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Policy Perspectives

Kurzdossiers "Paradise Left Behind" – Begleitmaterial zum Film "Es geht um differenzierte Bilder." – Ein Gespräch über Paradise Left Behind Die ägäischen Inseln: von Räumen des Transits zu Räumen der Immobilisierung 'Schengen', 'Dublin' und die Ambivalenzen der EU-Migrationspolitik. Eine kurze Geschichte Paradise Left Behind Migration und Wirtschaft Die wirtschaftlichen Auswirkungen von Zuwanderung Wie sich Migration auf die Herkunftsländer auswirkt Migrantische Ökonomien in Deutschland Fachkräfteengpässe und Arbeitsmigration nach Deutschland Migration und Handwerk – kurze Geschichte einer langen Verbindung Migration und Handwerk: Fachkräftemangel und integratives Potenzial Zugehörigkeit und Zusammenhalt in der Migrationsgesellschaft Was ist Heimat? Warum es so viel leichter ist über Nudelsalat zu reden als über Rassismus Die blinden Flecken antirassistischer Diskurse Was hält eine Gesellschaft zusammen? Was hält eine Gesellschaft zusammen? Konfliktbearbeitung ist der Klebstoff der Demokratie Sozialer Zusammenhalt und das Gefühl, fremd im eigenen Land zu sein Die Gruppe der Ostdeutschen als Teil postmigrantischer Integrationsfragen Kommunale Migrations- und Flüchtlingspolitik Der "local turn" in der Migrations- und Asylpolitik Kommunen und ihre Rolle bei der Flüchtlingsaufnahme Kommunale Aufnahme von Flüchtlingen Interview: Migrations- und integrationspolitische Debatten im Deutschen Städtetag Kommunale Integrationspolitik in Deutschland: Teilhabe vor Ort ermöglichen Zufluchtsstädte im amerikanischen Einwanderungsföderalismus Migration in städtischen und ländlichen Räumen Geflüchtete in ländlichen Räumen Perspektive Geflüchteter auf das Leben auf dem Land Landlust oder Landfrust? Fleischindustrie Migrantische Arbeitskräfte in der malaysischen Palmölindustrie (Il)legal? Migrant_innen in der spanischen Landwirtschaft Das Wachstum der Städte durch Migration Migration und Männlichkeit Männlichkeit im Migrationskontext Muslimische Männlichkeit Väterlichkeiten Intersektionale Diskriminierung Sozialisation junger Muslime Migration – Kriminalität – Männlichkeit Migration und Sicherheit Einführung Migration und menschliche Sicherheit Foreign Fighters "Gefährder" Smart Borders Grenzkontrollen: Einblicke in die grenzpolizeiliche Praxis Die Polizei in der Einwanderungsgesellschaft Interview Radikalisierung in der Migrationsgesellschaft Schlepper: Dekonstruktion eines Mythos "Racial Profiling", institutioneller Rassismus und Interventionsmöglichkeiten Migration und Klimawandel Umwelt- und Klimamigration: Begriffe und Definitionen Zur Prognose des Umfangs klimabedingter Migrationen Der Zusammenhang zwischen Klimawandel und Migration Indikator für Verwundbarkeit oder Resilienz? Klimawandel, Migration und Geschlechterverhältnisse Rechtliche Schutzmöglichkeiten für "Klimaflüchtlinge" Interview mit Ulf Neupert Frauen in der Migration Migration qualifizierter Frauen in der EU Selbstorganisation geflüchteter Frauen* "Gastarbeiterinnen" in der Bundesrepublik Deutschland Ein Überblick in Zahlen Migration und Geschlechterrollen Frauen auf der Flucht Interview Zahlenwerk: Frauen mit Migrationshintergrund in Deutschland Integrationskurse Geschlechtsbezogene Verfolgung – Rechtlicher Schutz Geflüchtete Frauen in Deutschland Kinder- und Jugendmigration Zahlenwerk Kindertransporte Die "Schwabenkinder" Kinder- und Jugendmigration aus GB Menschenrechte von Kindermigranten Third Culture Kids Kindersoldat_Innen Adoption und Kindermigration Kinderhandel Lebensborn e.V. Grenzzäune und -mauern Mauern und Zäune Integrationspolitik Integrationsmonitoring Integrationstheorien Interview mit Andreas Zick Integration in