Managing health professional migration from sub-Saharan Africa to Canada: a stakeholder inquiry into policy options

BACKGROUND: Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? METHODS: We interviewed a small sample of émigré South African physicians (n = 7) and a larger purposive sample of representatives of Canadian federal, provincial, regional and health professional departments/organizations (n = 25); conducted a policy colloquium with stakeholder organizations (n = 21); and undertook new analyses of secondary data to determine recent trends in health human resource flows between sub-Saharan Africa and Canada. RESULTS: Flows from sub-Saharan Africa to Canada have increased since the early 1990s, although they may now have peaked for physicians from South Africa. Reasons given for this flow are consistent with other studies of push/pull factors. Of 8 different policy options presented to study participants, only one received unanimous strong support (increasing domestic self-sufficiency), one other received strong support (increased health system strengthening in source country), two others mixed support (voluntary codes on ethical recruitment, bilateral or multilateral agreements to manage flows) and four others little support or complete rejection (increased training of auxiliary health workers in Africa ineligible for licensing in Canada, bonding, reparation payments for training-cost losses and restrictions on immigration of health professionals from critically underserved countries). CONCLUSION: Reducing pull factors by improving domestic supply and reducing push factors by strengthening source country health systems have the greatest policy traction in Canada. The latter, however, is not perceived as presently high on Canadian stakeholder organizations' policy agendas, although support for it could grow if it is promoted. Canada is not seen as "actively' recruiting" ("poaching") health workers from developing countries. Recent changes in immigration policy, ongoing advertising in southern African journals and promotion of migration by private agencies, however, blurs the distinction between active and passive recruitment

Neoliberalism and the revival of agricultural cooperatives: The case of the coffee sector in Uganda

Agricultural cooperatives have seen a comeback in sub‐Saharan Africa. After the collapse of many weakly performing monopolist organizations during the 1980s and 1990s, strengthened cooperatives have emerged since the 2000s. Scholarly knowledge about the state–cooperative relations in which this “revival” takes place remains poor. Based on new evidence from Uganda's coffee sector, this paper discusses the political economy of Africa's cooperative revival. The authors argue that donors' and African governments' renewed support is framed in largely apolitical terms, which obscures the contested political and economic nature of the revival. In the context of neoliberal restructuring processes, state and non‐state institutional support to democratic economic organizations with substantial redistributional agendas remains insufficient. The political–economic context in Uganda—and potentially elsewhere in Africa—contributes to poor terms of trade for agricultural cooperatives while maintaining significant state control over some cooperative activities to protect the status quo interests of big capital and state elites. These conditions are unlikely to produce a conflict‐free, substantial, and sustained revival of cooperatives, which the new promoters of cooperatives suggest is under way