The migration of health workers and pharmacists in particular is seen as a problem with no easy solution. It is not simply a matter of difference in salary, but also in training and career progression opportunities and a conducive practice environment. A comprehensive package which offers a range of incentives is the best way forward.
Tana Wuliji reports.
The migration of health workers has many catchy labels – some call it brain drain, others call it brain gain or even brain circulation, but for Ruth* – a final year pharmacy student from Zimbabwe – migrating abroad is a life changing decision which is not taken lightly. Over the past ten years, the migration of pharmacists to countries such as the UK, Australia and Ireland has increased. Half of all final year pharmacy students like Ruth, surveyed across nine countries worldwide including Nepal, Bangladesh and Zimbabwe, planned to migrate within five years. More than half of these planned to remain abroad long term.
Such figures are perhaps not surprising, but may be a cause for concern for any country which invests in the development of its own health workforce. In order for policies to be effective in maximising the gains and minimising the risks from migration, there is a need to take the underlying factors influencing migration intentions into account. In the case of pharmacists, it seems to be as much a reflection of the individual’s perception of the home environment as it is of the perception of opportunities abroad.
It is tempting to simplify the problem of migration to a matter of differences in salaries between countries. However, retaining health workers requires a more holistic understanding of the factors that influence migration intentions.
Ruth’s perception of opportunities to develop her career and financial situation abroad are just one set of factors she will take into consideration. The issue of salaries cannot be separated from professional development and both need to be addressed. For example in Australia, the rural workforce recruitment and retention programme offers packages to offset disincentives for working in remote and rural areas, like offering allowances and supporting continuing education. As a result, over the last six years, the number of pharmacists in the rural community has grown by 12 per cent.
However, salary and career are not the only considerations. Ruth’s attitudes towards the local practice and professional environment, and social and political environment will also shape her migration intentions. The latter may be outside the health sector’s zone of influence.
Those who plan to migrate long term also have negative perceptions of the professional status and practice environment within their home countries compared to those that do not plan to migrate. To ensure job satisfaction, Ruth needs to feel that her services are valued by her colleagues, members of other health care professions and patients. The work environment should also be felt to be conducive for her performance, with policies that support the services that she will provide.
Interestingly, an average of 20 per cent of final year pharmacy students plan to migrate on a short term basis. There is no difference in the attitudes of these students compared to those that do not wish to migrate at all; both view the home environment positively, in contrast to those planning long term migration. This means that it is very important to know the difference between those who plan to migrate on a short term basis and those planning to migrate on a long term basis as these groups have completely different attitudes and perspectives. Short term migrants are more likely to return home, hold positive perceptions about their home environment and facilitate mutual gains from migration abroad. Those planning long term migration will be the most difficult group to retain and least likely to return from abroad.
In packing away the labels for migration which oversimplify a complex issue, strategies that aim to retain pharmacists like Ruth are more likely to be successful with a comprehensive package of interventions that satisfy her needs. In addressing the underlying factors that influence migration, retention across the health system can be improved; the very same factors not only shape the movement of health workers between countries, but within as well.
Tana Wuliji, Editor of the 2009 International Pharmaceutical Federation (FIP) Global Pharmacy Workforce Report (www.fip.org/hr).