Physicians' migration in Europe: an overview of the current situation

<p>Abstract</p> <p>Background</p> <p>The migration of medical professionals as a result of the expansion of the European Union is cause for concern. But there is a significant lack of information available about this phenomenon.</p> <p>Methods</p> <p>Search of secondary databases about the presence of european doctors working abroad, through two search engines in the Internet (Google and Pubmed) and a survey of professional organisations and regulators in countries of the European Union.</p> <p>Results</p> <p>The United Kingdom has more foreign doctors than all other European countries for which figures are available (Ireland, France, Germany, Norway, Portugal, Italy, Austria and Poland). Some 74,031 foreign doctors are registered in the UK, 30.94% of the total. European countries with the highest percentage of doctors working abroad are Ireland (47.5%, or 10,065 doctors) and Malta (23.1%, 376 doctors). The data obtained from Norway, France and Germany do not indicate an increase in the migration of professionals from countries recently incorporated into the EU.</p> <p>Conclusion</p> <p>There is significant mobility and heterogeneous distribution of doctors within the EEA and it should be cause for concern among health care authorities. However, there is no evidence about a possible increase in this phenomenon after the recent expansion of the EU.</p

'Going private': a qualitative comparison of medical specialists' job satisfaction in the public and private sectors of South Africa

BACKGROUND: There is a highly inequitable distribution of health workers between public and private sectors in South Africa, partly due to within-country migration trends. This article elaborates what South African medical specialists find satisfying about working in the public and private sectors, at present, and how to better incentivize retention in the public sector. METHODS: Seventy-four qualitative interviews were conducted - among specialists and key informants - based in one public and one private urban hospital in South Africa. Interviews were coded to determine common job satisfaction factors, both financial and non-financial in nature. This served as background to a broader study on the impacts of specialist 'dual practice', that is, moonlighting. All qualitative specialist respondents were engaged in dual practice, generally working in both public and private sectors. Respondents were thus able to compare what was satisfying about these sectors, having experience of both. RESULTS: Results demonstrate that although there are strong financial incentives for specialists to migrate from the public to the private sector, public work can be attractive in some ways. For example, the public hospital sector generally provides more of a team environment, more academic opportunities, and greater opportunities to feel 'needed' and 'relevant'. However, public specialists suffer under poor resource availability, lack of trust for the Department of Health, and poor perceived career opportunities. These non-financial issues of public sector dissatisfaction appeared just as important, if not more important, than wage disparities. CONCLUSIONS: The results are useful for understanding both what brings specialists to migrate to the private sector, and what keeps some working in the public sector. Policy recommendations center around boosting public sector resources and building trust of the public sector through including health workers more in decision-making, inter alia. These interventions may be more cost-effective for retention than wage increases, and imply that it is not necessarily just a matter of putting more money into the public sector to increase retention

Perceived unfairness in working conditions: The case of public health services in Tanzania

The focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions. The study has a qualitative study design to elicit detailed information on health workers' experience of their working conditions. The data comprise focus group discussions (FGDs) and in-depth interviews (IDIs) with administrators, clinicians and nursing staff in the public health services in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in the same part of Tanzania. The article provides insights into health workers' understanding and assessment of their working conditions. An experience of unsatisfactory working conditions as well as a perceived lack of fundamental fairness dominated the FGDs and IDIs. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management. The study also revealed that many health workers lack information or knowledge about factors that influence their working conditions. The article calls for attention to the importance of locating the discourse of unfairness related to working conditions in a broader historical/political context. Tanzanian history has been characterised by an ambiguous and shifting landscape of state regulation, economic reforms, decentralisation and emerging democratic sentiments. Such a historic contextualisation enhances our understanding of the strong sentiments of unfairness revealed in this study and assists us in considering potential ways forward

Emergency Contraceptive Knowledge and Use among Urban Women in Nigeria and Kenya

Rates of emergency contraception (EC) use in sub-Saharan Africa are highest in Kenya and Nigeria, although little is understood about user characteristics and use dynamics in these countries. In order to better meet the emergency contraceptive needs of women, and contribute to the limited knowledge base on EC in Africa, this study examines a large, representative sample of EC users. It draws on data collected from household surveys that included 7,785 sexually experienced women in urban Kenya and 12,653 sexually experienced women in urban Nigeria. Bivariate and multivariate analyses found that among these urban women, knowledge of EC was higher than reported in other nationally representative surveys (58% in Kenya and 31% in Nigeria). About 12% of sexually-experienced women in Kenya and 6% in Nigeria ever used EC, although fewer women (less than 5%) reported using EC in the past one year. Recent users of EC were more likely to be in their twenties, unmarried, and more highly educated than never users or ever users of EC in both countries. Results contradict public perceptions of EC users as younger adolescents, and indicate the importance of strengthening EC provision in Africa, including targeting information and services to unmarried women and supporting private pharmacies in delivering quality EC services

Learning networks – enabling change through community action research

Learning networks are a critical element of ethos of the community action research approach taken by the Early Learning Initiative at the National College of Ireland, a community-based educational initiative in the Dublin Docklands. Key criteria for networking, whether at local, national or international level, are the individual’s and organisation’s commitment to improving the quality of the service they provide to children and their families along with their ability to work in partnership with others. Having reflected on our learning through these networks, our action research processes are used to generate new knowledge and arrive at satisfactory solutions to local and national issues. In this way, we test theory, policy and practice in real-life conditions and produce regular and systematic evidence for what does and does not work. Our capacity to work together to produce results we truly care about and to dialogue effectively with external stakeholders like government bodies, policy-makers and funders has been enhanced. This article begins by outlining the criteria used before engaging with a learning network, along with the types of networks we are currently involved with and our action research processes. Finally, the benefits and challenges in engaging with these local, national and international learning networks are considered. This article highlights how dynamic conversations with these networks enable us to improve outcomes for children and their families, maintain key local values and ways of working, and yet meet external requirements for evidenced-based programmes

Employment preferences of public sector nurses in Malawi: results from a discrete choice experiment.

OBJECTIVES: To understand the employment preferences of Malawian public sector registered nurses, and to ascertain whether salary increases significantly affect how nurses regard their employment. METHODS: A discrete choice experiment was used to assess the significance of six job attributes on nurses' preferences over pairs of job descriptions: net monthly pay, provision of government housing, opportunities to upgrade their qualifications, typical workload, availability of resources and place of work. A multivariate model was used to estimate the extent to which nurses were willing to trade between their monetary benefits, non-monetary benefits, and working conditions, and to determine the relative importance of the job attributes. RESULTS: Most nurses were willing to trade among attributes, and very few appeared to have preferences that were dominated by a single job attribute. All attributes had a statistically significant influence on nurses' preferences, and further analysis showed the rate at which they were willing to forego pay increases for other improvements in their employment conditions. Opportunities to upgrade professional qualifications, government housing and the increases in net monthly pay had the greatest impact on nurses' employment choices. CONCLUSIONS: Salary enhancement can improve the motivation and retention of nurses, as well as improvements of employment conditions, which support existing efforts to address the health worker shortage