Is Health Workforce Sustainability in Australia and New Zealand a Realistic Policy Goal?
Buchan, James M., Naccarella, Lucio, Brooks, Peter M., Australian Health Review
In May 2010 the World Health Organization(WHO)Global Code on international recruitment of health professionals was approved by the World Health Assembly.1,2 The Code sets out a range of practical and 'ethical' aspects of international recruitment of health workers, including an emphasis on health workforce 'sustainability' (Articles 3.6 and 5.4). This places an emphasis on developed, 'recruiter' countries making more effort to meet their health workforce requirements from their own resources. The aim is both to reduce the potential negative effect of outmigration of skilled health workers from the developing world, and to encourage improvements in the efficiency of workforce planning at country level. As WHO had noted 'The concept focuses on strengthening national health worker education. More broadly, achieving self-sufficiency or sustainability in the health workforce is about effective retention and deployment of available workers'.3
International migration of health workers is a complex issue, not fully captured by simplistic 'brain drain' arguments, as many health professionals move on their own initiative, for career development, security, or to find a job.2 Active international recruitment of health workers can be a relatively low cost compared to meeting the expense of domestic training in Australia or New Zealand, it can be a flexible quick fix to national health-worker shortages, and has been an attractive policy for governments in many countries. Australia and New Zealand have both been highly reliant on international recruitment to meet their health workforce requirements. Both countries cast their recruitment net widely, but have a pronounced effect on the Pacific islands.4 New Zealand is also a major 'source' country of international recruits - mainly for Australia - emphasising the point that some countries are both major 'sources' and 'destinations' for migrant health professionals.
The governments in both countries have also in the past made policy statements about the desirability of health workforce sustainability or self-sufficiency, a concept that could now take on a greater resonance and prominence with the adoption of the WHO Code. This paper assesses what health workforce 'sustainability' might mean for Australia andNewZealand, given the policy direction set out in the WHO Code, and within the broader context of health labour market dynamics and government policy in the two countries.
Australia and New Zealand have a high level of dependence on internationally recruited health professionals relative to most other OECD countries. Fully comparative and reliable data are limited, but recent statistics from the Organisation for Economic Co-operation and Development (OECD) gives some insight.5 In terms of 'stock' of health workers, one in three doctors in New Zealand was determined to be foreign trained, as was one in four doctors in Australia (see Fig. 1). Health workforce data collated by the Australian Institute of Health and Welfare6,7 confirm that about one in four doctors, and one in six nurses working in Australia is internationally trained.
The five countries with highest reported levels of foreigntrained doctors, out of 14 OECD countries for which there were comparable data, all were predominantly English speaking. There are significant flows of doctors, nurses and other health professionals within these English-speaking countries - for example, nurses from UK to Australia8 and doctors and nurses from New Zealand to Australia,9 but also significant inflows from less developed countries in Africa, Asia and the Pacific. Australia has placed a major reliance on international recruitment from countries such as India and South Africa to staff hard-to-fill medical posts in rural and remote health services.
Although the OECD 'stock' data do not tell us when these doctors arrived in the country, or by which route, it does give some indication of how achievable a target of 'self-sufficiency' or sustainability might be, if this is a concept based on meeting health workforce requirements from home-based training. …