Low- & Middle-Income Countries Suffer From ‘Brain Drain’ Of Nurses That Threatens Their Health Services – International Council of Nurses
Limited education and employment capacity in LMICs means has encouraged health workers to move to high-income countries
Limited education and employment capacity in LMICs means has encouraged health workers to move to high-income countries. One in eight nurses globally are migrant nurses.

The migration of health professionals to high-income countries should not lead to a dearth of healthcare workers and services low- and middle-income countries (LMICs), the International Council of Nurses (ICN) has warned.

Speaking at the World Health Assembly (WHA), the council flagged that the global shortage of six million nurses, in tandem with the burden of the COVID-19 pandemic, would continue to drive health worker migration, leading nurses away from LMICs.

One in eight nurses globally are migrant nurses, according to WHO’s 2020 State of the World’s Nursing report, drawing comparison to the limited education and employment capacity in LMICs.

The global shortage of six million nurses continues to drive health worker migration
The global shortage of six million nurses continues to drive health worker migration.

To address this, the ICN said high-income countries must train enough nurses to become self-sufficient at a large scale.

It urged countries to implement a self-sufficiency indicator, presenting their reliance on foreign-trained nurses as a percentage. This would give policymakers insight into the extent of dependence on international nurse supply, it said, and would enable tracking and monitoring of their commitment to the global strategy of human resources for health.

The representative said: “The impact of COVID-19 on the nursing workforce will continue to increase the flow of nurses from low- to high-income countries. High-income countries must train enough nurses to become self-sufficient.”

UK Admits Dependence on Health Worker Migration

The United Kingdom is one of the world’s top destinations for emigrating health professionals.

Workers born abroad have constituted 50% of the increase in the country’s health and social care workforce across the last decade, according to a Nuffield Trust analysis published in December 2019. The analysis also revealed that people born outside of the UK account for nearly a quarter of all staff working in hospitals, and a fifth of all health and social care staff in the country.

The UK spokesperson at the World Health Assembly admitted that the UK’s National Health Service relies to a large extent on international health workers.

“By forging international partnerships, the UK will foster collective efforts across the world to address the global shortage of health workers and provide health workforce-related support and safeguards to countries with the most vulnerable health systems, enabling progress towards universal health coverage and sustainable development goals,” she told the assembly.

She added that in consultation with WHO, the UK has updated its code of practice for international improvement based on the latest advice, due to be published later this year.

Feeling the Weight of Health Workforce Inequality

Evidence points to a direct correlation between the size of a country’s health workforce and its health outcomes, with WHO estimating a projected global shortfall of 80 million health workers by 2030, mostly in LMICs.

A COVID-19 responder in Kenya learns how to properly equip protective gowns in Kenya. The country is experiencing a critical resource shortage during the pandemic.

COVID-19 has piled additional pressure on the healthcare systems in many countries losing health professionals to high-income countries.

This is an especially pressing issue in Kenya. In a 2016 study published in BJPsych International, researchers noted that one in five nurses trained in Kenya applies to emigrate. They also found that up to 40% of the country’s 600 medical graduates leave upon completing their internship every year.

Kenya’s spokesperson said the East African country’s healthcare system is faced with a shortage of critical human resources for health demands. Similar situations occur in many other African countries.

“We continue to experience challenges in managing human resources for health, such as severe shortages of essential workers, inability to attract and retain health workers, and even remuneration among workers,” she told the assembly.

Kenya also urged WHO to establish and regularly update the list of countries with critical health workforce challenges.

Transparency and Accountability

A representative from the United States asked WHO to put more pressure on Member States to report information on international recruitment of health professionals.

She said this would promote fair, equitable and ethical decision-making. She referred to Cuba, which had more than 30,000 doctors working in nearly 70 countries in 2019.

The US called for the investigation of any allegations by health personnel of human trafficking and slave labour conditions. If substantiated those responsible must be held accountable, she said.

Dr Jim Campbell, WHO’s Director of Health Workforce, noted that the global health body will work on the strategic directions on the code of practice, and address the implementation gap.

Image Credits: Tim Kubacki/Flick, UNICEF/Frank Dejongh, Twitter: WHOAFRO.

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