superdiverse Nachbarschaften Migration und Entwicklung Entwicklung und Migration, Umsiedlung und Klimawandel Migration und Entwicklung – eine neue Perspektive? Stand der Forschung Rücküberweisungen Diaspora als Impulsgeberin für Entwicklung Landgrabbing Interview mit Roman Herre Strukturumbrüche und Transformation Diaspora Was ist eine Diaspora? Exil, Diaspora, Transmigration Diaspora: Leben im Spannungsfeld Türkeistämmige in Deutschland Postsowjetische Migranten Polnische Diaspora Vietnamesische Diaspora Kurdische Diaspora Diaspora als Akteur der Entwicklungszusammenarbeit Russlanddeutsche und andere postsozialistische Migranten Wer sind die Russlanddeutschen? Aussiedler Politische Partizipation von Russlanddeutschen Russlanddeutsches Verbandswesen Religiosität unter Russlanddeutschen Interview mit Peter Dück Russlanddeutsche in Russland Russlanddeutsche transnational Jüdische Kontingentflüchtlinge und Russlanddeutsche Transnationalismus als Beheimatungsstrategie Aushandlungen der Zugehörigkeit russlanddeutscher Jugendlicher Mediennutzung der russischen Diaspora in Deutschland 'Russische' Supermärkte und Restaurants in Deutschland Perspektiven auf die Integration von Geflüchteten in Deutschland Arbeitsmarktperspektiven von Geflüchteten Interview mit Gesa Hune Meinung: Geflüchtete fördern - oder es kann teuer werden Effekte der Fluchtmigration - Interview mit Prof. Dr. Herbert Brücker "Die müssen die Sprache lernen" Fremd- bzw. Zweitspracherwerb von Geflüchteten Die Arbeitsmarktintegration Geflüchteter in der Vergangenheit "Wohnst Du schon – oder wirst Du noch untergebracht?" Inklusion in das Schulsystem Ein Jahr Integrationsgesetz Interview mit Prof. Dr. Julia von Blumenthal Über die Zusammenhänge von Religion und Integration Interview: Digitale Bildungsangebote als Chance für Integration Innerafrikanische Migrationen Konsequenzen der Auslagerung der EU-Grenzen Kindermigration in Burkina Faso Flucht und Vertreibung Migranten als Akteure der Globalisierung Migrations- und Fluchtpfade Marokko Libyen Abschiebungen nach Afrika Leben nach der Abschiebung Flüchtlingslager Begriff und Geschichte des Lagers Orte der dauerhaften Vorläufigkeit: Flüchtlingslager im globalen Süden "Das Leben im Flüchtlingslager wird zur Normalität" Urbanisierungsprozesse Kleine Geschichte der Flüchtlingslager Lager in der Weimarer Republik Schlotwiese Uelzen-Bohldamm Friedland Zirndorf Marienfelde Das Jahr 2016: Ein Rückblick Globale Flüchtlingskrise hält weiter an Diskussion um kriminelle Geflüchtete Europa Literatur Resettlement Was ist Resettlement? Historische Entwicklung Resettlement durch UNHCR Resettlement im Vergleich zu anderen Aufnahmeprogrammen Aufnahme und Integration EU und Resettlement Deutschland Zukunft des Resettlements Literatur Akteure im (inter-)nationalen (Flucht-)Migrationsregime Akteure in Migrationsregimen und das Aushandeln von Migration Bundesamt für Migration und Flüchtlinge Die Europäische Grenzschutzagentur Frontex Die Asylagentur der Europäischen Union: neue Agentur, alte Herausforderungen UNHCR UNRWA – das UN-Hilfswerk für Palästina-Flüchtlinge im Nahen Osten Die Internationale Organisation für Migration (IOM) "Migration ist ein globales Thema, auf das es auch globale Antworten geben sollte." Flucht und Asyl: Grundlagen Abschiebung in der Geschichte Deutschlands Wie ist das Asylrecht entstanden? Das Asylverfahren in Deutschland Schutzanspruch im deutschen Asylverfahren? Sichere Herkunftsländer Das Konzept "sichere Herkunftsstaaten" Definition für Duldung und verbundene Rechte Flüchtlingsaufnahme und ihre Folgen Fluchtziel Deutschland Freiwillige Rückkehr Unbegleitete minderjährige Geflüchtete Abschiebung – Ausweisung – Dublin-Überstellung Begriff und