PDF Analysis of Health Professionals Migration: A Two-Country ...

[Pages:158]Analysis of Health Professionals Migration: A Two-Country Case Study for the United Arab

Emirates and Lebanon

Draft for discussion

Fadi El-Jardali, Department of Health Management & Policy, Faculty of Health Sciences, American University of Beirut Diana Jamal, Department of Health Management & Policy, Faculty of Health Sciences, American University of Beirut Maha Jaafar, Department of Health Management & Policy, Faculty of Health Sciences, American University of Beirut Zeinab Rahal, Department of Health Management & Policy, Faculty of Health Sciences, American University of Beirut

- October 2008 -

Table of Contents

Acronyms____________________________________________________ 5

I. Acknowledgements_________________________________________ 7

II. Executive summary_______________________________________ 8

III. Introduction ___________________________________________ 11

A. Human Resources for Health - International Context _______________ 11

Determinants of migration of health professionals__________________________ 13

B. HRH in the Eastern Mediterranean Region ______________________ 14

IV. Objectives _____________________________________________ 16

V. Methods ________________________________________________ 17

VI. Findings ______________________________________________ 17

A. Case of UAE ? Destination Country_____________________17

1. Context of UAE ________________________________________________ 17 a) Geography and Demography ______________________________________ 17 b) Labor Market __________________________________________________ 19 c) Health System in UAE ___________________________________________ 22

2. Health workforce _______________________________________________ 26 3. Existing Stock of Health Workers __________________________________ 30

a) Obtaining Information on the Stock of Health Workers__________________ 30 b) Stock of Physicians _____________________________________________ 30 i. Data from MOH ________________________________________________ 31 ii. Data from HAAD _______________________________________________ 31 iii.Data from DOHMS _____________________________________________ 32 iv.Discrepancies in number of physicians ______________________________ 33 c) Stock of Nurses ________________________________________________ 34 i. Data from MOH ________________________________________________ 34 ii. Data from HAAD _______________________________________________ 38 iii.Data from DOHMS _____________________________________________ 38 iv.Discrepancy in number of nurses ___________________________________ 40 d) Data on Midwives ______________________________________________ 40 4. Yearly inflow of health workers____________________________________ 40 5. Shortage in UAE Health Workforce_________________________________ 41 6. Shortage of National Health Workers _______________________________ 43 a) Potential reasons for shortage of national Physicians____________________ 43 b) Potential reasons for shortage of national Nurses_______________________ 44 7. Reasons Expatriate Health Workers Come to Work in UAE ______________ 44 8. Graduates from Medical and Nursing Schools_________________________ 46 a) Medical Schools ________________________________________________ 47

b) Nursing Schools ________________________________________________ 48 c) Understanding nurse education programs in UAE ______________________ 51 i. UAE Nursing Education Programs _________________________________ 51 ii. Problems Related to Nursing Education Programs in the UAE____________ 51 9. Recruitment of Health Professionals in UAE__________________________ 53 10. Turnover among UAE Health Professionals ________________________ 55 11. Tawam Hospital Case Study ____________________________________ 57 a) Health workers in Tawam ________________________________________ 58 b) Staff satisfaction survey __________________________________________ 61 12. Training and Continuing Education of Health Professionals ____________ 62 a) MOH ________________________________________________________ 63 b) HAAD _______________________________________________________ 63 c) DOHMS ______________________________________________________ 64 d) The Army Directorate of Medical Services ___________________________ 64 13. Licensure and Continuing Education ______________________________ 65 14. Retention of Health Workers in UAE______________________________ 66 a) Retention Strategies for MOH Facilities _____________________________ 68 b) Strategies to Remedy Shortage of Nurses ____________________________ 70 15. Self sufficiency in UAE ________________________________________ 72 16. Bilateral Agreements __________________________________________ 74 17. Challenges, Successes and Recommendations in UAE ________________ 75 a) Challenges facing UAE __________________________________________ 75 b) Successes and Opportunities in UAE ________________________________ 77 c) Recommendations for UAE _______________________________________ 78

B. Case of Lebanon ? Source Country ________________________ 80

1. Context of Lebanon _____________________________________________ 80 a) Geography and Demography ______________________________________ 80 b) Economic Profile _______________________________________________ 82 c) Migration Trends in Lebanon______________________________________ 83 d) Health System Profile____________________________________________ 84

2. Health Workforce in Lebanon _____________________________________ 85 a) Stock of Physicians in Lebanon ____________________________________ 86 b) Stock of Nurses in Lebanon _______________________________________ 90

3. Graduates from Medical and Nursing Schools_________________________ 92 a) Medical Schools ________________________________________________ 93 b) Nursing Schools ________________________________________________ 94 c) Midwifery Schools ______________________________________________ 97

4. HRH Migration from Lebanon_____________________________________ 97 a) Physician migration _____________________________________________ 98 b) Nurse migration _______________________________________________ 101

5. Recruitment agencies ___________________________________________ 102 6. Retention of health workers in Lebanon_____________________________ 103

a) Research on Nurse Retention in Lebanon ___________________________ 103 b) Research on Nurses' Intent to Leave _______________________________ 105 7. Challenges, Successes and Recommendations for Lebanon______________ 106 a) Challenges facing Lebanon ______________________________________ 106

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b) Successes and Opportunities in Lebanon ____________________________ 108 c) Recommendations for Lebanon ___________________________________ 109 VII. Limitations_____________________________________________________ 111 VIII. Conclusion___________________________________________________ 112 IX. References _____________________________________________________ 115 X. Appendices_______________________________________________________ 122

Appendix I: Methods_________________________________________ 122 Appendix II: Search Strategy ___________________________________ 128

Appendix III: Letter sent to schools and universities in UAE ____________ 133

Appendix IV: Data collection template for medical, nursing and midwifery schools

in UAE ___________________________________________________ 134 Appendix V: Letter sent to Recruitment agencies in UAE_______________ 135 Appendix VI: Data collection template sent to Recruitment agencies in UAE _ 136

Appendix VII: Template for Key Informant Identification (UAE) _________ 137 Appendix VIII: UAE Key informants identified______________________ 138 Appendix IX: UAE Key informants interviewed _____________________ 140

Appendix X: Letter sent to schools and universities in Lebanon __________ 141

Appendix XI: Data collection template for medical, nursing and midwifery schools

in Lebanon ________________________________________________ 142 Appendix XII: Letter sent to Recruitment agencies in Lebanon __________ 143

Appendix XIII: Data collection template sent to Recruitment agencies in Lebanon

144 Appendix XIV: Key informants interviewed in Lebanon _______________ 145

Appendix XV: Questions asked during phone interviews with Lebanese nurses

working in UAE ____________________________________________ 146

Appendix XVI: Detailed distribution of physicians registered in DOHMS by

nationality ________________________________________________ 147

Appendix XVII: Detailed distribution of nurses employed in MOH facilities across

districts __________________________________________________ 148

Appendix XVIII: Detailed distribution of nurses registered in DOHMS by

nationality ________________________________________________ 151

Appendix XIX: Detailed response from MOH ION and Institute of Applied

Technology ________________________________________________ 152

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Appendix XX: Detailed list of nationalities of physicians and nurses employed in

Tawam hospital_____________________________________________ 153

Appendix XXI: Detailed distribution of 1st year students and graduates from three

branches of the Lebanese University School of Nursing ________________ 155

Appendix XXII: Data received from Nursing Schools in Lebanon on program

duration, number of students migrating and most preferable destination____ 156

List of Tables

Table 1: National graduates of selected higher educational institutions _____________ 21 Table 2: Types of immigration policies in UAE and implementation status __________ 22 Table 3: Breakdown of Health Care Facilities in UAE __________________________ 23 Table 4: Breakdown of Health Workers in UAE Facilities _______________________ 28 Table 5: Number of physicians employed in public and private Hospitals in UAE (19962004) ________________________________________________________________ 31 Table 6: Physicians Working in MOH by Nationality in 2007_____________________ 31 Table 7: Physicians in DOHMS for the years 1997 to 2007 ______________________ 33 Table 8: Physicians in DOHMS distributed by nationality and gender (2007) ________ 33 Table 9: Distribution of Nurses across Health Authorities _______________________ 34 Table 10: Distribution of National Nurses working in MOH facilities only across different districts (December 2007) ________________________________________________ 35 Table 11: Distribution of nurses working in MOH facilities ______________________ 36 Table 12: Distribution of nurses in MOH facilities by gender _____________________ 36 Table 13: Distribution of nurses in MOH by nationality _________________________ 37 Table 14: Nurses registered in DOHMS for the years 1997 to 2007 ________________ 39 Table 15: Nurses registered in DOHMS distributed by nationality and gender (2007)__ 39 Table 16: Total number of recruited physicians and nurses in MOH facilities between 1998 and 2007 _________________________________________________________ 40 Table 17: Nurses in MOH Facilities (December 2007) __________________________ 42 Table 18: Performance of Applicants for Registration Examination (MOH 2007) _____ 43 Table 19: List of the educational institutions that were contacted in the UAE, whether they replied or not and whether they are public or private* __________________________ 46 Table 20: Information collected from Gulf Medical College ______________________ 47 Table 21: Number of 1st year students and graduates from nursing schools from 1998 to 2008 _________________________________________________________________ 49 Table 22: Contribution of nursing schools towards national supply according to sector 50 Table 23: Comparison between number of national and non-national graduates from MOH ION_____________________________________________________________ 50 Table 24: Degrees offered by the different nursing schools in UAE ________________ 52 Table 25: Nurse Recruitment and Resignation in MOH facilities by district (2006) ____ 57 Table 26: Nurse recruitment and resignation in MOH facilities by facility type (2007) _ 57 Table 27: Distribution of physicians and nurses in Tawam hospital by nationality ____ 58 Table 28: Physician trainees and physicians in rotation at Tawam hospital__________ 59

