examples at facility level in low and middle income countries where hospitals and institutions have managed to retain and expand their workforce.
We need more constructive dialogue and sharing of experiences and lessons, and indeed, further research on what interventions work and what interventions do not.
Hi Tana
I totally agree with you. Its not just about the differences in salaries but also the opportunities for professional development and the attitudes of people around you.. I have seen most of my classmates emigrate to the developed countries claiming better opportunities. I have also had a chance to work with a clinical pharmacist from the US and learnt a lot concerning pharmacy practice globally. Therefore, I think partnerships between the developed countries and the underdeveloped and developing countries will also help in reducing the brain drain from these countries. there also has to be a change in national policies that will lead to improved working environment and access to information.