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Yakubu K, Durbach A, van Waes A, Mabunda SA, Peiris D, Shanthosh J, Joshi R. Governance systems for skilled health worker migration, their public value and competing priorities: an interpretive scoping review. Glob Health Action 2022; 15:2013600. [PMID: 35037590 PMCID: PMC8765257 DOI: 10.1080/16549716.2021.2013600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Governments worldwide participate in skilled health worker (SHW) migration agreements to protect access to health services in their countries. Previous studies have described the value offered by these agreements in separate source and destination country perspectives. OBJECTIVE We sought to identify and summarise existing literature on shared value creation for both source and destination countries. METHOD We conducted a systematic scoping review of health databases and grey literature. Using Mark Moore and Colin Talbot frameworks, we summarised the public value propositions in migration agreements and how state actors addressed competing priorities. RESULTS Most articles (34/63, 53.9%) reported transnational SHW mobility as the public value proposition for source and destination countries. Fewer articles, 14 (22.2%) and 9 (14.3%) articles, respectively, referred to achieving health workforce sustainability and building capacity for SHW migration governance as shared public values. The most identified competing public value (CPV) was an overriding focus on addressing SHW shortages in destination countries (20/63, 37.7%). Efforts to address this CPV include mitigation of the adverse effects of migration (43/63, 68.3%) and promoting health workforce development in source countries (15, 23.8%). At the same time, state actors retained regulatory discretion for protecting their country's public health interest (34, 54%). Most articles reported the lack of funds (15/63, 23.8%) and implementation mechanisms (19/63, 30.2%) as constraints on the authorising environment and the operational capacity of SHW migration governance systems. CONCLUSION Regarding SHW migration governance, the literature reports shared public value propositions for source and destination countries. It also shows how the value-creating process in the management of SHW migration favours destination countries. Future studies will need to explore shared value creation models that ensure equity in the governance of SHW migration.
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Affiliation(s)
- Kenneth Yakubu
- Faculty of Medicine, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrea Durbach
- Australian Human Rights Institute, Faculty of Law and Justice, University of New South Wales, Sydney, Australia
| | | | - Sikhumbuzo A. Mabunda
- Faculty of Medicine, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - David Peiris
- Faculty of Medicine, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Janani Shanthosh
- Faculty of Medicine, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Australian Human Rights Institute, Faculty of Law and Justice, University of New South Wales, Sydney, Australia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Health Systems Science, The George Institute for Global Health India, New Delhi, India
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Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010751. [PMID: 34682492 PMCID: PMC8535610 DOI: 10.3390/ijerph182010751] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/31/2022]
Abstract
In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.
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Silvestri DM, Blevins M, Wallston KA, Afzal AR, Alam N, Andrews B, Derbew M, Kaur S, Mipando M, Mkony CA, Mwachaka PM, Ranjit N, Vermund SH. Nonacademic Attributes Predict Medical and Nursing Student Intentions to Emigrate or to Work Rurally: An Eight-Country Survey in Asia and Africa. Am J Trop Med Hyg 2017; 96:1512-1520. [PMID: 28719284 PMCID: PMC5462594 DOI: 10.4269/ajtmh.16-0756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/21/2017] [Indexed: 11/07/2022] Open
Abstract
AbstractWe sought to identify independent, nonacademic predictors of medical and nursing student intent to migrate abroad or from rural to urban areas after graduation in low- and middle-income countries (LMIC). This was a cross-sectional survey of 3,199 first- and final-year medical and nursing students at 16 training institutions in eight LMIC. Questionnaires assessed demographics, career intentions, and preferences regarding selected career, location, and work-related attributes. Using principal component analysis, student preferences were reduced into four discrete categories of priorities: 1) work environment resources, 2) location livability, 3) altruistic job values, and 4) individualistic job values. Students' preferences were scored in each category. Using students' characteristics and priority scores, multivariable proportional odds models were used to derive independent predictors of intentions to emigrate for work outside the country, or to work in a rural area in their native country. Students prioritizing individualistic values more often planned international careers (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.16-1.78), whereas those prioritizing altruistic values preferred rural careers (aOR = 1.82, 95% CI = 1.50-2.21). Trainees prioritizing high-resource environments preferentially planned careers abroad (aOR = 1.38, 95% CI = 1.12-1.69) and were unlikely to seek rural work (aOR = 0.60, 95% CI = 0.49-0.73). Independent of their priorities, students with prolonged prior rural residence were unlikely to plan emigration (aOR = 0.67, 95% CI = 0.50-0.90) and were more likely to plan a rural career (aOR = 1.53, 95% CI = 1.16-2.03). We conclude that use of nonacademic attributes in medical and nursing admissions processes would likely increase retention in high-need rural areas and reduce emigration "brain drain" in LMIC.
