LUSAKA, Zambia – There are few nurses in Zambia’s capital with the skills and experience of Alex Mulumba, who works in the operating room at a critical care hospital. But he has recently learned, through a series of social media posts and LinkedIn solicitations, that far-flung places are also eager for his expertise – and will pay him. more than $415 per month (including $8 health risk bonus) he earns Currently.
Mr. Mulumba, 31, is considering those options, especially Canada, where his friends have immigrated and quickly found work. “You have to build something with your life,” he said.
Canada is among many wealthy countries, including the United States and United Kingdom, actively recruiting healthcare workers from developing countries to replenish the healthcare workforce that is severely depleted by the Covid-19 pandemic. The strong urgency and pull from high-income countries – including countries like Germany and Finland, which previously did not recruit health workers from abroad – has reduced the migration patterns and raises new questions about the ethics of recruiting from countries with weak health systems during the pandemic.
“We absolutely see an increase in international migration,” said Howard Catton, executive director of the International Council of Nurses. However, he added, “The risk is high that you are recruiting nurses from countries that are least likely to lose their nurses.”
Sinead Carbery, president of O’Grady Peyton International, an international recruitment company, says about 1,000 nurses come to the United States each month from African countries, the Philippines and the Caribbean. While the United States has long attracted nurses from abroad, she said demand from American healthcare facilities is the highest she has seen in three decades. An estimated 10,000 foreign nurses with job offers in the United States are on waiting lists for interviews at US embassies around the world for the required visas.
Since mid-2020, the number of international nurses registered to practice in the UK has increased, “indicating that this year is the highest in 30 years in terms of numbers”, says James Buchan, a senior fellow from the Ministry of Health said. Foundation, a British charity that advises the World Health Organization and national governments on the movement of healthcare workers.
“There are 15 nurses in my unit and half are filing,” said Mike Novela, a senior neonatal nurse in the Philippines who has been temporarily appointed to run the Covid department at a major hospital in Manila. application to work abroad. “In six months, they’re leaving.”
As the pandemic enters its third year and infections from the Omicron variant increase around the world, health worker shortages are a growing concern everywhere. Up to 180,000 people have died from Covid, According to WHO. Others have exhausted themselves or given up in frustration due to factors such as a lack of personal protective equipment. About 20 percent in the United States have left their jobs during the pandemic. WHO has recorded strikes and other labor actions by health workers in more than 80 countries over the past year – numbers that would normally be seen in a decade. In both developing and wealthy countries, the decline of the medical workforce has made patient care expensive.
European and North American countries have created express immigration pathways specifically for healthcare workers and have expedited processes for the recognition of foreign qualifications.
The British government has introduced a “health and care visa” in 2020, target and fast-track foreign healthcare workers to fill vacancies. The program includes benefits such as reduced visa costs and faster processing.
Canada has relaxed language requirements for residency and has accelerated the process of recognizing the qualifications of foreign-trained nurses. Japan is providing a pathway of residence for people who care for the elderly temporarily. Germany is allowing doctors trained abroad to directly transition into physician assistant positions.
In 2010, WHO member states adopted a Global Code of Practice for the International Recruitment of Health Workers, driven in part by the migration of nurses and doctors from countries in Africa. Sub-Saharan Africa is ravaged by AIDS. African governments have expressed frustration that their universities have produced public-funded doctors and nurses who have been drawn to the US and UK soon after their training. adequate, with wages that the home country can never match.
The code recognizes the right to migrate of individuals but calls for rich countries to recruit through bilateral arrangements, with the participation of the health ministry in the country of origin.
In exchange for the organized recruitment of healthcare workers, the destination country needs to provide support for the health care initiatives designated by the source country. Destination countries must also offer “learn and come back,” in which healthcare workers with new skills will return home after a period of time.
But Mr Catton, of the international organization of nurses, says that is not the current model. “As for the nurses who are employed, they have no intention of coming back, often quite the opposite: They want to set up a career in another country and bring their family to join them,” he said.
