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Management of the Health Workforce

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  • 57
    The Health Workforce in Latin America and the Caribbean http://dx.doi.org/10.1596/978-1-4648-0594-3
    CHAPTER 5
    Management of the Health
    Workforce
    Key Messages
    • AsMembersStatesoftheWorldHealthOrganization(WHO),allsixfocus
    countrieshavevoluntarilyadoptedtheWHOGlobalCodeofPracticeonthe
    InternationalRecruitmentofHealthPersonnel.
    • Thenumberofforeign-trainedspecialistsareincreasingintheLatinAmerica
    andCaribbeanregionduetonewmigratorypatterns,as in Colombia,with
    increasinghealthprofessionalsfromtheRepúblicaBolivarianadeVenezuela
    andCuba,andinCostaRica,Jamaica, and Panama,who are hiring foreign
    healthprofessionalsasatemporaryfixtohealthpersonnelshortages.
    • Theregionisalsolosinghealthprofessionalstooutmigration:Peruaccounts
    for44.7percentofallmigrationsintheregion;healthprofessionalsinJamaica
    andPeruhaveagreatdesiretoleavetheircountries.
    • Thesixfocuscountriesarestrugglingtoputinplaceself-sufficiencypolicies
    to meet human resources for health (HRH) needs.The lack of promotion
    plans, limited nonmonetary incentives, and the shortage of personnel for
    recruitmentandeventualplacementarechallengestheyallface.
    • Colombia, Costa Rica, Peru, and Uruguay have developed mechanisms for
    certifying foreign-trained professionals through degree validation and have
    facilitatedformalhiringprocessestohelpthemfillthehealth-workerdistribu-
    tiongapsinrural,remoteareas.
    The outmigration of health workers significantly contributes to the deficit of
    health personnel worldwide, but it is felt particularly in developing countries.
    A global shortage of health workers and the increasing demand for health
    workers,especiallyfromhigherincomecountries,actaspullfactorsthatencour-
    agehealthworkermigration.Inaddition,suchpushfactorsaslowsalaries,lack
    of incentives, and lack of career development opportunities encourage health
    workers from developing countries to consider migrating out of their home
    countriesinsearchofbetterworkopportunities.Thechallengeisbalancingthe
  • 58 Management of the Health Workforce
    The Health Workforce in Latin America and the Caribbean http://dx.doi.org/10.1596/978-1-4648-0594-3
    rightofhealthworkerstofreedomofmovementwhileensuringthatcountries
    havethecapacitytodeliverhealthservicestotheirpopulation.TheWHOadvo-
    cates an international code of practice for the international recruitment and
    managementofhealthpersonnel.Developedcountriesareencouragedtoadopt
    binding codes of conduct governing ethical recruitment practices as a way to
    compensatethosecountrieswherehealthprofessionalsarebeingrecruitedfrom
    andtocommitthemselvestofollowingofficialpoliciesofhealthworkforceself-
    sufficiencyatthecountrylevel.
    Managing Migration
    The WHO’s Code of Practice on the International Recruitment of Health
    Personnel—which all six countries have adopted as member states—aims to
    establishandpromotevoluntaryprinciplesandpracticesfortheethicalinterna-
    tionalrecruitmentofHRH.Memberstatesarediscouragedfromactivelyrecruit-
    ingstafffromlow-andmiddle-incomecountriesthatarefacingcriticalshortages
    ofhealthworkers.
    Noestimatehasyetbeencalculatedontheproportionofforeign-trainedspe-
    cialiststhatleaveColombia,butitisknownthatthenumbersareontherise.In
    2000,anestimated5.7percentofphysicianstrainedinthecountryemigrated
    (Bhargava, Docquier, and Moullan 2010). Furthermore, a large number of
    ColombiannursesleftforcountriesincludingChile,Italy,Spain,andtheUnited
    States. In the aftermath of Europe’s economic crisis, however, many nurses
    returned;duringperiodsofpersonnelcuts,foreignersarethefirsttobepushed
    out to protect the jobs of national workers.
    1
    According to the National
    Commission for Quality Assurance in Higher Education (CONACES), the
    growingnumberofhealthworkershiredinothercountriesstemsfromseveral
    concurrent phenomena: first, an increase in the number of general-medicine
    graduateswithout a commensurate increase in the number of residency posi-
    tions;second,anewmigratorypatternofforeignphysiciansenteringColombia,
    particularlyCubanandVenezuelanprofessionalsonmedicalmissions.
