The Feminization of Health Care Migration

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Women pay the cost of global restructuring

From Public Service International’s (PSI) Migration and Women Health Workers Project and BC Government and Service Employees Union (BCGEU)

The failure of many rich countries to develop their own human resources for health has led them to resort to large scale international recruitment to address their health staffing needs. At the same time, failed reforms and decreased spending in public health in both home and host countries have led to the departure of health care workers to find other employment, or to work abroad. Today, virtually every country in the world records a shortage of health staff. It is women—both as workers and carers—who must bear the brunt of this situation.

Sub-Saharan Africa needs around 620,000 more nurses to tackle its HIV/AIDS epidemic. The size of the Tanzanian health workforce must triple in order to deliver priority interventions to the majority of its population by 2015. In Chad it must quadruple. In Botswana, health officials say that achieving universal coverage of antiretroviral treatment alone would require doubling the current nurse workforce, tripling the number of physicians and quintupling the number of pharmacists.

Still, every year Africa sees an exodus of around 23,000 health professionals, many of them women.

Structural changes in the global economy, such as public sector reforms, privatization, and the liberalization of trade and investment have led to a decline in the quality and investment in the public health sector worldwide. In richer countries, many have left the health care sector because of deteriorating working conditions and pressures of poorly financed health care systems. To temporarily address the gap in their human resources, these countries increasingly recruit health workers and professionals in huge numbers from developing countries, where the health situation is already worse and the human resource badly needed. Women comprise the majority of health care workers and the main users of public services, and are most negatively affected by this phenomenon.

Structural reforms have dealt women with heavier workloads, lower and inequitable wages, violence in the workplace, inadequate resources, and greater care-giving responsibilities within their families, increasing the number of women who migrate for work.

Overall, women comprise around half of those who migrate for work around the world, in what is known as the growing ‘feminization of migration’. Public Service International’s (PSI) Migration and Women Health Workers Project, which brings together the public sector unions of 16 participating countries, reveals that health work is no different—women migrant health workers fulfill much of the staffing needs of health systems in receiving countries.

Yet in many cases, these women health workers are badly treated, subjected to poor working conditions and compounded workload pressures. They face gender and racial discrimination, and are often misinformed about their rights by recruitment agencies in their host countries, such as being told it is illegal to join a union. As well, they are often led to believe they are coming to the host country to practice in their field of health care but end up working in a lower position at less pay. Frequently, they encounter financial difficulties due to lower than expected earnings and igher than expected cost of living in their host country. They often experience serious depression due to the isolation—most of them have left spouses and children behind. Finally, many are seen as deserters, and face exclusion upon returning to their home countries.

Meanwhile, the evacuation of workers has an obvious degrading effect on the health systems of sending countries, resulting not only in domestic health care worker shortages and decreased quality of care, often in the face of growing health crises, but also in a loss of control over national health care planning, not to mention the hidden social costs of dismantled family support systems. Participants at the Project’s partnership meetings in Barbados, the Philippines and Kenya observed that health worker poaching has left some hospital wards with a ratio of two nurses to 80 patients, with two patients occupying most beds. Nurses often spend a whole shift simply trying to get medication for a patient. Hospital administrators have difficulty providing work schedules as health workers do not notify the hospital about their plans to leave for another country.

The Migration and Women Health Workers Project has launched a series of joint actions to eliminate exploitative and discriminatory recruitment and employment practices in the health care sector, and to advocate for increased spending in health care and human resources for health, ethical recruitment practices and compensation mechanisms. One of its campaigns urges the governments of both host and sponsoring countries to support the development, adoption, implementation and monitoring of Ethical Recruitment Guidelines such as the proposed World Health Organization (WHO) Code of Practice on the international recruitment of health personnel. Another goal is to establish measures to compensate sending countries for the investment made in training and educating health workers, and to review and critique migration/poaching policies and activities.

At the same time, the Project is developing pre-departure and post-arrival orientation resources (activities, materials, kits), as well as organizing women migrant health workers into unions to better protect their rights, formulating union policies on migration and recruitment, and developing greater bilateral cooperation between unions in sending and receiving countries.

Anne-Marie DeLorey is Canadian coordinator of PSI’s Migration and Women Health Workers Project.

PSI is a global federation of unions representing 20 million workers involved in the delivery of public services in 150 countries around the world. An estimated 65% of PSI’s members are women.

For more information on the Migration and Women Health Workers Project, visit: