Health manpower migration in the Americas

This paper discusses the international migration of physicians and nurses in the Americas in terms of dimensions, directions, salient characteristics of migrants, and possible consequences of migratory flow. The paper is based on information from a previous multinational study on the international migration of physicians and nurses, carried out by the World Health Organization; the study is both descriptive of this phenomenon and prescriptive of the type of measures that may be needed to control it. There is sufficient evidence to substantiate the order of magnitude of the outflow of medical and nursing manpower from Central and South American countries to provide a guide to policy and action. The information for most countries is, however, incomplete and inaccurate and, consequently, the net flow remains to be determined. A large part of the migration appears to be due to the imbalance between the supply of, and the effective economic demand for, physicians' and nurses' services. Perhaps the most important finding is that countries which produce far more physicians and nurses than they can economically afford to employ become donors of such manpower, and those which produce fewer than they can afford become recipients. Almost all other factors either derive from or are secondary to the economic factor. The paper suggests some alternative policy issues that countries having excessive migration of medical and nursing manpower may consider to control the flows. Among these, the most important is the formulation of realistic health manpower and educational policies and plans.