With many persons opting to leave the region for better working conditions, higher salaries, better job security and even a better mental state of mind, the migration of health workers from the Caribbean and in most countries in the OECS, is critical. The migration and shortages of health care workers in the Region are impacting on health systems and services.

“The undersupply of these practitioners will impact negatively on both the quality and sustainability of health systems, especially in the smaller islands of the region,” said Jessie Schutt-Aine, coordinator of the PAHO Subregional Program for the Eastern Caribbean.

The following figures based on Health Workforce Migration, show the flows of professional doctors and nurses from independent territories in the Caribbean to Canada, the United Kingdom and the United States, 2002-2015:

                                                                                                                                                                  Source: Health Workforce Migration, OECD. Stat

In 2015, of the Caribbean non-Puerto Rican immigrants in the United States aged 25 and up, 13.5% had an undergraduate degree and 6.7% a postgraduate degree. For Puerto Rican immigrants these percentages were higher, standing at 16.6% and 10.1%, respectively.

As for doctors, their flow has been increasing, especially to the United States (Figure 5.1), which has resulted in a significant increase in stocks. The number of doctors trained in the Caribbean (excluding Puerto Rico), increased two-fold in Canada and the United States between 2006 and 2015, going from 407 to 850 in Canada and from 15,305 to 31,521 in the United States, and increased six-fold in the United Kingdom, going from 84 to 493.

These are some of the recommendations to be considered in all countries - depending on context- based on the Global Strategy on Human Resources for Health - Workforce 2030:

  • Strengthen health systems by making use of “big data”. Approaches to gain a better understanding of the health workforce, including its size, characteristics and performance to generate insights into gaps and possibilities for health workforce strengthening. Countries should invest resources to ensure they have the capacity to analyze and use the data for local decision-making, and serve as a platform to share and advocate best practices.
  • Enhance and promote the safety and protection of medical and health personnel. Develop effective preventive measures to enhance and promote the safety and protection of medical and health personnel, as well as respect for their respective professional codes of ethic.
  • Optimize health worker motivation, satisfaction, retention, equitable distribution and performance. Develop strategies to improve both performance and equitable distribution of health workers. Such an integrated package of gender-sensitive attraction and retention policies includes: job security, a manageable workload, supportive supervision and organizational management, continuing education and professional development opportunities, enhanced career development pathways, family and lifestyle incentives, hardship allowances, housing and education allowances and grants, adequate facilities and working tools, and measures to improve occupational health and safety, including a working environment free from any type of violence, discrimination and harassment.
  • Professional councils should collaborate with governments to implement effective regulations for improved workforce competency, quality and efficiency. Governments, professional councils and associations should work together to develop appropriate task-sharing models and inter-professional collaboration, and ensure that all cadres with a clinical role, beyond dentists, midwives, nurses, pharmacists and physicians, also benefit in a systematic manner from accreditation and regulation processes.
  • Invest in the education and training, recruitment, deployment and retention of health workers to meet national and subnational needs through domestically trained health workers. Educational investment strategies should match current and anticipated needs of the health system and health labour market.
  • Increase investments to boost market-based demand and supply of the health workforce, and align them more closely with population health needs. This includes appropriate strategies and incentives to deploy health workers in underserved areas.
  • Ensure that all countries have a Human Resources for Health (HRH) unit or department reporting to a senior level within the Ministry of Health. Such a unit should have the capacity, responsibility, financing and accountability for a standard set of core functions of HRH policy (analyze workforce data and labour economics, effectively track international mobility of health workers, managing migratory flows to maximize benefits for source, reward systems and career structures for health workers).

The problem is global in nature, with health workforce mobility increasing to meet the estimated 40 million new health care jobs required to achieve the Sustainable Development Goals related to health by 2030, according to the latest projections from WHO and the World Bank. That is why we urge countries to increase public investment in human resources for health, especially at the first level of care.