Nurses' exodus can be seen as trade in services
- 300 leaving every year
By Miranda La Rose
Stabroek News
July 13, 2004
The concept of the migration of skilled labour as a trade in services needs to be taken more seriously in trade negotiations, particularly at the World Trade Organisation says Minister of Health, Dr Leslie Ramsammy.
Ramsammy told nursing professionals at a workshop on 'International Trade Negotiations/Proposals: Trade in Nursing Services' at Le Meridien Pegasus yesterday, that developing countries have not been proactive on the issue nor addressed it in a comprehensive manner.
Meanwhile, the Caribbean has been losing an average sum of US$15M annually in investment in the training of nurses from 2000 to 2003 with the loss for 2000 accounting for US$16.7M.
The region also loses some 300 nurses annually to the United Kingdom, the US and Canada, said Barbados-based PAHO Human Resource Adviser, Jean Yan, who also made a presentation.
Ramsammy said developed countries have not done enough in terms of human resources, at least in the health sector. He noted that Jamaica has over the last four years been advocating that developed countries contribute to the training of nurses, leading the fight in Caricom with the concept of managed migration. He said developed countries would have to do more in terms of helping developing countries respond to their human resource needs.
Yan noted that during 2000, active recruitment drives from the UK, USA and Canada recruited skilled nurses, leaving behind new graduates and retirees. However, in 2003 because of the absorption rates of the nurses from the region by the developed countries, the recruiters were not "picky". They took the new graduates as well as the retirees in addition to those with qualifications and skills.
Ramsammy said approaches in dealing with adequacy of numbers and quality of service have remained unchanged in many ways. Health systems have tinkered over the years on matters that address immediate emergency needs but rarely have addressed long-term strategies that would ease the core problems.
This response, Ramsammy suggested, was not only true for developing countries but for developed ones which address their needs through recruitment from outside their borders. He warned that brain-drain plays an important role in the region's underdevelopment.
In brief remarks, Third Secretary in the Canadian High Commission in Guyana, Vishal Thakur said that while Canada does not have a position on managed migration, it has already demonstrated its openness to this approach as seen by hundreds of Mexican workers who go there for a few months every summer to work on Canadian farms.
He said the temporary migration of workers remains a highly sensitive issue as there are often valid concerns about migrants overstaying their work terms, as well as other accreditation and compensation issues. How well the response to this experiment is, could well have some bearing on how other international agreements are negotiated, he added.
Professor Clive Thomas noted that the trade in services was growing faster than the trade in goods and that any negotiation on trade in services whether it be at the level of the Caribbean Single Market and Economy or the Free Trade Area of the Americas, must be compatible with the General Agreement in Trade and Services (GATS) of the WTO.
GATS, he noted, came into force in January 1995 and is the first and only set of multilateral rules governing trade in services. He noted there were four modes of trade in health services according to the GATS regulations with managed migration being dealt with in the fourth mode `presence of natural persons'. This refers to the temporary movement of persons - such as doctors, nurses, and teachers - to supply services overseas.
He said 47% of nurses working in London alone were taken there through the managed migration process and through active recruitment drives.
Two broad factors - immigration requirements and labour market regulations - impede Mode Four access. The temporary movement of persons into countries is governed mainly by immigration/visa requirements and only marginally by trade policy. Thomas said that in the post 9/11 period security considerations have added to the need for political and not trade policy control of the temporary movement of persons.
Labour market regulations, which impede Mode Four access, he said, refer to a range of labour market prices including economic needs test and certification requirements. These practices, he said were deeply imbued with discriminatory, non-transparent and discretionary abuses.
Thomas, Yan and Dr Roger Hosein of the University of the West Indies have been commissioned by Caricom to devise a modality to address the issue of managed migration of nurses and the economic returns of skills, which Caricom might be able to adopt given political and labour considerations. The Institute of Distance and Continuing Education (IDCE) organised the workshop with funding from the Canadian International Development Agency (CIDA).