Migration intentions of pharmacy students

1. Migration intentions of pharmacy students A global study of root drivers Tana Wuliji Project Coordinator, FIP; Chair Moving On III Project IPSF Ian Bates, David Taylor, Sarah Carter School of Pharmacy, University of London Third Global Forum on International QA, Accreditation and the Recognition of Qualifications in Higher Education, UNESCO; Dar es Salaam 1

2. Migration is complex Migration is not a new phenomena Migration is a symptom Migration is a form of attrition Migration is not generic Migration is not only about money Migration is not ‘brain drain’ Points to need for workforce, social, policy, education development

3. Overview Migration Migration is a symptom, not the cause Workforce trends Migration intention study Questions for higher education providers

4. Migration is a symptom, NOT the cause “Results suggest that Africa's generally low staffing levels and poor public health conditions are the result of factors entirely unrelated to international movements of health professionals.” M Clemens, Centre for Global Development, Do Visas Kill? 2007. Workforce distribution, skill mix, performance incentives

5. Migration is a symptom, NOT the cause “International migration is neither the main cause nor would its reduction be the solution to the worldwide health human resources crisis.” J Dumont, P Zurn. OECD. Immigrant health workers in OECD countries in the broader context of highly skilled migration. 2007. Training capacity, employment opportunities, workforce distribution,

6. Migration is a symptom, NOT the cause “Attitudes towards professional practice, social and political environment at home coupled with perception of opportunities for economic and professional development abroad drive migration intentions” IPSF, FIP, School of Pharmacy University of London, 2007 Quality of education, working environment, learning and professional opportunities, social development

7. Migration: Flag pole or flag? Entry Workforce and education Migration Retention Workforce and education Attrition Planning

8. Health workforce crisis Critical shortage < 2.5 health workers per 1000 population (doctors, midwives, nurses) WHO Global Atlas: www.who.int/globalatlas Pharmacists?

9. Pharmacy Workforce Trends Shortages Workforce distribution imbalance – rural/urban, public/private Practice role development Increasing migration (within and between countries) Poor utilisation 2006 FIP Global Pharmacy Workforce and Migration Reportwww.fip.org/hr

10. Drivers of migration Attrition

11. Foreign born health workforce in OECD Context J Dumont, P Zurn. OECD. Immigrant health workers in OECD countries in the broader context of highly skilled migration. 2007.

12. Pharmacist migration trends Foreign pharmacist registrations per year in Canada 1995 -2005 FIP Global Pharmacy Workforce and Migration Report 2006

13. Pharmacist migration trends Number of foreign pharmacists registering in Australia FIP Global Pharmacy Workforce and Migration Report 2006

14. Pharmacist migration trends Number of pharmacists intending to leave Ghana Letters of good standing requested per year FIP Global Pharmacy Workforce and Migration Report 2006 Number of pharmacists

15. Migration theories Push-pull factors Spatial interactions Mobility transition Migrant networks Sociological Geographical Economic Labour and income differentials and demand Unifying Micro- and macro- levels Migration systems

16. Push-pull theories Sending country Receiving country • Push: • Workforce surplus • Lack of CPD/training opportunities and career opportunities • Poor remuneration and work conditions • Political/social instability • Pull: • Workforce shortage • Opportunities for CPD/training and career development • Greater financial rewards and improved working and living conditions Stick factors Stay factors

17. Pharmacy students and their intention to migrate – pilot study Collaborative research FIP, International Pharmaceutical Students’ Federation (IPSF) and School of Pharmacy, University of London Research Group (Moving on III) Input from WHO, OECD, IOM Nine countries: Australia, Bangladesh, Croatia, Egypt, Nepal, Portugal, Singapore, Slovenia, Zimbabwe

18. Methods Focus group workshop August 2005 Questionnaire development and review January – April 2006 Questionnaire distributed via MO III Group April 2006 Data collection April – May 2006 Analysis July 2006 – March 2007

19. Results 791 final year pharmacy student respondents 9 countries: Australia (336), Croatia (96), Singapore (60), Portugal (55), Zimbabwe (37), Bangladesh (58), Nepal (31), Egypt (103), Slovenia (25) Mean age: 22 years 61% respondents female Top destination countries: UK, USA, Australia

20. Intention to migrate 52% respondents plan to migrate 2/3 plan long-term migration (> 2 years) 80% of international students plan to migrate 80% plan long-term migration Implications for cross-border education? Students with past experience abroad are more likely to migrate (79% vs 49%, p<0.001). Variation in % planning to migrate between and within countries 13% (Croatia) – 90% (Bangladesh) Influence of education on attitudes & intention?

21. Drivers of Migration Factor 1: professional practice environment and status in own country 10 items, α= 0.8 Factor 2: opportunity to develop career and resources abroad 4 items, α= 0.7 Factor 3: social and political environment in own country 5 items, α= 0.7

22. Factors in migration decisions Positive perceptions of other countries Negative perceptions of own country p<0.001 N = 791

23. Factors in migration decisions Positive perceptions of other countries Negative perceptions of own country p<0.001 N = 791

24. Country differences Mean Zscore p<0.001

25. Factors and the intention to migrate Intention to migrate long-term Connections Professional environment Opportunities abroad Social and political environment Gender Residence status Migration intention Past international experience Multiple Correspondence Analysis

26. Pharmacy education Opportunities for workforce development? Social development Recognition of pharmacist roles Practice environment Fair recruitment and employment terms Sustainable development Levels of practice Supportive policy Career development pathways Utilisation of pharmacist skills Improve interprofessional relationships

27. Questions for higher education What is the influence of the quality of education on attitudesthat drive the intention to migrate? What is the responsibility of higher education providers to produce and support a workforce catered for local needs? What is the role of life long learning and local post-graduate learning opportunities? Migration = attrition

28. Stepping up global and national action Drivers of migration study (20+ countries) 2007 pharmacy workforce study (2008 report) FIP-WHO Pharmacy Education Taskforce Global Pharmacy Education Consultation (2007) Competency, academic workforce, quality FIP Global Conference on the Future of Hospital Pharmacy – workshop on HRH Global Health Workforce Alliance – scaling up education and training, migration Country case study and pharmacy human resource policy development – Zambia And more…….

29. More information FIP Human Resources for Health: www.fip.org/hr WHO World Health Report 2006: www.who.int/whr/2006/en Global Atlas of the Health Workforce: www.who.int/globalatlas Human Resources for Health Journal: www.human-resources-health.com International Organization for Migration: www.iom.int HRH Global Resource Center: http://www.hrhresourcecenter.org Acknowledgements: IPSF Moving On III Research Group and Executive Mr Ton Hoek, CEO and General Secretary, FIP Mr Xuan Hao Chan, Project Coordinator, FIP Prof Hugo Mercer, HRH Department, WHO

30. www.fip.org/hr tana@fip.org