Figur des Flüchtlings in historischer Perspektive Zivilgesellschaftliches Engagement Ehrenamtliches Engagement von Geflüchteten Interview mit J. Olaf Kleist Engagement in der Migrationsgesellschaft Politische Proteste von Geflüchteten Proteste gegen Abschiebungen Zivilgesellschaft und Integration Städte der Solidarität – ein Interview Beim Kirchenasyl geht es um den Schutz des Einzelnen. Ein Gespräch. Zivilgesellschaftliche Initiativen für sichere Fluchtwege – ein Überblick Migrantenorganisationen – vielfältige Akteurinnen gesamtgesellschaftlicher Integration (Flucht-)Migration und Gesundheit Medizinische Versorgung Interview David Zimmermann Definition von Migration Gesundheitszustand von Migranten Barrieren/ Prävention Erklärungsmodelle Schlussfolgerungen Literatur Das Jahr 2015: Ein Rückblick Fluchtmigration: Hintergründe Verwaltungs- und Infrastrukturkrise EU: Reaktionen auf die Fluchtzuwanderung Flüchtlingszahlen weltweit Internationale Studierende Einleitung Bildungsmigration Internationale Studierende Internationale Studierende in Deutschland Übergang in den Arbeitsmarkt Literatur Migration und Pflege Einführung Altern in der Migrationsgesellschaft Interview mit Helma Lutz Deutsche Asylpolitik und EU-Flüchtlingsschutz Einleitung Flüchtlingsrecht Asylrecht, Flüchtlingspolitik, humanitäre Zuwanderung Flucht und Asyl als europäisiertes Politikfeld Asyl und Asylpolitik Ausblick Literatur Integration in der postmigrantischen Gesellschaft Einleitung Die postmigrantische Gesellschaft Paradigmenwandel Brauchen wir den Integrationsbegriff noch? Integration als Metanarrativ Notwendigkeit eines neuen Leitbildes Literatur Lifestyle Migration Was ist Lifestyle Migration? Briten in Spanien Einen neuen Lebensstil entdecken Folgen des Residenztourismus Zusammenfassung Literatur Wahlrecht und Partizipation von Migranten Einleitung Politische Rechte und Kommunalwahlrecht Wahlrecht für Drittstaatsangehörige Einbürgerung Aktuelle Entwicklungen Schlussbemerkungen Literatur Frontex und das Grenzregime der EU Einleitung Frontex – Fragen und Antworten Die Entwicklung des europäischen Grenzregimes Externalisierung Technologisierung Grenzwirtschaft/border economies Auf der anderen Seite des Grenzzauns Ist Einwanderung ein Risiko? Literatur Demografischer Wandel und Migration Einleitung Demografischer Übergang Deutschland und Europa Internationale Wanderung Integration und Reproduktionsverhalten Wanderungspolitik Regionale Muster Literatur Glossar English Version: Policy Briefs "Having a nationality is not a given, it is a privilege" Sanctuary and Anti-Sanctuary Immigration Law in the United States Migrant Smugglers Urbanizing Skilled Female Migrants in the EU Self-Organization of Women* Refugees Impact of Migration Revisited Child and Youth Migration Human Rights Protections Migration from the United Kingdom Adoption and Child Migration Third Culture Kids Trafficking in Children Actors in National and International (Flight)Migration Regimes UNHCR UNRWA International Organization for Migration The International Organization for Migration (IOM) German Asylum Policy and EU Refugee Protection Introduction Refugee Law Asylum Law, Refugee Policy, Humanitarian Migration Flight and Asylum Current Developments Current and Future Challenges References Integration in a Post-Migrant Society Introduction Post-Migrant Society Paradigm Shift Do We Still Need the Concept of Integration? Integration as a Metanarrative Need for a New Concept References Lifestyle Migration What Is Lifestyle Migration? British in Spain Realizing a New Style of Life Outcomes of Lifestyle Migration Conclusion References Voting rights and political participation Introduction Political and Municipal Voting Rights