Kathy Barrett
KINGSTON, Apr 13 2010 (IPS) – The shortage of nurses throughout the Caribbean has reached chronic proportions, in a region already struggling with an ailing health care system.
A World Bank report released on Mar. 2 revealed that between 2002 and 2006, more than 1,800 nurses left the Caribbean for higher paying jobs abroad, mostly in the United States, Canada and Britain.
The director of the World Bank s Human Development Department in Latin American and the Caribbean, Dr. Evangeline Javier, predicted that the shortage of nurses will worsen in coming years, with increasing demand for nurses overseas and widespread dissatisfaction with their salary and working conditions.
According to World Bank estimates, 7,800 nurses are working in English-speaking Caribbean countries, or 1.25 nurses per 1,000 people. That is about one-tenth the concentration of nurses in some major advanced economies.
These shortages have tangible impacts that may compromise the ability of English-speaking CARICOM (Caribbean Community) countries to meet their key health care service needs, especially in the areas of disease prevention and care. In addition, the shortage of highly trained nurses reduces the capacity of countries to offer quality health care at a time when Caribbean countries aim to attract businesses and retirees as an important pillar of growth, the report stated.
In Jamaica, the largest English-speaking country in the region, about three out of every four nurses trained here have migrated to developed countries.
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The migration of nurses from Jamaica is not a new phenomenon, says Dr. Hermi Hewitt, director of the School of Nursing at the University of the West Indies.
The same reasons causing nurses migration in the 1960s continue to be the push and pull factors today, she said. The key push factors which have driven the migration wave have been identified as poor remuneration, lack of opportunities for education and training violence and stressful working conditions.
Hewitt lists the pull factors attracting nurses as better salary packages, working conditions and opportunities for professional development. In Jamaica, an experienced nurse earns an average of 600 dollars a month, far less than even a trainee would abroad.
In the face of this constant migration, there is some hope in regional collaboration. The single most significant achievement has been the Managed Migration Programme, launched in 2001 and built on a concept originally developed in Jamaica.
The programme has been defined as a regional strategy for retaining an adequate number of competent nursing personnel to deliver health programmes and services to the Caribbean nationals .
In Barbados, for example, the government has worked to increase the enrolment of nurses in training at the Barbados Community College on an annual basis.
In St. Vincent, the government had sought bilateral agreements to obtain compensation from health care provider institutions that recruit nurses away from the country.
Still, nursing migration from Jamaica and other countries has created severe shortages and major workforce challenges compromising the quality of care, creating stressed working conditions and eroding some cultural norms, such as male and female patients being accommodated in the same hospital ward.
Edith Allwood-Anderson, the feisty president of the Nurses Association of Jamaica (NAJ), believes there will be deliberate efforts by the United States in particular to lure almost one million nurses from Caribbean countries even as the global economic recession abates.
The NAJ represents registered nurses across Jamaica. Allwood-Anderson says there has been no meaningful effort on the part of the governments to retain local nurses other than lip service.
It has had absolutely no impact, the dangling of the carrot is not evident anymore and as the World Bank report said, there is now a window period for Caribbean governments which ordered the study . to try and dangle and implement retention strategies for nurses before the recovery of the American economy which needs 800,000 nurses and it is the Caribbean that they are banking on, she said.
Most of the recommendations were not put in place We continue to be underpaid and overworked, but our spirits are very high, Allwood-Anderson said.
In St. Vincent and the Grenadines, the government is training more nurses to cope with the drain. But the struggle is ongoing.
Jerry George is a regional journalist based in St. Vincent and the Grenadines who believes it s too early to tell if any of the strategies implemented by the various governments would really work.
Whereas in the past the nurses trained were automatically employed by the Health Ministry, the new system trains the nurses and they then have to apply for available positions in the health services, he said.
What is anticipated is that those who don t make it would be available to take up job opportunities overseas. Where that strategy falls down is that the countries which are looking for nurses are looking for trained and experienced nurses so how well this works as a strategy is still in question, he explained.
The World Bank report notes that in the coming years, demand for nurses in the English-speaking Caribbean will increase due to the health needs of the aging population.
Christoph Kurowski, the lead author of the report, has reiterated some aspects of the managed migration programme.
English-speaking Caribbean countries need to examine their policy responses towards the migration of health workers, he said. Countries in the region should adopt a joined approach that balances the rights and interests of nurses and governments.