Nurse Migration and Its Impacts on Caribbean Health Care Systems: With Special Focus on St. Lucia and Jamaica

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Nurse Migration and Its Impacts on Caribbean
Health Care Systems With Special Focus on St.
Lucia and Jamaica

• Dr. Natasha Kay Mortley
• University of the West Indies,
• Mona Campus, Jamaica
• 11th Annual Global Development Network Conference
  
• Regional and Global Integration Que Vadis?
• Prague January 16 18, 2010

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Kofi Annan

• Health workers save lives. They strive to
  ensure that advances in health care reach those
  most in need. They contribute to the social and
  economic well-being of their countries. And they
  are essential to their countries security by
  being the first to identify a new disease or a
  new threat to public health.
• (Address delivered on the occasion of World
  Health Day - The Jamaican Gleaner 7th April 2006)

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Role of Nurses

• Nurses account for 70 of health care staff
• Create awareness of the multiple and changing
  determinants of health
• Lobby for living and working conditions that are
  safe, stimulating and supportive
• Promote caring environments that foster support
• Strengthen community action and involvement in
  setting priorities, decision-making, planning
  strategies and implementation to achieve better
  health
• Foster joint action for safer products, healthier
  public services, and cleaner environments

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Rationale for the study

• Unprecedented migration flows among nursing
  profession
• Increasing global demand due to increasing ageing
  populations and increasing demand for nurses in
  developed countries
• Orientation towards liberalization of world trade
  in all services under the GATS Article XIX
• Raised alarm among Caribbean Community (CARICOM)
  governments

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Objectives of the Research

• Assess the impacts of nurse migration on health
  care systems in St Lucia and Jamaica
• Assess the wide ranging implications for health
  systems and the developmental goals of the
  English speaking Caribbean
• Suggest means of managing nurse migration ( in
  light of limited resources) in a manner designed
  to limit negative impacts while optimizing
  positive effects on health care and wider country
• Demonstrate the link between the impacts and
  policy for national development (developmental
  potential)

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Data Sources

• Secondary data data obtained from the migration
  literature, archival and web sources and
  international institutions dealing with migration
• Primary data
• general survey of 150 registered nurses in St.
  Lucia, Jamaica and the UK
• In depth interviews with 20 institutional actors
  (senior registered nurses, managers, hospital
  administrators and policy makers)
• Form of triangulation

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Context of the Study

• Absenteeism of nursing personnel due to migration
  outflows
• Return migration and intentions to return
• Linkages with home communities

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Caribbean Scenario - Nurse Shortage

• Nurse Vacancy Rates in Selected Caribbean
  Countries 2005

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Health Indicators

• Jamaica professional nurse ratio 16.5 per
  10,000 inhabitants
• St. Lucia professional nurse ration 22.6 per
  10,000 inhabitants
• North America 77.3 per 10,000 inhabitants
• (PAHO 2007)

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Survey Results - Reasons for migration
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It was highlighted that the major reason why
nurses are leaving is for opportunities, for
professional development and then work
conditions came second

• (Interview with President of the St. Lucia
  Nursing Association
• November 2005)

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Views From Some Interviewees

• Sometimes there is nothing to work with. No
  syringe, no needles, no gauze or drugs for the
  patient.
• (Senior registered nurse, Kingston Public
  Hospital)
• Our offices are not even properly equipped.
  Insufficient desks and chairs and no computer.
  We have no technology to work with.
• (Junior registered nurse, Golden Hope Hospital)

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ImpactsIf we were to talk about impacts on
the health system, I would say depletion of human
resources, a crisis of confidence by the
citizenry of the countryon the service, there is
the impact of the standard and quality of care
being compromised.

• (St. Lucias Minister of Health 2005)

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Negative Impacts

• Massive shortages of staff
• Overworked and over burdened staff
• Low staff morale
• Deteriorating quality of care
• Lack of confidence of citizenry in the health
  care system

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Positive Impacts

• Better planning and efficiency in the health
  system
• Challenge for nurses creates greater performance
  management
• New skills, technology and experience of
  returning nurses (knowledge transfer)
• Remittances (money and equipment/technology)
• Links and investments from diaspora groups

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Impacts and Implications for Development

• Economic (remittances, financial gains for health
  care system through economic contributions and
  other resources)
• Human Resource Development and Capacity (skill
  and technology transfers)
• Social Impacts (social networks and links with
  diaspora)

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Developmental Potential of Diaspora

• Donations of money and goods to health care
  systems
• Initiate community projects (infra structural
  projects like construction of health center)
• Assist local government in allocations for public
  health (greater transparency)
• Impact of civic participation (empowerment of
  people)

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Government Strategies to Manage Nurse Migration
Based on Respondents Views

• Improved remuneration packages and greater
  economic incentives
• Improved work conditions
• Increased training and education in nursing
• Shared governance
• Meritocracy

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• Where Do We Go From Here?
• Managed migration is a regional strategy for
  retaining adequate numbers of competent nursing
  personnel to deliver health programmes and
  services to the Caribbean nationals at the
  highest levels, and while doing that, making sure
  that you have surplus
• (Director School of Advance Nursing, Mona 2005)

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Aspects of Managed Migration

• Managed migration focusing on critical areas
• Terms and conditions of work
• Recruitment
• Education and training
• Valuing of nurses
• Utilization and deployment of nurses
• Shared governance
• Policy and health sector reform

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Policy Implications

• Increasing retirement age and return of retired
  nurses
• Train more nurses locally and for export
• Greater representation of nurses at
  decision-making and policy level (Nursing
  Associations)
• Greater valuing of nursing profession
• Actively attract Caribbean nurses back home
  through incentives and meritocratic system (freq
  appraisals and promotion opp)
• Bi lateral agreements with main destination
  country governments
• Continuing education of all stakeholders
• Employer inputs and support

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Conclusions

• Paper links statistics, in-depth interviews and
  policy questions
• Institutional actors are those who live and
  experience the problem and their input in future
  strategies is key
• While negative impacts are evident in short term,
  positive impacts can be seen in the longer term
• Impacts have further implications for development
  policy
• There is need to nurture positive impacts in
  order to mitigate negative effects and make
  health care more sustainable

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• Thank you
• Prague, Czech Republic 2010