|Parallel Session, Friday, September 1 2006, 11:00-12:30|
|Chair(s): Manuel Dayrit, Switzerland, Peter Suter, Switzerland|
|Lola Dare, Exectuvie Secretary, African Council for Sustainable Health Development, Nigeria|
|Nurses on the Move: International Nurse Migration|
|Mireille Kingma, Consultant, Nursing and Health Policy, International Council of Nurses, Geneva, Switzerland|
|Opportunity Knocking: Exploiting e-Health for Global Health Human Ressources Planning|
|Kendall Ho, Continuing Professional Development & Knowledge Translation, University of British Columbia, Vancouver, Canada|
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The global phenomena of massive migration of health professionals and the advent of e-Health solutions are evidence of the fact that significant trends in health are no longer regional. Worldwide, doctors, nurses and ancillary staff are increasingly seeking better prospects for themselves, not only in the northern economic powerhouses but also in developing countries. However, a severe lack of knowledge-sharing mechanisms and appropriate funding has meant that patients and health professionals in poor countries are still denied the opportunity to benefit from pioneering e-Health programmes now being developed in countries such as the UK and Canada.
Ms. Lola Dare from Nigeria, representing the African Council for Sustainable Health Development, referred to the work of the Global Stakeholder Alliance and the African Platform, as she emphasised that srategic responses to migration involving local stakeholders are essential to ease the burden on poorer countries of the brain drain of qualified health workers. In a similar vein, Ms. Mireille Kingma of the International Council of Nurses (ICN) in Switzerland stressed the importance of the ICN's nurse-specific reports, both in supporting individual nurses who elect to migrate and in devising measures to combat the shortfall in skilled professionals in both rich and developing nations.
The negative effect of the skills gap on the health services of countries in Africa and South-East Asia is acute. But, as Ms. Dare illustrated, budget caps imposed by international monetary institutions are critically hampering the attempts to redress the balance. In Nigeria, for example, it is estimated that current spending on health sector wages would need to increase almost four-fold, to 8.7 million dollars, in order to reach the minimum health-worker to patient threshold advocated by international experts. This is of particular importance in terms of a nation's health, since there is a direct correlation between incidence of disease and the patient to health professional ratio.
Aside from monetary concerns, both Ms. Dare and Ms. Kingma highlighted the importance of addressing the wider issues constituting the "push factor" behind the decision of professionals to migrate. Studies have revealed that improvements in working conditions, greater job satisfaction and patriotism can be key in persuading them to remain in their countries of origin. It is also important to ensure that the right type of human resource policies are in place, so that "anchor effects" can stem the migratory tide. As Ms. Kingma explained, a policy of retaining older nurses while denying employment prospects to newly qualified professionals has caused high nurse unemployment in certain African countries.
Facing such prospects, and given other contributory factors, it is hardly surprising that large numbers of health professionals choose to chance their hand abroad. Their right to professional mobility should not be denied, not only due to the advantages migration may bring to them as individuals and to their new host countries, but also in view of the indirect benefits which almost always accrue in the supplier countries.
While the latter point might seem counter-intuitive, it is not only host countries which gain from the global movement of health personnel. Nurses who have spent a period abroad are able to apply their increased expertise to their work if and when they choose to return to their native countries. More importantly perhaps, remittances sent home amount to a total of 225 billion dollars, more than the sum of all the world development aid budgets.
Given the precarious state of health infrastructures in many poor countries, it would appear that their citizens and health professionals are unlikely to benefit in the near future from the breakthroughs in e-Health. However, as Dr. Kendall Ho from the University of British Columbia in Vancouver, Canada emphasised, with the appropriate investment in new technologies and with improved access to knowledge, it would be feasible for the benefits brought by e-Health to "underserved populations" in outlying areas of British Columbia (Canada) to be replicated even in poor parts of the globe.
Health informatics and e-learning can be effective tools in providing support to doctors in rural areas and also to patients in urban environments, for example in post-operation situations. As long as appropriate networks are established and the necessary resources are put in place, the capacity of e-Health to bridge geographical gaps could become a key factor in improving access to health and support to health professionals in poor countries. Dr. Ho highlighted the urgent need for "global debate" on e-Health.
It is vital that human resource policies are adapted to take account of the new global realities. Appropriate support should be provided for workers choosing to exercise their right to professional mobility, while funding and other strategic issues clearly need to be revisited in order to alleviate the crisis situation faced by health services in many poorer countries. The debate should now focus on the full complexity of the issue, including advantages for supplier countries and non-financial measures geared to retaining health professionals. Furthermore, we must grasp this opportunity to share knowledge and transfer technology so that patients and health professionals in developing countries are not excluded from the e-Health revolution in the rich nations that is beginning to deliver on access and quality.