Voting Rights for Nationals of Non-EU States Naturalization Recent Developments Conclusions References Frontex and the EU Border Regime Introduction Frontex — Questions and Answers The Development of a European Border Regime Externalization Technologization Border Economies On the Other Side of the Border Fence Is Migration a Risk? References Demographic Change and Migration in Europe Introduction Demographic Transition Germany and Europe International Migration Reproductive Behavior Migration Policy Regional Patterns Glossary Further Reading Global Migration in the Future Introduction Increase of the World Population Growth of Cities Environmental Changes Conclusion: Political Migration References Germans Abroad Introduction Germans Abroad Expatriates in Hong Kong and Thailand Human Security Concerns of German Expatriates Conclusions References Migrant Organizations What Are Migrant Organizations? Number and Structure Their Role in Social Participation Multidimensionality and the Dynamic Character Interaction with their Environments Between the Countries of Origin and Arrival Conclusion References EU Internal Migration EU Internal Migration East-West Migration after the EU Enlargement Ireland United Kingdom Spain Portugal Greece Italy Germany Assessment of Qualifications Acquired Abroad Introduction Evolution of the Accreditation Debate The Importance of Accreditation Basic Principles Thus Far of the Accreditation of Qualifications Acquired Abroad Actors in the Accreditation Practice Reasons for Establishing a New Legal Framework The Professional Qualifications Assessment Act What Is Being Criticized? The Accreditation System in Transition Conclusion References From Home country to Home country? Context Motives Immigration and Integration in Turkey Identification Emigration or Return? References Integration in Figures Approaches Development Six Approaches Conclusion References Climate Change Introduction Estimates Affected areas Environmental migration Conclusion References Dual citizenship Discourse Classic objections Current debate Rule of law Conclusion References Female Labour Migration The labour market Dominant perceptions Skilled female migration Issues Conclusion References How Healthy are Migrants? Definition The Health Status Prevention/Barriers Migration and Health Conclusions References Networks Spain Migrant networks Effects of networks Romanian networks Conclusion References Integration Policy Introduction Demographic situation Economic conditions Labour market The case in Stuttgart Integration measures Evaluation Outlook References Irregular Migration Introduction The phenomenon Political approaches Controlling Sanctions Proposed directive Conclusions References Integration Courses Introduction The Netherlands France Germany United Kingdom Conclusions References Recruitment of Healthcare Professionals Introduction The Situation Health Worker Migration Costs and Benefits Perspectives and Conclusion References Triggering Skilled Migration Introduction Talking about mobility Legal framework Coming to Germany Mobility of scientists Other factors Conclusions References Remittances Introduction The Term Remittance Figures and Trends Effects Conclusion References EU Expansion and Free Movement Introduction Transitional Arrangements Economic Theory The Scale The Results Continued Restrictions Conclusion References The German "Green Card" Introduction Background Green Card regulation Success? Conclusion References Does Germany Need Labour Migration? Introduction Labour shortages Labourmarket Conclusion Labourmigration References Dutch Integration Model The "Dutch model"? The end? Intention and reality A new view Where next? References Impressum