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Table 29: Trends in recruitment and termination of medical and nursing staff in Tawam hospital between 2004 and 2007 ___________________________________________ 59 Table 30: Medical Termination summary for 2007 and 2008 _____________________ 60 Table 31: Reason for termination of medical and nursing staff from 2006 to 2008_____ 60 Table 32: Number of vacancies for physicians and nurses in Tawam _______________ 61 Table 33: Issues identified by staff satisfaction survey (Matarelli, 2008) ____________ 61 Table 34: DOHMS Continuing Education Department, Scholarship and Higher Education Department____________________________________________________________ 74 Table 35: Population and Health Indicators for Lebanon ________________________ 81 Table 36: Number of physicians inscribed/year________________________________ 87 Table 37: Physician numbers by Mohafazat 2005* _____________________________ 88 Table 38: Physician distribution by gender ___________________________________ 89 Table 39: Results of data retrieved from the Order of Nurses in Lebanon ___________ 91 Table 40: Number of training institutions by type and capacity of enrollment ________ 92 Table 41: Name, type, affiliation and reply status of medical and nursing schools in Lebanon ______________________________________________________________ 93 Table 42: Number of 1st year students and graduates at two medical schools in Lebanon94 Table 43: Number of 1st year students and graduates from nursing schools in Lebanon between 2000 and 2006 __________________________________________________ 96 Table 44: Number of 1st year students and graduates from two midwifery schools in Lebanon between 2000 and 2008___________________________________________ 97 Table 45: Push and pull factors as reported by medical students (Akl et al. 2007) _____ 98 Table 46: Data on Lebanese Nurses retrieved from four nursing schools ___________ 101

List of Figures

Figure 1: Health Workers Save Lives (Adapted from World Health Report 2006) _____ 13 Figure 2: Major expatriate nationalities in UAE_______________________________ 18 Figure 3: Distribution of health workers across sectors by nationality______________ 28 Figure 4: Distribution of physicians across different facilities ? HAAD (2007) _______ 32 Figure 5: Distribution of nurses working in UAE by nationality ___________________ 35 Figure 6: Distribution of nurses across different facilities ? HAAD (2007) __________ 38 Figure 7: Distribution of physicians and nurses in the EMR ______________________ 87 Figure 8: Top Retention Challenges as perceived by Lebanese Nursing Directors____ 104 Figure 9: Retention strategies adopted by hospitals ___________________________ 105

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Acronyms

(In alphabetical order)

AD CME AUB BSN BT CCS CE CME DHA DMS DOHMS EMR EMRO FDON GAHS GCC GDP GHQ HAAD HIC HRH IBP IMR ION KSA LE LHS LMG LMIC

Abu Dhabi Continuing Medical Education American University of Beirut Bachelors of Science in Nursing Baccalaureate Technique Country Cooperation Strategy Continuing Education Continuing Medical Education Dubai Health Authority Directorate of Medical Services Department of Health and Medical Services Eastern-Mediterranean Region Eastern Mediterranean Regional Office Federal Department of Nursing General Authority for Health Services Gulf Cooperation Council Gross Domestic Product Directorate of Defense Medical Services Health Authority-Abu Dhabi High Income Countries Human Resources for Health International Best Practices Infant Mortality Rate Institute of Nursing Kingdom of Saudi Arabia Life Expectancy Lebanese Health Sector Lebanese Medical Graduates Low-Middle Income Countries

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MD MENA MHIC MMR MOH MOH ION MOPH NNMAC PHC RAK ROV SEHA TS U5MR UAE UAQ UK US USJ WHO

Medical Doctor Middle East and North Africa Middle-High Income Countries Maternal Mortality Rate Ministry of Health Ministry of Health Institutes of Nursing Ministry of Public Health National Nursing and Midwifery Advisory Committee Primary Health Care Ras Al-Khaimah Rate of Variation Abu Dhabi Health Services Technique Superieur Under-5 Mortality Rate United Arab Emirates Umm al-Qaiwain United Kingdom United States Universit? Saint Joseph World Health Organization

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