Hiding in plain sight: the absence of consideration of the gendered dimensions in ‘source’ country perspectives on health worker migration

Background Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. Methods A Canadian-led research team partnered with co-investigators in the Philippines, South Africa, and India to examine the causes, consequences and policy responses to the international migration of health workers from these ‘source’ countries. Multiple-methods combined an initial documentary analysis, interviews and surveys with health workers and country-based stakeholders. We undertook an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3580 health workers. Results The documentary analysis of health worker emigration from South Africa, India and the Philippines reveal that gender can mediate access to and participation in health worker training, employment, and ultimately migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stereotypical views were evident amongst stakeholders; for example, in South Africa female health workers were described as “preferred” for “innate” personal characteristics and cultural reasons, and in India men are directed away from nursing roles particularly because they are considered only for women. The finding that inadequate remuneration was as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, was not necessarily linked to underlying gender-based pay inequity. The documentary data suggest that migration may improve social status of female nurses, but it may also expose them to deskilling, as a result of the intersecting racism and sexism experienced in destination countries. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses. Conclusion An explicit gender-based analysis of health worker emigration, which may help to emphasize important equity considerations, could offer useful insights for the health and social policy responses adopted by source countries.

Hiding in Plain Sight: The Absence of Consideration of the Gendered Dimensions in ‘Source’ Country Perspectives of Health Worker Migration

Background: Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. Methods: A Canadian-led research team with co-investigators in the Philippines, South Africa, and India examined the causes, consequences and policy responses to the international migration of health workers from these ‘source’ countries through documentary, interview and survey data with workers and country-based stakeholders. Here we undertake an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3,580 health workers. Results: The literature on health worker migration from South Africa, India and the Philippines reveal that gender can mediate access and participation in health worker training, employment, and migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stakeholders in South Africa described female health workers as “preferred” for “innate” personal characteristics and cultural reasons, and in India that men are directed away from nursing roles particularly because they are considered only for women. That inadequate remuneration was identified as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, may be linked to the impact of underlying gender-based pay inequity. The literature suggests that migration may improve social status of women nurses, but it may also expose them to deskilling, as a result of intersecting racism and sexism in their destination country. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses.Conclusion: An explicit gender-based analysis on health worker migration could offer useful insights for health and social policy responses and emphasize the importance of equity considerations to their decisions in these countries.

Hiding in Plain Sight: Gendered Dimensions of Health Worker Migration from ‘Source’ Country Perspectives

Background: Gender roles affect health worker migration and their migration experiences, but policy responses have rarely considered the gender dimensions of health worker migration. This invisibility and lack of attention can lead to social, health and labour market inequities. Methods: A Canadian-led research team with co-investigators in the Philippines, South Africa, and India studied the international migration of health workers from these ‘source’ countries through documentary, interview and survey data with workers and country-based stakeholder interviews. Our particular focus was to examine the causes, consequences and policy responses to health worker migration. Here we undertake an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the literature, policy documents and empirical data. Results: Our data from nurses, physicians, and other health workers reveal that gender mediates health workers’ access and participation in health worker training, employment, and migration, and the impact of health worker migration is gendered, depending on country context. Female migrant health workers were “preferred” for “innate” personal characteristics and cultural reasons. Female nurse migration in particular is greatly influenced and linked to personal relationships and social networks including friends in the diaspora. Remittances by female nurses to family back home may play a large role in the decision to migrate. Migration may improve social status of women nurses, but it also exposes them to deskilling, sexism and racialization. Regardless of these apparent differences in migration decision-making and experiences for women and men health workers, gender is rarely considered either as an important contextual influence or analytic category in the policy responses.Conclusion: An explicit gender-based analysis on health worker migration offers useful insights for health workers considering migration and those that ultimately migrate, the workplaces and families they leave behind, and social and health policy of their countries.

Global flows

Health systems rely upon two groups of people: health workers and patients. In recent decades both groups have been on the move globally, with the creation of internationalized labour market opportunities (the hunt for skilled labour in the case of health workers) and private investments in high-end health care on lower-cost developing countries (one of the key incentives for patients seeking care outside of their own country, for uninsured or under-insured services). Both flows raise a number of health equity concerns. Health worker migration can pose undue hardships on low-resource, high-disease burden countries who lose their workers to richer nations, creating a ‘perverse subsidy’ of poor to rich. With medical tourism, private, fee-paying foreign patients in poorer countries could ‘crowd out’ access to care for domestic patients in those countries, while potentially returning with drug resistant infections or complications burdening their home country’s health systems.