In 2018, the Pan American Health Organisation (PAHO) contracted the Canadian research firm of Dunn, Pierre, Barnett and Company Limited to conduct a comprehensive study into issues impacting the migration of Health Workers in the Caribbean region.
The findings of the report were similar to those of other reports that sought to identify the causes and effects of migration of health professionals from the Caribbean region. The report noted that the overall motivation for health professionals to migrate can be summarised as: poor working conditions; low wages; poor treatment; lack of respect for health workers; and inadequate facilities, equipment, and medical supplies to perform their work. In summary, the report revealed the weak health systems as the root cause for population emigration, an indictment on the Public Health systems in the region with few exceptions.
The report stated that almost 60% of all health professionals who are still residing in their home countries and who participated in the survey stated that they would migrate if given the opportunity. Notwithstanding, the report suggested ways for local governments to retain and attract some of their health professionals back to their health systems.
Approximately 92% of health professionals surveyed and who are currently residing in the Caribbean, stated that they would not consider migration if promotional opportunities and career advancements were made available to them. In addition, 74% of the sampled diaspora of English-speaking Caribbean health professionals residing in North America and Europe would seriously consider returning home if salaries, working conditions, and employment opportunities improved significantly.
The survey was conducted with 11,200 respondents from the Caribbean region regarding their perceptions on migration of health workers. The outcome revealed that drastic improvements were needed in the healthcare system in the Caribbean if the rapid exodus of health workers (especially nurses and doctors) from the Caribbean region were to be halted or significantly reduced.
The popular opinion regarding reasons why people migrate from the Caribbean countries are generally stated as for better working/employment conditions (33%); followed by problems with the health and medical systems (15%); the country’s social, economic, political and security issues (15%); better financial/ economic opportunities (13%); and finally, education/training opportunities (13%). However, when the health workers (nurses) were taken as a subset, 45% of respondents stated that better working/employment conditions, followed by better financial/economic opportunities (25%) were the main reasons why they would leave.
Regional Health Care
In March 2019, Dr C Justine Pierre, the researcher who conducted the survey on behalf of PAHO in all the countries, in a presentation hosted by the St. Georges University (Phi Zeta Research Day March 16, 2019) Grenada, noted that at the Public Health system in the Caribbean needed urgent attention.
Regionally, many of the countries in the Caribbean place little emphasis on healthcare. For example, prior to 2018, Health Budgets across all countries accounted for an average of less than 4.5% of Governments’ annual budgets and little distinction is made in the treatment of health expenditure allocations for governance and administration versus health operations. Dr Pierre stated in his presentation that most of the countries (12) in the region have serious health infrastructural deficits, with the exceptions being Antigua and Barbuda and the Turks and Caicos Islands. Only 3 countries have National Insurance Schemes in place and only 4 countries had some levels of decentralised health management systems in place (Jamaica, Trinidad, Barbados, and Guyana). All countries have less than robust or no health information systems and only Antigua and Barbuda has an outsourced medical benefit scheme as well as a robust computerised health information system that was integrated with all sectors. Data collection is most robust in Antigua and Barbuda when compared to the rest of the region, while only Jamaica has a bilateral health labour programme in place.
With regard to Staffing and Administration, Dr Pierre stated that his research showed that some leadership and management positions in some countries were politically influenced and, in several instances, policy and strategic management were not centralised. Bonding after sponsorship for health personnel was not properly regulated and monitored by the Ministries of Health and or Education and the qualifications for nurses entering the system was not standardised across the region. There was a direct disconnect between policy planning and operations throughout the region owing to a lack of adequate Labour Market Intelligence and computerisation.
Data Specific to Grenada
When questioned about Grenada, Dr Pierre said that he was fortunate to have “over-sampled Grenada”, and that during his 10 days visit to the country, he was able to communicate and visit 4 of the main hospitals and many of the health clinics in the country. He stated migration of health workers is a serious concern and had the opportunity to interview 11 Grenadian nurses who were scheduled to leave the country and who gave invaluable information for the research. In the presentation, he revealed that many of the nurses in Grenada were employed in the country through a third-party employment agency and not directly through the Ministry of Health. To quote: “the situation in Grenada is more severe than those I have encountered in other Caribbean territories”.
Dr Pierre stated that to gain a better appreciation of the perception and attitude of health workers towards their countries’ healthcare systems, health workers from across the Caribbean region were asked the same questions to gauge their levels of agreement.
He noted that on average, 75% of health workers in the region indicated that they were dissatisfied with working environment and wages, however this percentage was much higher in Grenada (94%). When asked if the quality of healthcare was adequate in the Caribbean region, 32% of the respondents stated that they were satisfied; however in Grenada, only 3% of health workers surveyed indicated that they were satisfied. Dr Pierre stated that this pattern was the same in almost every category of Grenadian health workers surveyed, with the exception of 2 questions; one on their use of a public health facility over a private healthcare facility. 43% of those surveyed stated that if they had a serious medical condition, which had to be addressed only in Grenada, they would prefer to have the procedure done at a public institution rather than in the private hospitals. The other question was about “the choice to migrate”, where 53% of Grenadian health workers stated that if promotional opportunities and career advancement were improved in Grenada, they would remain and serve their country.
The full report is available on the PAHO website https://www.paho.org/en/documents/health-workers-perception-and-migration-caribbean-region.
Dunn, Pierre, Barnett & Company Canada Ltd