    PanamaandCostaRicahaveauthorizedforeignhealthprofessionalstowork
    intheircountriesasawaytotemporarilyaddresspersonnelshortages.InPanama,
    theMinistryofHealthandtheSocialSecurityFund(CSS)areauthorizedtohire
    foreignhealthprofessionalsandtechniciansonatemporarybasis.Foreignphysi-
    cianshavebeenauthorizedtoworkinCostaRicatohelpprovidecareinprov-
    incesoutsidetheGreaterMetropolitanArea.Despiteazoningincentivepaidover
    the base salary in Costa Rica, health professionals tend to concentrate in the
    Greater Metropolitan Area.This situation has forced the country’s College of
    Physicians and Surgeons to authorize foreign physicians to work in outlying
    provinceswhereCostaRicanphysiciansprefernottowork(Castillo2012).
    Even before adopting the WHO’s Code of Practice on the International
    Recruitment of Health Personnel, Jamaica had already entered into bilateral
    agreementswithCubaandNigeriaforthesupplyofnurses.Todate,49percent
    of nurses recruited from Cuba are specialist nurses. The recruitment of
  • Management of the Health Workforce 59
    The Health Workforce in Latin America and the Caribbean http://dx.doi.org/10.1596/978-1-4648-0594-3
    nonspecialist nurses from Cuba is of concern for the Nurses Association of
    Jamaica, given the oversupply of level-1 nurses and the lack of employment
    opportunitiesinthepublichealthsector.Apartfromtheseformalchannels,the
    publichealthsectorrecruitsnurseswhoapplyfromothercountriesandfromthe
    privatesector,providedtheymeettherequirementsofthehiringinstitutionand
    theNursingCouncilofJamaica.Jamaicahastriedtomanagemigrationbyimple-
    mentinganeconomicbondingprocess.TheBondingPolicyoftheGovernment
    ofJamaica(establishedonJanuary1,2009)statesthat,“Onceanindividualwho
    receivesanawardbeginsthecourseoftraining,thecostoftrainingisregardedas
    aloanandtheindividualasaborrower.Thisloanistobedischarged,inthefirst
    instance,throughservingofabond.Theamountforwhichtheborrowerwillbe
    bondedcoverstheactualcosttoGovernmentofthetraining.Thesalariesfor
    specialist nurses in Jamaicacannotcompete with those of recipient countries,
    whichisareasongivenformigration(Kurowskiandothers2012).
    Accordingtoa2013report(PAHO2013),Peruhasthehighestnumbersof
    outmigratingdoctorsandnursesintheregion,losinganaverageof588doctors
    and881nursesthattogetheraccountfor44.7percentofallmigrationsinthe
    region. In Peru, the intention to migrate is high among health professionals,
    particularlyamongstudents,whereitisat78percent.Thisfigureissignificantly
    higherthanthatreportedbyMayta-Tristanandcolleagues(2010)for2008.In
    their study, a survey was administered to medical interns at the Universidad
    NacionaldeSanMarcostoassesstheirintentiontomigrate.Resultsshowthat
    38.1percentoftheinternsintendedtomigrate;ofthose,70percentplannedto
    emigratetoEuropeand 23 percent to the United States. Oneof the leading
    factors that feeds this intention is the improved economic conditions in the
    receivingcountries.
    Managing Self-Sufficiency to Meet Country HRH Needs
    The six focus countries are struggling with putting self-sufficiency policies in
    place to meet HRH needs. Information gathered through the case studies is
    examinedbelow,asawaytobetterunderstandthedifferentstrategiesthecoun-
    triesarepursinginthisregard.
    Promotion and Career Path
    InJamaica,nurses and midwives face many obstacles along their career paths.
    Thehighestpositionanursecanattaininthepublichealthsectoristhatofchief
    nursingofficer.ThisisapositionwithintheMinistryofHealththathasrespon-
    sibilityforpolicydevelopment,standardsetting,andmonitoringandevaluation
    ofnursingservices.Whilethecareerpathforregisterednursesisclear,thosefor
    midwivesandenrolledassistantnursesarenot.Nursesandmidwivesmayoptfor
    alternative positions within the health system, such as program development
    officersandsurveillanceofficerswithintheMinistryofHealthorashealthman-
    agerswithintheRegionalHealthAuthorities,iftheyhavetherequisitequalifica-
    tions. However, several barriers remain to the successful pursuance of career

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Management of the Health Workforce

Management of the Health Workforce

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