Libyan exodus creates refugee and health worker crisis

International migration of health labour: monitoring the two-way flow of physicians in South Africa

INTRODUCTION

Although health labour migration is a global phenomenon, studies have neglected the flow of health workers into low-income and middle-income countries (LMICs). In compliance with the data-monitoring recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (Code), we estimated post-Code physician net migration (NM) in South Africa (SA), and SA's net loss of physicians to Organisation for Economic Co-operation and Development (OECD) countries from 2010 to 2014.

METHODS

We sourced data from the National Reporting Instrument reports, the OECD and the General Medical Council. Using the numbers of foreign nationals and international medical graduates (IMGs) registered in SA, and SA medical graduates registered in OECD countries (South African-trained international medical graduates (SA-IMGs)) as respective proxies for immigration and emigration, we estimated 'NM' as the difference between immigrant physicians and emigrant physicians and 'net loss' as the difference between OECD-trained IMGs and OECD-based SA-IMGs.

RESULTS

In 2010, SA hosted 8443 immigrant physicians, while OECD countries hosted 14 933 SA-IMGs, yielding a NM of -6490 physicians and a NM rate of -18% in SA. By 2014, SA-based immigrant physicians had increased by 4%, while SA-IMGs had decreased by -15%, halving the NM rate to -9%. SA-to-OECD estimated net loss of physicians dropped from -12 739 physicians in 2010 to -10 563 in 2014. IMGs represented 46% of 2010-2014 new registrations in SA, with the UK, Nigeria and the Democratic Republic of the Congo serving as leading sources. Registrants from conflict-scarred Libya increased >100-fold. More than 3400 SA-IMGs exited OECD-based workforces.

CONCLUSION

NM is a better measure of the brain drain than simply the emigration fraction. Strengthened health personnel data management and reporting through implementation of the Code-related system of National Health Workforce Accounts will further increase our understanding of health worker mobility in LMICs, with policymakers empowered to make more informed policies to address shortage.

Training and deployment of lay refugee/internally displaced persons to provide basic health services in camps: a systematic review

BACKGROUND

Training of lay refugees/internally displaced persons (IDPs) and deploying them to provide basic health services to other women, children, and families in camps is perceived to be associated with public health benefits. However, there is limited evidence to support this hypothesis.

OBJECTIVES

To assess the effects of interventions to train and deploy lay refugees and/or IDPs for the provision of basic health service to other women, children, and families in camps.

METHODS

PubMed, Science and Social Science Citation Indices, PsycINFO, EMBASE, POPLINE, CINAHL, and reference lists of relevant articles were searched (from inception to June 30, 2014) with the aim of identifying studies that reported the effects of interventions that trained and deployed lay refugees and/or IDPs for the provision of basic health service to other women, children, and families in camps. Two investigators independently reviewed all titles and abstracts to identify potentially relevant articles. Discrepancies were resolved by repeated review, discussion, and consensus. Study quality assessment was undertaken using standard protocols.

RESULTS

Ten studies (five cross-sectional, four pre-post, and one post-test only) conducted in Africa (Guinea and Tanzania), Central America (Belize), and Asia (Myanmar) were included. The studies demonstrated some positive impact on population health associated with training and deployment of trained lay refugees/IDPs as health workers in camps. Reported effects included increased service coverage, increased knowledge about disease symptoms and prevention, increased adoption of improved treatment seeking and protective behaviors, increased uptake of services, and improved access to reproductive health information. One study, which assessed the effect of peer refugee health education on sexual and reproductive health, did not demonstrate a marked reduction in unintended pregnancies among refugee/IDP women.

CONCLUSION

Although available evidence suggests a positive impact of training and deployment of lay refugees/IDPs as health workers in camps, existing body of evidence is weak, and calls for a re-examination of current practices. Interventions that promote training and deployment of lay refugees/IDPs as health workers in camps should include strong evaluation components in order to facilitate assessment of effects on population health.