Migration and the Globalisation of Health Care
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Migration and the Globalisation of Health Care

The Health Worker Exodus?

John Connell

The international migration of health workers has been described by Nelson Mandela as the ‘poaching’ of desperately needed skills from under-privileged regions. This book examines the controversial recent history of skilled migration, and explores the economic and cultural rationale behind this rise of a complex global market in qualified migrants and its multifaceted outcomes.
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Chapter 6: Moving Out? Rationales for Migration

John Connell


Underlying most migration moves are substantial differences in development status. In 1978, Mejia observed that ‘the main factor influencing migration, within and outside the health systems of both the donor and the recipient countries, is the international problem of unequal economic and social development’ (1978: 269). That has never changed. While migration takes place in the context of global and regional uneven development, it is usually explained at a local level, and by the migrants themselves, in terms of such proximate factors as low wages or poor working conditions. Perhaps the earliest study of migrant health workers, conducted in 1972 with 147 Filipino nurses in the USA, found that 101 regarded their salaries in the Philippines as inadequate, over 100 complained about the lack of compensation for shift work, holidays and overtime, poor working conditions and nepotism in employment and promotion (Pablico 1972). Inadequate education, lack of leadership and rapid turnover of nurses accentuated these problems (Choy 2003: 113). Remarkably little has changed since then, whether in the Philippines or elsewhere, in terms of uneven development and the rationale for migration, although migrants have reached new destinations, as labour market and other conditions changed and new social networks were created. Promotion limitations, inadequate management support, heavy workloads, limited access to technology, medicines and other supplies have all been regularly and generally cited as ‘push factors’ and repeatedly documented for 30 years (Mejia et al. 1979; Ojo 1990; Buchan et al. 2004; Bach 2003, 2008; Kingma 2006). Centred on economic circumstances,...

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