Policy Perspectives

James Stewart Darlene Clark Paul F. Clark

/ 7 Minuten zu lesen

Sending countries

The primary dilemma facing any proposal for regulation is how to balance the rights and the needs of the main actors involved - healthcare professionals, developed countries and developing countries.

Most observers of globalisation agree that freedom of movement to improve one's professional and personal circumstances is a basic human right. Denial of this right by source countries is not a tenable strategy for dealing with the problem of migration. However, unfair terms of trade and the legacy of colonialism have created market conditions in which a wholesale reliance on free markets will devastate healthcare provision in developing countries.

The types of policies that can best improve outcomes for sending countries should focus on meeting domestic needs and addressing the "push" factors that motivate healthcare workers to emigrate. There is an urgent need for countries to examine medical education curricula to ensure that training programmes focus on domestic, rather than foreign, healthcare problems . Improving compensation, working conditions and professional opportunities for healthcare personnel in their home countries would almost certainly reduce the impetus to leave. Some countries are trying less expensive incentives, such as better housing, subsidised transport to work, and inexpensive car loans. While many of the poorest nations do not have sufficient resources to make these types of improvements, some developing countries are exploring the use of international development funds to improve the remuneration packages for healthcare professionals – an option that did not exist in the past . A coalition of government and nurse association officials in the Caribbean has gone one step further, by developing a comprehensive Managed Migration Programme that attempts to ensure "the delivery of quality healthcare to the people in the Caribbean, in the midst of significant migration of skilled professional nursing staff." Developed and signed by a significant number of Chief Nursing Officers (top government officials) and by the presidents of the nurses' associations of most countries in the Caribbean, the programme lays out a plan of action to mitigate the impact of migration on healthcare in the region. The programme focuses on several areas, including terms and conditions of work, recruitment, retention and training. A recent agreement among governments will enable nurses to move more freely across borders. One initiative that has been undertaken under the auspices of the program is a St. Kitts program that trains nurses for employment in the US, with the US providing reimbursements for training costs. Another innovative project allows Jamaican nurses to work two weeks per month in Miami while working the remainder of the month in Jamaica .

Source countries could also intervene in the healthcare labour market by raising the cost of recruiting RNs or MDs from a developing country, in the form of a tax or a tariff on such transactions, to recover some of the training costs . Unfortunately, such a provision is problematic in a number of ways and, to date, no country has taken this step. However, there has been some support in the international assembly of the WHO for a fund that would train healthcare personnel in developing countries negatively affected by migration. The fund would be financed by developed countries as compensation for the investment in training lost by developing countries .

Another strategy that some developing countries have actually initiated involves "bonding" graduates of healthcare training programmes. Bonding requires graduates of nurse and physician training programmes to work in the country that funded the training for a period of time, in partial payment for their publicly-funded education. However, implementing and enforcing these types of provisions have proved difficult . If a worker decides to migrate, thereby abrogating the reimbursement contract, a "departure" payment could reasonably be claimed by public authorities in the country of origin. The question of whether the individual or the future employer should pay these costs is another important policy question, and who pays these costs would depend on the relative bargaining power of the worker and the employer.

In the absence of established and effective policies, and in the face of a growing consensus that the current patterns of globalisation affecting healthcare workers do not serve the interests of developing countries, some observes have called for developing countries to disengage from the current system. As a case in point, Physicians for Human Rights (PHR) has recommended that African countries resist the efforts to liberalise trade in health services advocated by the World Trade Organization .

Receiving countries

Policies that can be implemented by receiving countries to solve their problems and to generate more equitable outcomes for all parties should focus primarily on reducing the strength of "pull" factors that artificially increase migration. Some countries have already taken voluntary steps of this kind . As an example, ethical concerns raised about the impact of migration on developing countries have caused the national health services in the UK and Ireland to adopt ethical guidelines for the recruitment of overseas nurses. These guidelines require the services to provide accurate and truthful information to potential recruits about terms and conditions of employment and, in the case of the UK, they prohibit the NHS from actively recruiting nurses from South Africa and the West Indies. However, these guidelines do not apply to private healthcare facilities. Nor do they restrict public healthcare systems from hiring foreign nurses who migrate and apply for positions on their own initiative. For this reason, their impact has been limited .

