1.8.2007 | Von:
James Stewart
Darlene Clark
Paul F. Clark

Causes of Health Worker Migration

Worker migration is a result of the interplay of economic, social, cultural, political and legal forces. Here we will briefly address the factors encouraging cross-border migration.
Angestellte eines Krankenhauses in Nairobi bei der Durchführung eines DNA-Tests.An employee at a hospital in Nairobi conducts a DNA test. (© picture-alliance/AP)

These factors are often considered under two categories: supply-push factors and demand-pull factors [1]. Over time, migration patterns are sustained through networks that provide prospective migrants with information about job opportunities in destination countries as well as various forms of support to help adjustment after migration [2].

Supply-push factors

Supply-push factors are those issues and conditions that cause healthcare workers to be dissatisfied with their work and careers in their home country, such as poor compensation, working and living conditions or career opportunities. These push factors may be present in some developed countries, causing healthcare personnel to leave one developed country for another. However, these factors are present in a much more dramatic way in developing countries, and they contribute significantly to the decision by doctors and nurses in these countries to emigrate. Workers who are satisfied with their current employment situation, and thus unmoved by push factors, are unlikely to leave their home countries.

Demand-pull factors

Demand-pull factors are the conditions in destination countries that motivate workers to migrate. Like push factors, pull factors can cause workers in one developed country to move to another developed country. However, the pull factors present in developed countries are a more powerful influence on individuals in developing countries. For example, after adjustment for the cost of living, nurses' salaries in Australia and Canada are double those of nurses in South Africa, 14 times those in Ghana, and 25 times those in Zambia [3]. As with push factors, healthcare professionals are unlikely to migrate to a destination country unless they perceive conditions there (the pull factors) as superior to those at home.

Employers are likely to regard the qualifications and experience of migrating healthcare professionals as highly country-specific and, therefore, require that the migrating worker undergo substantial retraining. Migrating workers are thus likely to be offered a "training wage" that is lower than that paid to local workers with comparable qualifications and experience. The limited bargaining power of foreign workers is also likely to result in their bearing a higher proportion of new country-specific training costs than domestic workers. The available evidence suggests that this is the case in most developed countries where large numbers of foreign RNs and MDs are employed [4]. Despite the likelihood of receiving lower wages in the country of migration than their domestic counterparts, there are still incentives for healthcare workers to migrate. Healthcare personnel who migrate to developed countries often do find improvements in compensation, working conditions and lifestyle, as well as opportunities for personal and career development that would not be available in their home countries [5].

The role of historical ties

Individuals and employers are, of course, not the sole agents shaping the patterns of health worker migration. Relationships among governments clearly constrain the extent to which free-market forces operate and individual contracts are executed. Many critics of existing migration trends view the patterns as simply another manifestation of systemic neocolonial exploitation. Such criticism emphasises that the migration of healthcare professionals often serves the interests of former colonial powers and insists that arrangements are largely agreed to by the elite in former colonies who are relatively insulated from the consequences of their decisions. In fact, in countries with both public and private healthcare, these elites are able to strictly avoid the public system [6].

In some cases former colonial powers are actively involved in setting educational and training standards in former colonies, and the type of training received is relatively adaptable to meet the needs of the destination country. These workers, however, have little bargaining power in negotiating their compensation and working conditions, leading to lower pay and less favourable working conditions than exist for domestic workers. In some cases, professionals are forced to accept positions that are one or more steps below their positions in their home countries (e.g. RNs working as – less skilled – practical nurses, or physicians working as RNs).

Most emigrating healthcare professionals move to the nation that formerly exercised colonial control over their country of origin. Other than those from the Philippines, most foreign nurses and physicians in the UK have migrated there from countries formerly part of the British Empire. Also, a significant number of the RNs and MDs in Portugal are migrants from former Portuguese colonies, such as Angola, Mozambique and Cape Verde. The Philippines, a former American colony, is the leading country supplying foreign nurses for the United States healthcare system.


See Mejia, Pizurki and Royston (1979); Kline (2003).
See Martin (2003a, 2003b).
See Brown (2003).
See Forcier, Simoens and Giuffrida (2004).
See Buchan and Dovlo (2004).
See Clark and Clark (2004).



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