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Review - Nurses on the move

Article review: “Nurses on the move: A global overview”
by Sejuti Jha1

Author: Mireille Kingma
Title: Nurses on the move: A global overview
Published: Health Services Research, Volume 42, No. 3, June 2007 (Part II) (pp 1281-1298)

Click Here to view the Online Source

Globalisation and regional integration across the world has seen an upsurge in international migration of labour and increasingly more women are moving to different countries not on a spouse visa but on their own for work. Mobility of women gives them a sense of empowerment and through remittances such migration helps them become agents of economic change. In the population of migrant women nurses constitute a major bulk and they are increasingly moving from the South to the North. Such migration has thrown up many challenges both for less developed and developing countries from which these nurses move out and also for developed countries where they go. Highlighting such challenges are a set of papers brought out by Health Services Research in its special issue (June 2007, Part II) which focus mainly on country case studies. However, a global perspective can be got from Mireille Kingma’s article there: “Nurses on the move: A global overview”, in which the author discusses the push and pull factors of such migration, their implications and the concept of brain circulation as against brain drain that such movements get associated with.

Some figures from her article gives the extent of the South to North nurse migration: 30,000 nurses from one of the poorest regions of the world, sub-Saharan Africa, are currently working in just seven OECD countries; between 1999 and 2001 32% of registered nurses from Zimbabwe left their jobs for UK. The pull factors for such migration are mainly the existing shortage of healthcare professionals in the industrialized countries, the better pay packets that such countries can offer, existing diaspora there etc. The push factors are invariably the poor working condition and financial status of nurses in their home countries. Much policy attention and media coverage focus on the worsening of health care sector in the South due to migration of nurses to the North and have many a times blamed the shortage in the North as the culprit. However, Kingma rightly points out, “…no matter how attractive the pull factors of the destination country, little migration takes place without substantial push factors driving people away from the source country”.

The author notes that the structural adjustment programmes in less developed and developing countries in the 1980s led to massive cutting in public sector spending on health sector and how it led to a lot of vacancies in nursing stuff positions in these countries and a huge work-load (for example nurse to patient ratio in Zimbabwe is 1:700). The resulting problem in giving proper care esp. in antiretroviral treatments is a huge concern and Kingma states that by artificially curbing nurse migration and injecting them into dysfunctional health systems will not meet the growing health needs of national populations.

The author further states, with some examples, that the return rates of these nurses are quite high. So it is not an absolute brain drain but has some evidence of brain circulation in it. But she cautions that for such circulation to be effective the governments should keep in mind the needs of the returning nurses. Kingma also talks about various other issues in the article: data limitations, the remittances these nurses bring, the immigration policies and international recruitment practices and the social implications of such migration. She concludes by saying that migration of nurses from their home countries is the symptom of the weak scenario of health care sector there. The disease is the poor condition of the health care sector in these countries and policy focus should be on how to improve it.

Kingma’s article is a comprehensive review of many existing studies and makes a very interesting and informative read esp. because of the numerous examples she gives to define the dimension, direction and problems associated with international migration of nurses. It is a must read to understand the dynamics of nurse migration as it is unfolding today and also to have a vision of how to manage this migration in the right direction for a better future tomorrow.

1 Research Scholar, Indian Institute of Foreign Trade, New Delhi