Chapter 7: Migration and Health Provision
Migration of skilled health workers has diverse impacts, from more obvious effects on the delivery of health services and the economic consequences of the loss of locally trained workers to more subtle social, political and cultural impacts. Migrants tend to be relatively skilled and experienced, compared with those who stay. They move to improve their own livelihoods, and those of their families, and are usually the key beneficiaries of that migration. Recipient countries benefit from having workers to fill gaps in the health care system. Conversely, source countries and their populations, especially in remote areas, lose valuable skills unless those skills are an ‘overflow’ or are otherwise compensated for, perhaps through remittances. The provision of health care may be affected in both quality and quantity. Logic, widespread assumptions and vast amounts of anecdotal data suggest strong links between migration and the subsequent reduced performance of health care systems. Actual correlations between migration and malfunctioning health care systems are difficult to make, since it is hard to quantify what is not there, whether midwives or maternity wards, whose loss is often the stuff of journalism rather than academic analysis. Assessing the impact of migration – even indirectly – is difficult, and numerous anecdotes overwhelm reliable data. This chapter examines the direct impacts of migration on health care while the following chapter examines the more complex socioeconomic consequences of migration. Migration affects both the quality and quantity of health care. While it is axiomatic that lack of workers should disrupt health care provision, clear...
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