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Olivia Roberts on the migration merry go round debate

10 Dec, 09 | by BMJ Group

Last week the British Medical Association (BMA) published an updated statement on the international migration of health workers. In the BMA’s view individuals have the right to migrate for personal and professional reasons. As Michael Clemens writes in his paper for the Center for Global Development from August 2009, health workers, educated and trained at the public expenses or through their own means, are not a “statist property right.” They are individuals with the right to seek to improve their own lives, professionally and personally.

Data on developing country migration is sorely lacking, but what we do have doesn’t show a strong correlation between number of migrants leaving a country and health worker numbers, health care system quality or health outcomes. Countries have poor health outcomes for a myriad of reasons, not solely due to migration. What is also absent from the debate is discussion of migration as a livelihood strategy for the poor  – it is possible that stopping people moving to countries with the aim of improving prospects for themselves and their families will have a starker impact on development and health outcomes. Remittances are also a vital source of income for many developing countries, and research shows that these are spent on capital-intensive ‘extras’ such as education and healthcare .

The arguments about the costs of migration are showing their age and “brain drain – it’s a bad thing for health systems” has proved too simple when it comes to developing policy solutions. The BMA feels that policy solutions should focus on countries with shortages of health workers.

The UK has had a code of conduct (albeit voluntary and only applicable to the public sector) in place since 2001. But now the World Health Organization is developing its own code  and the global discussions are taking an interesting turn. Issues under debate include compensation (despite being impractical, unquantifiable and tough to implement), or visas which are only granted if workers promise to leave after a few years and not to return. But where they go from there is, rightly, up to the individual to decide – no code can, or should, aim to regulate individual choice in this way.

The BMA feels more should be done to support health workers here who chose to migrate. It is a win-win-win argument: the individual benefits by receiving support and being able to access decent educational and career opportunities. The health system benefits by helping its staff  make their transition into their new workplace without problems. And patients benefit by having staff who are up to speed on NHS policies and practices.

Let’s accept the fact that people do migrate – within regions or to neighbouring countries most of all. The BMA feels that energy should be spent supporting the health professionals who migrate and the health systems with shortages, rather than trying to stop the movement or only on terms that benefit developed countries. Supply will inevitably respond to demand. To try and stop this is to defy classical economic theory as well as violate individual rights.

Olivia Roberts is a senior researcher, BMA International Department

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