WHO Raises Alarm Over Increased Healthcare Worker Migration To Rich Countries Post Pandemic

Healthcare workers
Countries rich and poor suffered during the COVID pandemic due to healthcare worker shortages, but rich countries were able to import more workers.

Eight more countries in the global south have dangerously low numbers of healthcare workers in the wake of the COVID pandemic, a new WHO report has found. 

The World Health Organization’s 2023 report on “Health workforce support and safeguards” found that some 55 countries now rank below the global median in terms of their density of doctors, nurses and midwives per capita. 

That is in comparison to 47 countries in 2020 when the last report was produced, based on data collected just prior to the outbreak of the COVID pandemic. 

The WHO report series tracks countries where the number of professionally trained healthcare workers falls below the global median of 49 per 10,000 population. It also examines countries’ rankings in terms of a Universal Health Service coverage index. 

The negative health, economic and social impacts of COVID-19, coupled with the increased demand for healthcare workers in high-income countries experienced during the pandemic, likely helped trigger more outward migration of healthcare workers from countries that are already suffering from low health workforce densities, the report found. 

“Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems do not have enough and many are losing their health workers to international migration,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a press release that accompanied the report

Rich countries still falling short on global code of practice for international recruitment of health professionals 

The outward migration of healthcare workers from low or middle income countries in search of better wages and working conditions is a longstanding issue, which has only become more serious as the global workforce becomes more mobile generally. 

For instance, the proportion of foreign-trained physicians increased from 32% in 2010 to 36% in 2020, in eight OECD countries already blessed with a high density of healthcare workers.

The voluntary Global Code of Practice for the International Recruitment of Health Personnel, adopted at the 2010 World Health Assembly, aims to curb aggressive recruitment of healthcare workers from the global south by rich countries – as well as supporting fair and transparent employment terms for those who do choose to migrate elsewhere.  

Healthcare Workers
Factors acting on healthcare workers demand and supply in the market.

Accompanying the code, WHO was mandated to track and periodically update member states on trends in health workforce numbers in countries deemed “vulnerable”, as well as examining how such worker migration is affecting progress toward the goal of Universal Health Coverage. 

Since 2010, member-states have reported every three years on data and trends regarding international migration of healthcare workers. 

The fourth round of review was launched in May 2021 against the background of the COVID-19 pandemic, which caused severe disruptions to healthcare services in many countries, as well as increasing rich countries’ reliance on international healthcare workers, the report stated. 

African countries are the hardest hit 

Among the countries that recently joined the list of those with vulnerable health workforces are Rwanda, Comoros, Zambia and Zimbabwe in the African region; Timor-Leste in the South-East Asia region; and Lao People’s Democratic Republic, Samoa and Tuvalu in the Western Pacific region of the WHO. 

Among all 55 countries with sub-par numbers of health care workers, 37 are WHO’s Africa region, eight in the Western Pacific region, six in the Eastern Mediterranean region, three in south-east Asia region and one country in the agency’s Americas region, the report found.  All of these countries have a healthcare workforce density of less than 49 workers per 10,000 people. 

These countries also rank at 55 or less on WHO’s Universal Health Coverage (UHC) service coverage index – which tracks access to key, lifesaving services on a scale of 0, to 100. Service coverage is calculated as the average of 14 “tracer indicators” for access to four broad groups of health services: reproductive, maternal, newborn and child health; infectious diseases;  noncommunicable diseases; and service capacity and access. 

Policy research has documented the linkages between the size of a country’s healthcare workforce and health outcomes. And the global data collected by WHO also shows a strong association between health workforce density, and UHC coverage rankings overall. 

Healthcare workers
Healthcare workforce density per 10,000 population. The countries in the blue rectangle are the ones added in the updated list, with healthcare worker density less than 55 per 10,000 population.

Approximately 15% of health care workers globally are working outside of their country of birth, WHO has found. But this varies widely by region – with the proportion of foreign-trained nurses reaching 70% to 80% in some affluent Gulf countries in WHO’s Eastern Mediterranean Region. About 10-12% of foreign trained doctors and nurses hail from countries deemed vulnerable by WHO due to their lack of sufficient numbers of indigenous healthcare workers.  

While the 2010 WHA resolution did not prohibit international recruitment of healthcare workers, it calls on the countries, particularly the high income countries, to ensure that their recruitment does not adversely affect the healthcare systems and delivery of healthcare services in the source countries. 

Call to countries to reduce adverse effects of international recruitment 

The WHO also recommends that healthcare workers migration agreements signed between two governments should explicitly ensure that benefits to the source country are “commensurate and proportionate” to the benefits accrued by the healthcare system of the destination country. 

It also recommends that such safeguards be applied to all low and middle income countries, regardless of their ranking on the list. 

Scarcity of healthcare workers in low and middle income countries, and their outward migration in search of better pay and conditions, has been a longtime global health policy issue. The COVID-19 pandemic only exacerbated an existing inequalities that hobble the development of robust health systems in many developing countries.

In 2020, the International Council of Nurses estimated that there is a global shortage of six million nurses and the effects of the pandemic will drive health worker migration from the low and middle income countries. A WHO report on the State of the World’s Nursing profession, published in that same year, estimated that one in eight nurses globally have migrated from elsewhere. 

Healthcare workers
Estimation of healthcare workers shortage across the world in 2013 and in 2030.

In 2020, when the list of vulnerable countries was first compiled, the UHC service coverage index benchmark was was 50 out of a score of 100. However, after COVID-19 caused widespread health, social and economic impacts, WHO increased the threshold to 55. 

“The increasing demand for health and care workers in high-income countries might be increasing vulnerabilities within countries already suffering from low health workforce densities,” observes the new WHO report. 

“WHO is working with these countries to support them to strengthen their health workforce, and we call on all countries to respect the provisions in the WHO health workforce support and safeguards list,” stated Tedros.

Image Credits: Photo by Carlos Magno on Unsplash, World Health Organization (WHO), World Health Organization (WHO).

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