Human resources for health

Migration

Health Workforce Mobility

Global demand for health services is increasing because of ageing populations and the rise of chronic illnesses such as diabetes and heart disease, especially in rural areas. Demand for health workers is increasing in high-income countries, where health systems can depend heavily on doctors, nurses and other health workers who have been trained abroad. Many health workers migrate to high-income countries for a better income, job satisfaction, career opportunities and management quality.

Migration is often stepwise: people tend to move from the poorest regions to richer cities within a country, and then to high-income countries. In most countries, there is also movement from the public to the private sector, particularly if there are considerable differences in income levels.

In a number of middle-income countries with good health education systems – such as Fiji, Jamaica, Mauritius and the Philippines – a significant proportion of students, especially in nursing schools, begin their education with the intention of migrating, usually in search of a better income.

Some countries, notably the Philippines, are capitalizing on the demand for imported health workers by deliberately training graduates for international careers, with the intention that remittances from those workers overseas will help support the domestic economy. However, migration of health workers often weakens health systems in the countries of origin.

Key Facts about health workforce migration

  • There are about over 60 million health workers worldwide;
  • Approximately two-thirds provide health services and the rest are in management and support work;
  • Over the past 30 years, the number of migrant health workers into European countries increased by more than 5% per year in many countries;
  • In countries of the Organisation for Economic Co-operation and Development (OECD), around 20% of doctors come from abroad. In some Gulf States, such as Kuwait or the United Arab Emirates, more than 50% of health workers are migrants;
  • Nurses from the Philippines have historically accounted for the largest share of migrant health workforce in OECD countries; and
  • Over 50% of highly trained health workers leave for better job opportunities abroad in some low-income countries.

Action is required to address the negative effects of migration:

In source countries
  • Better health workforce retention, especially in rural and remote areas;
  • Stronger protection and fairer treatment of health workers, who may face difficult and often dangerous working conditions and poor pay;
  • Improved domestic training of health workers and development of policies that facilitate the return of migrants.
In destination/receiving countries
  • Reduced dependency on migrant health workers, notably through educating and training of more health workers domestically and by making better use of the existing health workforce;
  • Responsible recruitment policies and fair treatment of migrant health workers.

WHO's response

WHO has developed a Global Code of Practice on the International Recruitment of Health Personnel to achieve an equitable balance of the interests of health workers, source countries and destination countries.

The Code of Practice is voluntary, global in scope and applies to all health workers and stakeholders. It sets out principles and encourages the setting of voluntary standards. It promotes an equitable balance of the interests of health workers, source countries and destination countries, with a particular emphasis on redressing the negative effects of health worker migration on countries experiencing a health workforce crisis.

WHO has also developed global recommendations on health workforce retention in remote and rural areas, so that countries can see what options have worked in different settings around the world to attract and retain health workers.