Around the Institute

Forging solutions to health worker migration

February 14, 2008  • Mary Robinson and Peggy Clark

This article appeared in Vol 371 of the Lancet on February 23, 2008.

All over the world, increased demand from wealthier countries resulting from ageing populations and medical advances has pulled large numbers of health workers from some of the world’s poorest countries—many of whom are left with acute shortages of health workers of their own. Africa carries 25% of the world’s disease burden yet has only 3% of the world’s health workers and 1% of the world’s economic resources to meet that challenge. Migration, together with other factors in many source countries such as insufficient health systems, low wages, and poor working conditions, are key factors determining low health-worker density in countries with the lowest health indicators, In Zambia, for example, there are fewer than 0.12 physicians for every 1000 people, whereas Italy enjoys 4.2 physicians for every 1000 people. Between 1993 and 2002, Ghana lost 604 trained doctors; roughly half of all doctors and a third of nurses leave the country after training. Globally, WHO estimates that 4·3 million more health workers are required to achieve the health-related Millennium Development Goals and has identified 57 countries with critical shortages of health workers—36 of these countries are in Africa.


The challenge of international health-worker migration seems insurmountable given its scope and reach. Health workers have a clear human right to emigrate in search of a better life. Yet people in source countries hard hit by an exodus of health workers also have the right to health in their own countries. The space between these two fundamental rights is the area where the Health Worker Migration Global Policy Advisory Council is looking to gather best practice, assess efforts to date, and identify and debate key elements of solution-oriented policies to frame efforts by both source and destination countries. Under the umbrella of the Global Health Workforce Alliance, and in partnership with WHO and Realizing Rights, which serves as its secretariat, the Health Worker Migration Global Policy Advisory Council and Technical Working Group will make recommendations to WHO and member states to guide new discussions and policies between source and destination countries, with the aim of developing a framework for a Global Code of Practice for Health Worker Migration.


To date, however, there are few rigorous data on the outcomes of new policies such as those shown in the panel. It is widely agreed that the complexity and scope of the challenge has meant that efforts to date have had unclear, and perhaps minimal, effects as well as some unintended consequences—such as continued unethical recruitment on the part of private sector agencies who operate outside of the scope of an agreement, a perception that some wealthier countries are restricting free access to foreign nurses in a way that discriminates against them on the basis of their country of origin, and other critiques. Some agreements have been criticised for being impossible to implement given their aspirational nature and requirements for “compensation” to source countries, which has proven to be extremely problematic to operationalise.


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