Another approach to regulating the migration of healthcare professionals is the signing of inter-country agreements that place limits on the number of professionals who can be recruited, thus minimizing the damage to the sending country's health system. In 2000, the UK signed such an agreement with Spain to engage in "the systematic and structured recruitment" of Spanish nurses for the NHS . The United Kingdom has also discussed similar agreements with India and China.

In 2003, the NHS and the South African government reached agreement on an exchange programme entitling healthcare professionals of both countries to work in the other country for up to six months. Although the programme will probably bring more South African RNs and MDs to the UK than the reverse, the migration will be for a fixed period of time . The Caribbean Community (CARICOM) has implemented a programme "to encourage [healthcare] professionals to work overseas on a rotational basis, going for three years or so and then returning." The CARICOM nations hope this programme will encourage temporary, rather than permanent, migration.

Perhaps the most ambitious attempt to address the problems caused by the recruitment of healthcare professionals is the 2003 Commonwealth Code of Practice for International Recruitment of Health Workers. The code establishes an ethical framework to discourage the recruitment of such workers from countries experiencing shortages, and safeguards the rights of healthcare employees who choose to migrate . The critical question is whether such bilateral or regional agreements can be effective in the context of global trade protocols emerging from the World Trade Organization.

However, the most direct way of reducing the power of pull factors in developed countries is for those nations to address the reasons underlying the shortages of healthcare professionals they encounter more aggressively. Ultimately, recruiting RNs and MDs from abroad is a stopgap strategy. These countries need to take steps to train and retain the personnel they need from among their own populations. Falling medical school enrolments are a major factor contributing to the shortage of physicians in the US, and a second contributing factor is soaring malpractice insurance rates.

Conclusion

The various policy initiatives discussed here constitute useful first steps toward addressing the problems associated with the increased migration of healthcare workers induced by the global crisis in national healthcare systems.

However, a long-term solution will require more active involvement from another group of actors – international and regional organizations such as the WHO, the ILO and PHR. These organizations have played an important role in examining and documenting the seriousness of migration and have also developed guidelines and codes of conduct that encourage the parties involved in migration to engage in responsible and ethical practices . However, while these entities have the expertise to help source and destination countries alike, at present they do not appear to have the standing needed to impose the types of regulations on the labour market for healthcare professionals that are needed to address the complex and dynamic aspects of the problem. One possible strategy to improve this standing of regional and international organizations would be the development of formal agreements between regional and national governmental and quasi-governmental bodies which provided an international supervisory body with some degree of specific regulatory and oversight authority.

Fussnoten

Fußnoten

  1. See PHR (2004).

  2. See Brown (2003).

  3. See RNB (2004): 1.

  4. See Salmon et. al. (2007).

  5. See Jordan, B. (2001): "Nurses face emigration tax." Sunday Times-Johannesburg. 9 Sep.

  6. See Dugger, C. (2004): "Africa needs a million more health care workers, report says." The New York Times. 26 Nov., A27.

  7. See Buchan, Parkin and Sochalski (2003).

  8. See PHR (2004).

  9. See Schmid (2004).

  10. See Buchan, Parkin and Sochalski (2003).

  11. Buchan and Dovlo (2004).

  12. Mulholland, H. (2003): "UK agrees health staff swap with South Africa." The Guardian. 24 Oct.

  13. Stilwell et al. (2004): 598.

  14. Commonwealth Secretariat (2003).

  15. See, for example, ICN (2001).

James Stewart is Professor of Labor Studies and Employment Relations, and of Management and Organization, Pennsylvania State University.

Darlene Clark is Senior Lecturer in the School of Nursing, Pennsylvania State University, and Clinical Assistant Professor, College of Nursing, University of Arizona.

Paul F. Clark is Professor and Head, Department of Labor Studies and Employment Relations, Pennsylvania State University.