Nurse Migration and Its Impacts on Caribbean Health Care Systems: With Special Focus on St. Lucia and Jamaica

1. Nurse Migration and Its Impacts on Caribbean Health Care Systems: With Special Focus on St. Lucia and Jamaica Dr. Natasha Kay Mortley University of the West Indies, Mona Campus, Jamaica 11th Annual Global Development Network Conference Regional and Global Integration: Que Vadis? Prague January 16 – 18, 2010

2. Kofi Annan: “Health workers save lives. They strive to ensure that advances in health care reach those most in need. They contribute to the social and economic well-being of their countries. And they are essential to their countries’ security by being the first to identify a new disease or a new threat to public health.” (Address delivered on the occasion of World Health Day - The Jamaican Gleaner 7th April 2006)

3. Role of Nurses: Nurses account for 70% of health care staff Create awareness of the multiple and changing determinants of health Lobby for living and working conditions that are safe, stimulating and supportive Promote caring environments that foster support Strengthen community action and involvement in setting priorities, decision-making, planning strategies and implementation to achieve better health Foster joint action for safer products, healthier public services, and cleaner environments

4. Rationale for the study: Unprecedented migration flows among nursing profession Increasing global demand due to increasing ageing populations and increasing demand for nurses in developed countries Orientation towards liberalization of world trade in all services under the GATS Article XIX Raised alarm among Caribbean Community (CARICOM) governments

5. Objectives of the Research: Assess the impacts of nurse migration on health care systems in St Lucia and Jamaica Assess the wide ranging implications for health systems and the developmental goals of the English speaking Caribbean Suggest means of managing nurse migration ( in light of limited resources) in a manner designed to limit negative impacts while optimizing positive effects on health care and wider country Demonstrate the link between the impacts and policy for national development (developmental potential)

6. Data Sources: Secondary data – data obtained from the migration literature, archival and web sources and international institutions dealing with migration Primary data general survey of 150 registered nurses in St. Lucia, Jamaica and the UK In depth interviews with 20 institutional actors (senior registered nurses, managers, hospital administrators and policy makers) Form of triangulation

7. Context of the Study: Absenteeism of nursing personnel due to migration outflows Return migration and intentions to return Linkages with home communities

8. Caribbean Scenario - Nurse Shortage: Nurse Vacancy Rates in Selected Caribbean Countries 2005

9. Health Indicators: Jamaica professional nurse ratio – 16.5 per 10,000 inhabitants St. Lucia professional nurse ration – 22.6 per 10,000 inhabitants North America – 77.3 per 10,000 inhabitants (PAHO 2007)

10. Survey Results - Reasons for migration

11. “It was highlighted that the major reason why nurses are leaving is for opportunities, for professional development and then work conditions came second…” (Interview with President of the St. Lucia Nursing Association November 2005)

12. Views From Some Interviewees: “Sometimes there is nothing to work with. No syringe, no needles, no gauze or drugs for the patient.” (Senior registered nurse, Kingston Public Hospital) “Our offices are not even properly equipped. Insufficient desks and chairs and no computer. We have no technology to work with.” (Junior registered nurse, Golden Hope Hospital)

13. Impacts:“If we were to talk about impacts on the health system, I would say depletion of human resources, a crisis of confidence by the citizenry of the country…on the service, there is the impact of the standard and quality of care being compromised.” (St. Lucia’s Minister of Health 2005)

14. Negative Impacts: Massive shortages of staff Overworked and over burdened staff Low staff morale Deteriorating quality of care Lack of confidence of citizenry in the health care system

15. Positive Impacts: Better planning and efficiency in the health system Challenge for nurses creates greater performance management New skills, technology and experience of returning nurses (knowledge transfer) Remittances (money and equipment/technology) Links and investments from diaspora groups

16. Impacts and Implications for Development: Economic (remittances, financial gains for health care system through economic contributions and other resources) Human Resource Development and Capacity (skill and technology transfers) Social Impacts (social networks and links with diaspora)

17. Developmental Potential of Diaspora: Donations of money and goods to health care systems Initiate community projects (infra structural projects like construction of health center) Assist local government in allocations for public health (greater transparency) Impact of civic participation (empowerment of people)

18. Government Strategies to Manage Nurse Migration Based on Respondents Views Improved remuneration packages and greater economic incentives Improved work conditions Increased training and education in nursing Shared governance Meritocracy

19. Where Do We Go From Here? “Managed migration is a regional strategy for retaining adequate numbers of competent nursing personnel to deliver health programmes and services to the Caribbean nationals at the highest levels, and while doing that, making sure that you have surplus…” (Director School of Advance Nursing, Mona 2005)

20. Aspects of Managed Migration: Managed migration focusing on critical areas: Terms and conditions of work Recruitment Education and training Valuing of nurses Utilization and deployment of nurses Shared governance Policy and health sector reform

21. Policy Implications: Increasing retirement age and return of retired nurses Train more nurses locally and for export Greater representation of nurses at decision-making and policy level (Nursing Associations) Greater valuing of nursing profession Actively attract Caribbean nurses back home through incentives and meritocratic system (freq appraisals and promotion opp) Bi lateral agreements with main destination country governments Continuing education of all stakeholders Employer inputs and support

22. Conclusions: Paper links statistics, in-depth interviews and policy questions Institutional actors are those who live and experience the problem and their input in future strategies is key While negative impacts are evident in short term, positive impacts can be seen in the longer term Impacts have further implications for development policy There is need to nurture positive impacts in order to mitigate negative effects and make health care more sustainable

23. Thank you Prague, Czech Republic 2010