On paper, Zambia has a surplus of nurses – thousands of nursing school graduates are unemployed, even though the new government has pledged to hire 11,200 health workers this year. But it is veteran nurses like Lillian Mwape, the chief nursing officer of the hospital where Mr. Mulumba works, that are most sought after by employers.
“People are leaving all the time, whose inboxes are flooded with emails from employers telling how quickly she can get a visa to the US,” Ms. Mwape said.
The real consequence, she said, is “we are disabled.”
“Those are the most skilled nurses we’ve lost and you can’t replace them,” Ms. Mwape said. “Now in the ICU we can have four or five trained critical care nurses, where we should have 20 nurses the rest are routine nurses, and they can’t shoulder the burden of Covid. .”
Dr Brian Sampa, a general practitioner in Lusaka, recently started a language test as the first step towards immigrating to the UK. He is the head of the doctors association and is well aware of how valuable doctors are in Zambia. There are less than 2,000 doctors working in the public sector – on which the vast majority of people depend – and 5,000 across the country, he said. There is one doctor for every 12,000 people; WHO recommends a minimum of one in 1,000.
20 Zambian doctors have died from Covid. In Dr. Sampa’s last job, he was the only doctor in a district of 80,000 people and he often spent nearly 24 hours in the operating room performing emergency surgeries, he said.
The pandemic has made him unhappy about Zambia’s health system. He describes his days treating critically ill Covid patients as he scours the hospital to find just a single C-clamp needed to run the oxygen delivery equipment. He makes a little less than $1000 a month.
“Clearly there are more advantages to leaving than staying,” said Dr. Sampa. “So for those of us who are staying, it’s just because there are things holding us back, not because we’re comfortable where we are.”
Health care worker migration – often from low-income countries to high-income countries – was growing well before the pandemic; Dr Giorgio Cometto, a health workforce issues expert working with WHO, said it had grown 60 per cent in the decade to 2016.
The Philippines and India have been deliberately recruiting too many nurses over the years with the intention of sending them abroad to earn and send money home; nurses from these two countries make up almost the entire workforce of several Persian Gulf countries. But now the Philippines is reporting shortages in the country. Noveda, a nurse in Manila, said his colleagues, exhausted by the pandemic that required 24-hour shifts, had quit in record numbers.
However, moving across borders is more complicated during the pandemic, and immigration has slowed dramatically, leaving many potential workers and employers in limbo.
While some countries are sincere about bilateral arrangements, that is not the only level where recruitment takes place. “What we hear over and over again is that recruitment companies advertise in the country and speak directly to nurses offering very attractive packages,” said Mr. Catton.
The UK has a “red list” of countries with weak health systems that it will not employ for its National Health Service. But some healthcare workers have overcome that by entering the UK first with a position through an agency staffed by private nursing homes, for example. Then, when they were established in the UK, they moved to the NHS, which paid better.
Michael Clemens, an expert on international migration from developing countries at the Center for Global Development in Washington, says there is growing alarm about the influx of healthcare workers from developing countries at risk of leaving the country. through the rights of individuals.
“Giving someone a life-changing career opportunity for themselves, one that can make a huge difference to their children, is not a moral crime,” he said. “It was an act with complicated consequences.”
The UK has fallen into a pandemic with 1 in 10 nursing jobs vacant. Mr. Catton said some countries are making overseas recruitment a core part of their staffing strategy, not just using it as a pandemic stopper. If that is the plan, he said, then recruiting countries must more closely monitor the impact on the source country and calculate the costs incurred by the country that trains those nurses.
Alex Mulumba, a Zambian operating room nurse, says that if he comes to Canada, he won’t stay forever, just five or six years to save some money. He won’t bring his family because he wants to keep his relationship with home.
“This is my country, and I have to try to do something about it,” he said.
Miriam Jordan in Los Angeles and Cora Engelbrecht in London contributed reporting.
https://www.nytimes.com/2022/01/24/health/covid-health-worker-immigration.html Wealthy countries attract healthcare workers from low-income countries to combat shortages