Employer’s viewpoint on incentives, programmes and policies susceptible to facilitate the acquisition and retention (circular migration) of health professionals

October 2013 - January 2014

Background

International migration among healthcare professionals is not a new phenomenon, however migration flows of workers in this sector has increased significantly in recent years and has been attracting more attention from policy makers. The European Union and a number of its member states have sought to address this issue by promoting the concept of circular migration. While different definitions have been used to describe this concept, it essentially captures the idea of temporary migration, which would allow – within the context of the healthcare systems – receiving countries to benefit from the opportunity to fill labour needs and skill gaps, while encouraging and ensuring that foreign skilled workers return to their country of origin, after having benefited from further training and work experience, thereby enriching the health care systems of source countries.

Moreover, imbedded in the concept of circular migration is the attempt to design policies to facilitate the possible repetition of the migration journey if such is the desire of the migrant worker. In other terms, circular migration is conceptualized as a form of migration that allows some degree of legal mobility back and forth between sending and receiving countries. Such policies could include avenues for permanent residency and citizenship, fair repartition of the costs associated to the repeated migration process, portability of social protection measures, facilitation of skills recognition and career progression measures, and family-friendly reunification options, to name a few.

The ILO recognizes that circular migration of skilled workers is one of the options to mitigate the impact of “brain drain”. Principle 5 of the ILO Multilateral Framework on Labour Migration states that “Expanding avenues for regular labour migration should be considered, taking into account labour market needs and demographic trends”. Additionally, guideline 15.8 under Principle 15 suggests “adopting policies to encourage circular and return migration and reintegration into the country of origin, including by promoting temporary labour migration schemes and circulation-friendly visa policies”.

An important underlying aspect of a policy on circular migration policy is that it should be made available as an option to migrant workers, and not something that should be forced upon them. When implemented within this voluntary framework of return, a circular migration model can be promoted as a potential ‘win-win-win’ scenario. However, it requires the understanding and development of incentive measures to entice migrants to return to their home countries before – if they so desire to immigrate again. The identification, documentation, and understanding of these incentive measures are therefore essential to the voluntary circular migration process, but apparently there have been very little known about what such incentives should entail, particularly for health professionals.

Incentives measures can exist at different levels, such as 
  • Personal level incentives
  • Work place level incentives
  • State level incentives
  • Bi or multi-lateral (cooperation) incentives

Each of these levels is a composite index of different unique elements or incentives. The personal level may include the acquisition of a certification for higher education, the earning of a higher income needed for various reasons, or the desire to explore other cultural contexts. At the work place level, incentives to acquire or retain skilled health professionals may include the provision of a challenging working environment, a path for career progression, opportunities for continuous education, or various other salary and non-salary incentives. Furthermore, at the state level, the acquisition or retention of workers may include measures such as sound economic policies including decent minimum wage, economic, social, and political stability. At the bilateral or multilateral level, policies focused on the circulation of health professionals may include, as stated above, avenues for permanent residency and citizenship, fair repartition of the cost associated to the repeated migration process, portability of social protection measures, facilitation of skills recognition and career progression measures, among others.

At the junction between workers and the state (as a national actor or as player in the bi or multilateral arena), employers of health professionals, both public and private, are important stakeholders in the debate over health professional mobility. Therefore, it is important to explore from their view point, the type of policy environment that is needed to facilitate the acquisition and retention of health professionals.

Employers have a multiplicity of differing interests regarding the migration of health workers. While some Indian employers encourage and provide opportunities for their workers to migrate overseas, others attempt to retain workers and find ways to keep their workers from going abroad. Healthcare employers are generally well situated to construct an informed opinion on state level policies (at the national and international level) regarding the acquisition or retention of health professionals. Currently, there is very little known about this particular area, therefore ILO has identified the need to delve into the employer’s role in the acquisition and retention of health professionals and furthermore to foster sharing and dialoguing on this particular issue.

Assignment overview

In 2011, the European Union awarded the ILO funding to better understand the issue of circular migration (INT/09/11/EEC), especially of health professionals. This project, named Decent Work Across Borders (DWAB) project: A Pilot project for Migrant Health Professionals and Skilled Workers, seeks to facilitate an approach to migration that benefits migrant workers, and the source and destination countries within a rights-based framework for labour migration management. In regards to the importance of understanding the perspective of employers within the circular migration context, one of the goals of the project is to document and analyse incentives, programmes, and policies that are related to facilitating the acquisition and retention of health professionals between India and selected European destination countries, especially from the perspective of private and public employers of health professionals. This assignment is intended to enhance stakeholders’ understanding of a sustainable incentive system that promotes the acquisition and retention of health professionals across borders.

The outputs of this particular assignment will include:
  1. An inception report, including a detailed methodological note including draft versions of data collection tools for interviews and of focus group, Complete list of stakeholders to be reached by interviews and focus groups, precise work plan and relevant review of literature on the topic of incentives for the circular migration of health professionals
  2. A draft report documenting and analysing incentives, programmes and policies susceptible to facilitate the acquisition and retention (circular migration) of health professionals between India and selected European destination countries from the perspective of private and public employers of health professionals
  3. Report of a validation/dissemination event focusing on the results of the research
  4. A final report (refer annex for contents) including the creation of a systemic model showing the synergies between the various incentives, programme and policies identified through the review of literature, interviews and focus group and recommendations to be directed at various stakeholders such as government, employers and trade union organizations.
This segment of the DWAB project started on 30 October 2013 until 15 January 2014.