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Affiliation(s)
| | - Meridith Blevins
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kenneth A. Wallston
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Arfan R. Afzal
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Nazmul Alam
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Ben Andrews
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Miliard Derbew
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Simran Kaur
- Department of Physiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, Delhi, India
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | | | - Charles A. Mkony
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Nirju Ranjit
- Department of Anatomy, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Sten H. Vermund
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Kurniati A, Chen CM, Efendi F, Ogawa R. A deskilling and challenging journey: the lived experience of Indonesian nurse returnees. Int Nurs Rev 2017; 64:494-501. [PMID: 28168716 DOI: 10.1111/inr.12352] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To illuminate the lived experiences of Indonesian nurses who previously worked as caregivers in Japanese residential care facilities, by exploring the journey of becoming returnees. BACKGROUND The creation of bilateral agreements between Indonesia and Japan has facilitated the movement of Indonesian nurses to work as caregivers in Japan since 2008. While this decision raised concerns with regard to the degradation of nursing skills, little is known about this issue from the perspective of nurse returnees and how the experience affects their life. METHOD A hermeneutic phenomenological method was employed for this study. A purposive sample of 15 Indonesian nurse returnees participated in this study. Semi-structured interviews were conducted in four of Indonesia's provinces between August and October 2015. Data were analysed thematically, supported by QSR NVIVO 10 software. FINDINGS Four key themes emerged from the data analysis: (i) returning home; (ii) going back to zero; (iii) walking through a difficult journey; and (iv) overcoming barriers. These findings described the lived experiences of nurse returnees when they got back to the country of origin. CONCLUSION Indonesian nurse returnees experienced deskilling and struggled to re-enter the nursing profession or to find other non-nursing jobs. The significant impact of this migration on individual nurses with regard to maximizing the benefits of return migration deserves further investigation. IMPLICATION FOR NURSING AND HEALTH POLICY The Indonesian government, jointly with other stakeholders, should develop a brain gain strategy to align returnees' expertise with the needs of the national labour market. The public-private partnership should be strengthened to utilize returnees in healthcare services.
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Affiliation(s)
- A Kurniati
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Center for Planning and Management of Human Resources for Health, The Board for Development and Empowerment of Human Resources for Health (BPPSDMK), Ministry of Health, Jakarta, Indonesia
| | - C-M Chen
- Department of Nursing, Institute of Gerontology, Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - F Efendi
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Faculty of Nursing, Airlangga University, Surabaya, Indonesia
| | - R Ogawa
- Graduate School of Social and Cultural Studies, Kyushu University, Japan
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Tam V, Edge JS, Hoffman SJ. Empirically evaluating the WHO global code of practice on the international recruitment of health personnel's impact on four high-income countries four years after adoption. Global Health 2016; 12:62. [PMID: 27729049 PMCID: PMC5059925 DOI: 10.1186/s12992-016-0198-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 09/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Shortages of health workers in low-income countries are exacerbated by the international migration of health workers to more affluent countries. This problem is compounded by the active recruitment of health workers by destination countries, particularly Australia, Canada, UK and USA. The World Health Organization (WHO) adopted a voluntary Code of Practice in May 2010 to mitigate tensions between health workers’ right to migrate and the shortage of health workers in source countries. The first empirical impact evaluation of this Code was conducted 11-months after its adoption and demonstrated a lack of impact on health workforce recruitment policy and practice in the short-term. This second empirical impact evaluation was conducted 4-years post-adoption using the same methodology to determine whether there have been any changes in the perceived utility, applicability, and implementation of the Code in the medium-term. Methods Forty-four respondents representing government, civil society and the private sector from Australia, Canada, UK and USA completed an email-based survey evaluating their awareness of the Code, perceived impact, changes to policy or recruitment practices resulting from the Code, and the effectiveness of non-binding Codes generally. The same survey instrument from the original study was used to facilitate direct comparability of responses. Key lessons were identified through thematic analysis. Results The main findings between the initial impact evaluation and the current one are unchanged. Both sets of key informants reported no significant policy or regulatory changes to health worker recruitment in their countries as a direct result of the Code due to its lack of incentives, institutional mechanisms and interest mobilizers. Participants emphasized the existence of previous bilateral and regional Codes, the WHO Code’s non-binding nature, and the primacy of competing domestic healthcare priorities in explaining this perceived lack of impact. Conclusions The Code has probably still not produced the tangible improvements in health worker flows it aspired to achieve. Several actions, including a focus on developing bilateral codes, linking the Code to topical global priorities, and reframing the Code’s purpose to emphasize health system sustainability, are proposed to improve the Code’s uptake and impact.
