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Migration of health personnel

Challenges and opportunities in the MENA region

Christiane Wiskow

& Lamia Rhoufrani

ILO Sectoral Activities Department

Mobilising Migrants’ Skills for Development in the MENA region

UNFPA- OECD Conference, Tunis, 13-14 May 2013

Roundtable 3: brain drain versus brain gain

International Labour Organization

Migration for decent working & living conditions

• 214 million international migrants

105 million economically active

• Labour market shortages in many destination countries

EU: health, science & technology

• Fair deal for migrant workers:

Rights based approach

recognizing labour market needs

2

Youth unemployment: a significant concern for MENA countries

3

5/ 12/ 13 12:45 PMGlobal youth unemployment trends and projections from 2007 to 2013

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Image | 08 May 2013

Mouse over the chart to see the data

Tags: youth employment, unemployment, research, data analysis, projections

Regions and countries covered: Global

Unit responsible: Employment Trends (EMP/TRENDS)

Global youth unemployment trends and projections from 2007 to 2013After a brief recovery, global youth unemployment continues to rise.

Youth unemployment rat... Youth unemployment (m... 1/2

2007

2008

2009

2010

2011

2012p

2013p

9.5

9.9

10.3

10.7

11.1

11.5

11.9

12.3

12.7

13.1

13.5

60

62

64

66

68

70

72

74

76

78

80

Youth

unem

plo

ym

ent

rate

(%

)

You

th u

ne

mp

loym

en

t (m

illio

ns)

Youth unemployment rate, by region, 2007 to 2013

WORLD

Developed Economies

& European Union

Central &

South-Eastern Europe

(non-EU) & CIS

East Asia

South-East Asia & the

Pacific

South Asia

Latin America & the

Caribbean

Middle East

North Africa

Sub-Saharan Africa

2007

2008

2009

2010

2011

2012p

2013p5

10

15

20

25

30

ILO, 2013

World: 12.6 %

73.4 million unemployed

Youth and labour migration Making the most of young migrant skills?

Youth employment crisis

• 27 mill. young people seek jobs outside their country of birth

Support their families financially

Pursue studies

Gain work experience

Concern: De-skilling

• Demand in host country may not match migrant education & skill levels

• Highly skilled young migrants working below their qualification

4

DSPD/UNDESA/ILO: UN World Youth Report 2013;

Youth and labour migration online discussion, 2013

Health Worker Migration Why does is matter?

• Global health workforce shortage: 4 million

• Unequal distribution of health workers

5

Distribution of health workers by level of health and burden of disease,

WHO regions

0

5

10

15

20

25

30

35

0 5 10 15 20 25 30 35 40 45

% of global workforce

% o

f g

lob

al b

urd

en

of

dis

ease Africa

South-East Asia

Eastern Mediterranean

Western Pacif ic

EuropeAmericas

WHO, 2006

Health Workforce MENA region

6

0

2

4

6

8

10

12

MENA: Health professional (physicians, nurses & midwives) density per 1000 population

Nursing and Midwifery personnel density per 1000 Physician density per 1000

Critical shortage treshhold 2.3

WHO GHO; latest year available, ca 2007-2010

Gender matters: Women share in health professions

7

100 100 100 100 100

42.9

94.4

33.8

49.9

84.9

53

36 35.2

14.7

37.4

0

20

40

60

80

100

120

Algeria Egypt Iraq Jordan Oman

Wo

me

n (

% o

f h

eal

th p

rofe

ssio

ns)

Distribution of women in health professions in 5 countries (2004)

Percentage of Women in Midwifery

Percentage of Women in Nursing personnel

Percentage of Female physicians

WHO GHO, accessed 2013

Health worker migration

• Health labour markets globally dynamic;

• High demand in destination countries

— Nursing is no. 1 amongst occupations with job vacancies in Europe

8

(Sources: EC internal estimate, 2010; EU Skills Forecast 2012; European Vacancy Monitor)

Health worker migration MENA region

• Data on HW migration scarce

• Diverse picture:

— source countries & destination countries

— Gulf States: destination countries

— Lebanon, Morocco: source countries

9

Health professionals from MENA countries working in OECD countries

10

53.5

48.5

35.8

19.3 17.7 17.6 16.9 16.6

13.1 11.4

9.1 8.7

5.2

1.4 0.8 0.8

0

10

20

30

40

50

60

Expatriation rate of doctors and nurses in OECD countries, by country of birth in 2000.

expatriation rate of nurses in OECD countries

Expatriation rate of doctors in OECD countries

Total number ofexpatriate nurses and doctors in OECD countries

GCC: Destination Countries Reliance on international health professionals

11

McKinsey, 2007; based on MOH data 2003

Health worker migration policies: balancing rights and interests • Need to balance rights:

— Right to health versus freedom of movement

• Reconciling competing interests:

— Economical:

livelihoods, remittances;

— Social:

development, public health;

access to health services

12

Freedom of movement

Right to decent

working & living

conditions

Right to health

Rights-based approach to labour migration

• National policies based on international labour standards and other international instruments

C97 Migration for Employment Convention (Revised), 1949

C143 Migrant Workers (Supplementary Provisions) Convention, 1975

• Policies that manage migration in a way beneficial to

migrant workers, countries of origin and destination countries

• Fair, effective, coherent policies

— Consultation with social partners and civil society

• Protection of migrant workers — Equality of treatment between nationals and regular migrant

workers — Prevention of & protection against abusive migration practices — Licensing/regulating recruitment agencies ( C 181)

13

Fair approach to international recruitment of health personnel Ethical international recruitment

Aims:

• protecting vulnerable health systems

• protecting migrant health workers

• encouraging adequate workforce planning by all countries in order to meet their own needs

Instruments

WHO global code of practice on the international recruitment of health personnel, 2010

14

Implementation WHO Global Code of Practice

15 WHO EB132/23; January 2013

Governance tools - New ?

“ Recruitment of foreign nursing personnel for employment should be authorized only—

(a) If there is a lack of qualified personnel for the posts to be filled in the country of employment;

(b) If there is no shortage of nursing personnel with the qualifications sought in the country of origin. (…)”

ILO Nursing Personnel Recommendation, 1977 ( R 157), Chapter XIII, Art. 67 (1)

16

Conclusion Health sector:

important employment sector

Health Worker migration:

opportunity where it is a choice

• contributes to meeting labour market needs

• contributes to development

— where migrants acquire new skills & return

Challenge for all countries:

• how to attract young people to health careers

and retain HW where they are needed?

17

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