quinta-feira, 4 de dezembro de 2008

BMJ: uma vez mais a emigração de profissionais de saúde da África.

Globalisation spurs migration of healthcare workers from poor nations; John Zarocostas Globalisation has made it easier for rich nations to "pull in" skilled migrants such as healthcare workers from poor nations, says a report from the International Organization for Migration, which promotes humane and orderly migration. Such migrants include a large number from sub-Saharan Africa, the region with the greatest shortage of healthcare personnel, and the trend is unlikely to abate, the report says. "Their [rich countries’] ability to offer higher pay, better working conditions and greater opportunities in safer environments will continue to pull foreign health workers until supply exceeds demand," says the report. It says that the search for employment is at the heart of most migration and concludes that pressures "are set to increase." There are "more than 200 million international migrants in the world today, two and a half times the number in 1965," it says, and most countries are now simultaneously countries of origin, transit, and destination. Nearly a quarter of foreign trained doctors in countries of the Organisation for Economic Co-operation and Development were trained in sub-Saharan Africa, and the report suggests a series of possible policy options to limit the negative effects of emigration on the countries of origin. Countries of destination should continue to develop guidelines for recruiting skilled professionals from poor nations, the report recommends, but it emphasises that self imposed restraints on recruitment by public sector employers "have not been effective in limiting the migration." It says that "exhorting private-sector employers to recruit ethically" is also likely to prove equally ineffective. "These [guidelines] can serve as a benchmark against which civil society organisations and the nationals and governments of destination and origin countries can evaluate the practice of destination countries." Anita Davies, a public health specialist at the International Organization for Migration, said that the World Health Organization has taken the lead by preparing a global code of recruitment of health workers, in consultation with other relevant agencies and stakeholders. A draft has been sent out for comment and will be presented to WHO’s governing board for consideration in January. If agreed, it will be sent to the annual World Health Assembly for adoption. The report says that policy innovations can help to mitigate some of the risks to poorer nations of diminished service access and availability. These schemes include flexible, multi-use, multi-annual work permits that may allow poor nations of origin to manage flows more effectively and thus avoid critical shortfalls in the provision of health care. Such schemes may include fixed term contracts to train or work for a period in a rich nation and may also include commitments to upgrade their own healthcare system with the support of a destination country. The report estimates that Lesotho and Namibia have lost more than 30% of their physicians to emigration and that this percentage rises to more than 50% in Malawi, Tanzania, and Zambia and to 75% in Mozambique. Every year 1000 doctors emigrate from South Africa, says the report, and an estimated 30% to 50% of all South African medical school graduates emigrate to the United Kingdom or the United States annually. Doctors from South Africa make up just under 10% of all foreign trained doctors in Australia and 7% in the UK, it says However, it points out that South Africa is also the destination for skilled health workers from other parts of Africa, including Botswana, the Democratic Republic of Congo, Ghana, Nigeria, and Zimbabwe. South Africa has the highest ratio of doctors to population on the continent, at 56.3 per 100 000 people, whereas in the Democratic Republic of Congo the figure is only 6.2 per 100 000. The report says that South Africa has tried to deal with staff shortages in the public health sector by hiring Iranian and Cuban health personnel to work in rural areas. Meanwhile, a joint working paper by the OECD and WHO on international health mobility in Canada concludes that foreign trained doctors accounted for more than 22% of Canada’s total in 2005-6. Among rich OECD nations, New Zealand had the highest proportion of foreign trained doctors, with 36%, it says. The joint study also found that in 2005 about 15% of newly registered doctors in Canada were trained in countries from the WHO list of countries with critical shortages of health personnel. The corresponding figure for the UK was 46% and that for the US was 39%. But the report also shows that in 2006 about 8000 Canadian trained doctors were practising in the US. It says that differences in income and availability of positions were often among the reasons cited for emigrating

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