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Affiliation(s)
- Vivian Tam
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jennifer S Edge
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, 57 Louis Pasteur St, Ottawa, ON, K1N 6N5, Canada. .,Department of Clinical Epidemiology & Biostatistics and McMaster Health Forum, McMaster University, Hamilton, ON, Canada. .,Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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Bärnighausen T, Bloom DE, Humair S. Human Resources for Treating HIV/AIDS: Are the Preventive Effects of Antiretroviral Treatment a Game Changer? PLoS One 2016; 11:e0163960. [PMID: 27716813 PMCID: PMC5055321 DOI: 10.1371/journal.pone.0163960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022] Open
Abstract
Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART's prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it. We develop a mathematical model to analytically study the net effects of these countervailing factors. Using South Africa as a case study, we find that contrary to previous results, universal ART coverage is achievable even with current HRHA numbers. However, larger health gains are possible through a surge-capacity policy that aggressively recruits HRHA to reach universal ART coverage quickly. Without such a policy, TasP roll-out can increase health losses by crowding out sicker patients from treatment, unless a surge capacity exclusively for TasP is also created.
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Affiliation(s)
- Till Bärnighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), Mtubatuba, KwaZulu Natal, South Africa
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - David E. Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Salal Humair
- Amazon.com, Inc., Seattle, Washington, United States of America
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Bourgeault IL, Labonté R, Packer C, Runnels V, Tomblin Murphy G. Knowledge and potential impact of the WHO Global code of practice on the international recruitment of health personnel: Does it matter for source and destination country stakeholders? HUMAN RESOURCES FOR HEALTH 2016; 14:25. [PMID: 27381004 PMCID: PMC4943484 DOI: 10.1186/s12960-016-0128-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The WHO Global Code of Practice on the International Recruitment of Health Personnel was implemented in May 2010. The present commentary offers some insights into what is known about the Code five years on, as well as its potential impact, drawing from interviews with health care and policy stakeholders from a number of 'source' and 'destination' countries.
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Affiliation(s)
- Ivy Lynn Bourgeault
- Telfer School of Management, University of Ottawa, 1 Stewart St, Ottawa, ON, K1N6N5, Canada.
| | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Corinne Packer
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vivien Runnels
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gail Tomblin Murphy
- WHO/PAHO Collaborating Centre Health Workforce Planning and Research, School of Nursing, Dalhousie University, Halifax, NS, Canada
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van de Pas R, Mans L, de Ponte G, Dambisya Y. The Code of Practice and its enduring relevance in Europe and Eastern and Southern Africa. HUMAN RESOURCES FOR HEALTH 2016; 14:30. [PMID: 27381472 PMCID: PMC4943475 DOI: 10.1186/s12960-016-0122-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The relevance and effectiveness of the WHO Global Code of Practice on the International Recruitment of Personnel will be reviewed by the World Health Assembly in 2015. The origins of the Code of Practice and the global health diplomacy process before and after its adoption are analyzed herein. METHODS AND RESULTS Case studies from the European and eastern and southern African regions describe in detail successes and failures of the policy implementation of the Code. In Europe, the Code is effective and even more relevant than before, but might require some tweaking. In Eastern and Southern Africa, the code is relevant but far from efficient in mitigating the negative effects of health workforce migration. CONCLUSIONS Solutions to strengthen the Code include clarification of some of its definitions and articles, inclusion of a governance structure and asustainable and binding financing system to reimburse countries for health workforce losses due to migration, and featuring of health worker migration on global policy agendas across a range of institutional policy domains.
