The migration of skilled health workers (doctors, nurses, pharmacists, radiologists, and other specialists) is a recognised contributor to the global health workforce crisis and a growing concern in the Pacific and parts of Asia. Several countries in the region are among the 57 identified by WHO as having critical workforce shortages. In the Asia-Pacific region, health worker migration is not a new phenomenon. Since the 1960s there has been significant mobility of skilled health workers from the Philippines, Bangladesh, Sri Lanka, India and other countries in south Asia, as well as across the Pacific.
In recent years, the scale and dimension of health worker migration in Asia and Pacific island countries has become more complex with growing intra-regional mobility. There are increasing concerns about the impact of migration on health care delivery especially in countries with fragile health systems. In other cases, countries over-produce health workers knowing that some will migrate and add value to the general economy through remittances. Internal migration (migration of health workers within a particular country), including migration from the public to private sector and to international organisations, is also a common feature.
Recently, the HRH Hub commissioned two reviews of skilled health worker migration in the Asia- Pacific region Mobility of Health Human Resources in Asia (Iredale and Turpin 2008, currently being reviewed for publication) and the Migration of Health Workers in the Asia-Pacific Region (Connell 2010). These reviews highlighted the complex nature of migration of skilled health workers in the region and the need for a systematic approach to managing the flow of these workers, especially in the Pacific.
Pacific Island countries recognise the challenge they face with health worker migration and have developed and endorsed a Pacific Code of Practice for the Recruitment of Health Workers. The code provides guidelines for an ethical approach to the international recruitment of health workers in a manner that takes into account the potential impact of such recruitment on health services in source countries. No concrete implementation plan with resource mobilization has been developed and it is unclear whether the Pacific Code of Practice will have a significant impact upon health worker migration in the Pacific Island region. Similarly, in response to demand by member countries, WHO launched the Global Code of Practice on the International Recruitment of Health Personnel in May 2010. Implementation of the WHO code is voluntary and it is unclear what impact it might have on health worker mobility.
Health worker migration remains a challenge to Pacific Island countries despite the regional and global initiatives to manage it. At present there is insufficient data to understand the scale and dimensions of the problem. For example, there are no reliable data on the number of health workers moving from one Pacific island country to another or to other countries outside the region. Furthermore, limited information is available on formal or informal bilateral agreements in the Pacific region concerning movement of health personnel. Regional initiatives are in development, although there is still no published information on a current potential of a bilateral agreement between Solomons and Vanuatu for international recruitment of nurses. This information is critical for understanding and informing policy development in managing health worker mobility in the region. While the migration of health workers cannot be entirely controlled and is likely to continue, it can be more effectively managed so as to reduce the downsides and increase the potential benefits for both source and destination countries.