Migration in the Caribbean Region

Migration in the Caribbean Region Dr. Gillian Barclay, Advisor Human Resources Development

AN OVERVIEW OF MIGRATION IN THE CARIBBEAN REGION

DOM. REPUBLIC GUADELOUPE MARTINIQUE FR. GUIANA Countries

THE CARIBBEAN REGION AND MIGRATION • Over the past 4 decades, the Caribbean region has lost more than 5 million people to migration • The net migration rate in the Caribbean region is one of the highest in the world with great variation within the region • Jamaica, Guyana, St. Lucia and Suriname have shown the greatest losses to international migration. Data from United Nations Population Division, 2003

THE CARIBBEAN REGION AND MIGRATION Dynamics: Workforce • Migration is international, intraregional, and into the region Other Dynamics: • Human trafficking of women and children • Return of deportees

MIGRATION IN THE CARIBBEAN REGION International Migration: Workforce and Brain Drain • Migration to the US, Canada and the UK • Skilled migration rates from the Caribbean region are some of the highest in the world (IADB, 2006)

MIGRATION IN THE CARIBBEAN REGION International Migration: Workforce and Brain drain • More than 60% of highly-skilled or tertiary-educated migrating • More than 30% of secondary-educated migrating • Jamaica, Guyana, Grenada, Haiti, more than 80% of tertiary-educated skilled labour migrating with increased migration to the United States

MIGRATION IN THE CARIBBEAN REGION Reasons for migration to the United States: Workforce • Proximity to the Caribbean • Wages and increased earning capacity • Common language for English-speaking islands • Social and family networks resident in the United States • Favourable immigration policies for skilled labour such as nurses, physicians, teachers and other professionals

MIGRATION IN THE CARIBBEAN REGION There are positive impacts of international migration and some of these include: • Return or transfer of knowledge, for example the strengthening of health and education facilities through partnerships and contribute to country level development • Remittances and economic investments although the data for the health professions is not known.

MIGRATION IN THE CARIBBEAN REGION Negative impacts of international migration include: • Loss of human capital • Reduced productivity • Loss of financial investments borne by countries These are critical issues for some of the countries in the region that are undergoing public sector and health sector reforms.

MIGRATION IN THE CARIBBEAN REGION Intraregional migration in the Caribbean: Workforce The Caribbean Single Market and Economy (CSME) was established in 1989 by the Heads of Government of CARICOM through the Grand Anse Declaration

MIGRATION IN THE CARIBBEAN REGION Intraregional migration in the Caribbean: Workforce • Major goals of CSME are to deepen the integration process and to strengthen the Caribbean community in all its dimensions • Facilitate the free movement of labour and abolish needs for work permits for workforce from CSME participating countries. • This represents the move towards a common policy agenda for migration at the intra-regional level

MIGRATION IN THE CARIBBEAN REGION Migration and the Health Workforce

MIGRATION IN THE CARIBBEAN REGION • Health today is complex and needs a public health and population approach • Critical needs to address include the capacity to use trans-sectoral approaches to: -measure needs -manage, plan and evaluate -conduct research and development -strengthen information systems -develop health, education and social programs

MIGRATION AND BRAIN DRAIN IN THE CARIBBEAN REGION: DATA AND EVIDENCE • Lack of data and evidence-base for country and regional level policy development for migration especially as this relates to the health workforce • Difficult to move towards policy when the evidence base regarding the health workforce is questionable.

MIGRATION AND BRAIN DRAIN IN THE CARIBBEAN REGION: DATA AND EVIDENCE • Trans-sectoral approaches needed to gather evidence that must involve the inclusion of labour, trade, education, health and social development • Important to share data because governments will find it easier to design, monitor and evaluate the impact of migration policies • Need to have policies in place to protect personal information to balance the need to share information

MIGRATION IN THE CARIBBEAN REGION Migration in the Caribbean region is an important issue for the health sector since labour market needs for this sector are aligned to the skills of the secondary and tertiary educated workforce.

THE CONTEXT: THE MIGRATION DISCUSSION IS OCCURING IN PARALLEL WITH HIGHLY VISIBLE EVENTS “These examples illustrate the enormous richness and diversity of the workforce needed to tackle specific health problems” World Health Report, 2006

MIGRATION IN THE CARIBBEAN REGION Migration and the Health Workforce • Historical regional migration and a shared sense of regional integration • CSME has enhanced the migration or free movement of qualified professionals and skills within the region by liberalizing conditions of access to markets and skills within the region • July 2006: Extension of the free movement agreement to include nurses among other professionals

Health Workforce in the Caribbean Health Workforce in the Caribbean Region per 10,000 Population (PAHO 2004)

MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION: THE EXAMPLE OF NURSING New Challenges for Nursing: • Large numbers of nurses leaving the region • Loss of more experienced nurses • Loss of nursing educators • Limited educational capacity to replace lost nurses

MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION New Challenges for Nursing: • Inability to assimilate ‘returnees’ • Image and work conditions for nurses • Aggressive recruitment of nurses by companies representing employers from countries with shortages

MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION • The wage differential is the major pull factor for Caribbean health professionals, especially physicians and nurses. • A comparison of average monthly wages show that Caribbean nurses working in the US are paid $3,056, in Canada $2,812, and in the United Kingdom $2,578. In Trinidad and Tobago nurses are paid an average monthly salary of $913.

MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION • 42% of nursing positions were vacant in 2005 (CARICOM/PAHO 2005) • PAHO estimates that the departure of 300 nurses from the Caribbean represented losses of $15 to $16.5 million US dollars in training costs

MIGRATION OF THE HEALTH WORKFORCE IN THE CARIBBEAN REGION Most common reported reasons for resignation were: • Poor remuneration • Limited opportunities for professional development and career mobility • Non-involvement in the decision-making process • Poor working environment • Lack of support from supervisors

Number of Registered Nurses, Vacancies and Vacancy Rates by Country (Hewitt, 2004)

Registered Nurses' Resignations with Declared Intentions to Migrate to the UK, USA, or Canada, by Year and Country (Hewitt 2004)

MIGRATION OF THE HEALTH WORKFORCE OF THE CARIBBEAN REGION Development concerns: • A highly skilled health workforce plays a major role in a country’s sustainable development • Countries are experiencing severe limitations in their capacity to provide affordable, quality, health and social services to their nationals. • The lack of skilled workforce in the health sectors slows the steps or progress in improvements in economic and social sectors in the region Caribbean Commission on Health and Development Report, 2005

THE FUTURE: POLICY IMPLICATIONS • The issue of migration does not belong to any one organization, thus faces challenges relating to: • Funding • Coordination • Infrastructure • Difficult to put into place appropriate evaluation, measurement and dissemination mechanisms • In the Caribbean region there is the need for a coordinated approach to the issue of migration.

THE FUTURE: POLICY IMPLICATIONS • Necessary to consider the multilateral approach to managing migration • Use the experience in bilateral agreements as building blocks to wider market access • Governments may experience increased pressure to ensure that conditions of work and pay are satisfactory

THE FUTURE: POLICY IMPLICATIONS • Evolution from individual and country specific work to efforts relating to major regional health, social and economic policy. • Changed nature of collaboration and partnerships in ways that reflect movement from program and evidence to policy.

“At the heart of each and every health system the workforce is central to advancing health.” World Health Report, 2006

Migration in the Caribbean Region