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Affiliation(s)
- Remco van de Pas
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Linda Mans
- Wemos Foundation, P.O. Box 1693, 1114 AK, Amsterdam, The Netherlands
| | - Giulia de Ponte
- Amref Health Africa Onlus, via Alberico II, n.4, 00193, Rome, Italy
| | - Yoswa Dambisya
- ECSA Health Community Secretariat, 157 Olorien, Njiro Road, P.O. Box 1009, Arusha, Tanzania
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Heimburger DC, Carothers CL, Blevins M, Warner TL, Vermund SH. Impact of Global Health Research Training on Career Trajectories: The Fogarty International Clinical Research Scholars and Fellows Program. Am J Trop Med Hyg 2015. [PMID: 26195466 DOI: 10.4269/ajtmh.14-0705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
From 2004 to 2012, the Fogarty International Clinical Research Scholars/Fellows Program (FICRS-F) provided 1-year research training opportunities for U.S. and international doctoral "Scholars" and postdoctoral "Fellows" at low- and middle-income country (LMIC) centers. We collected data prospectively and then surveyed a representative sample of 100 alumni (94% response), assessing Program impacts on their careers and collaborations. Frequently, collaborations continued beyond the formal training period with U.S.- (63%) and site-based mentors (66%). U.S. Fellows reported the highest post-training focus on research (88 on a 100-point scale), and the highest Program impact on competitiveness for career or training positions and choices of post-training topics and institutions (95 points). Interest in global health research increased markedly during the training period, especially for LMIC trainees, and was sustained post-training. LMIC alumni reported a significantly higher focus on global health and research than did U.S. alumni. Alumni reported that their mentored research training had a substantial impact on their career trajectories.
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Affiliation(s)
- Douglas C Heimburger
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Catherine Lem Carothers
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Meridith Blevins
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Tokesha L Warner
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Sten H Vermund
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
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Vermund SH, Sheldon EK, Sidat M. Southern Africa: the Highest Priority Region for HIV Prevention and Care Interventions. Curr HIV/AIDS Rep 2015; 12:191-5. [PMID: 25869940 PMCID: PMC4536916 DOI: 10.1007/s11904-015-0270-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The global HIV pandemic began to expand rapidly in southern Africa a decade later than was noted in central Africa, Europe, the Caribbean, and North America. Multiple factors played a role in this rapid expansion which led Southern Africa to become the most heavily afflicted region for HIV/AIDS globally. In this issue of Current HIV/AIDS Reports, investigators with active research interests in the region have reviewed key elements of the causes of and responses to the epidemic. Putative causes of the high HIV prevalence in the region are discussed, including host and viral biology, human behavior, politics and policy, structural factors, health services, health workforce, migration, traditional healers' role, and other issues. Regional epidemiological trends are described and forecasted. Issues related to the continuum of HIV care and treatment are highlighted. We hope that the reviews will prove useful to those policymakers, health care workers, and scientists who are striving to reduce the burden of HIV in the southern African region, as well as prove insightful for key issues of broader global relevance.
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Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute of Global Health, Vanderbilt University School of Medicine, 2525 West End Ave., Suite 750, Nashville, TN, 37203, USA,
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Tankwanchi ABS, Vermund SH, Perkins DD. Monitoring Sub-Saharan African physician migration and recruitment post-adoption of the WHO code of practice: temporal and geographic patterns in the United States. PLoS One 2015; 10:e0124734. [PMID: 25875010 PMCID: PMC4395332 DOI: 10.1371/journal.pone.0124734] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/03/2015] [Indexed: 10/28/2022] Open
Abstract
Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians' locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician "brain drain", it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians.
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Affiliation(s)
- Akhenaten Benjamin Siankam Tankwanchi
- Program in Community Research and Action, Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Douglas D. Perkins
- Program in Community Research and Action, Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee, United States of America
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12
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Silvestri DM, Blevins M, Afzal AR, Andrews B, Derbew M, Kaur S, Mipando M, Mkony CA, Mwachaka PM, Ranjit N, Vermund S. Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa. Bull World Health Organ 2014; 92:750-9. [PMID: 25378729 PMCID: PMC4208487 DOI: 10.2471/blt.14.136051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/09/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess medical and nursing students' intentions to migrate abroad or practice in rural areas. METHODS We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students' intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models. FINDINGS Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25-2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21-6.29) and rural (OR: 4.84; 95% CI: 3.52-6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19-1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50-0.96). CONCLUSION A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.
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Affiliation(s)
- David M Silvestri
- Vanderbilt University Institute for Global Health, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 750, Nashville, Tennessee, 37203, United States of America (USA)
| | - Meridith Blevins
- Vanderbilt University Institute for Global Health, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 750, Nashville, Tennessee, 37203, United States of America (USA)
| | - Arfan R Afzal
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ben Andrews
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Miliard Derbew
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Simran Kaur
- Department of Physiology, Maulana Azad Medical College, New Delhi, India
| | | | - Charles A Mkony
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Nirju Ranjit
- Department of Anatomy, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Sten Vermund
- Vanderbilt University Institute for Global Health, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 750, Nashville, Tennessee, 37203, United States of America (USA)
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