Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges

Barbara Stilwell¹ , Khassoum Diallo² , Pascal Zurn³ , Mario R Dal Poz⁴ , Orvill Adams⁵ and James Buchan⁶

¹Scientist, Department of Health Service Provision, World Health Organization, Geneva

²Demographer, Department of Health Service Provision, World Health Organization, Geneva

³Health Economist, Department of Health Service Provision, World Health Organization, Geneva

⁴Coordinator of Human Resources for Health, Department of Health Service Provision, World Health Organization, Geneva; Associate Professor and former Deputy Director, Social Medicine Institute, University of the State of Rio de Janeiro, Brazil

⁵Director, Department of Health Service Provision, World Health Organization, Geneva

⁶Professor, Faculty of Social Sciences and Health Care, Queen Margaret University College, Edinburgh, United Kingdom

author email corresponding author email

Human Resources for Health 2003, 1:8doi:10.1186/1478-4491-1-8


Published:	28 October 2003

Abstract

It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills.

The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed.

The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.