LITERATURE REVIEW
2.12 FACTORS CONTRIBUTING TO INTERNATIONAL MIGRATION
2.12.1 Globalization and health
The health sector is among the most rapidly growing sectors in the world economy. Itis estimated to generate US$ 3 trillion per year in countries in the Organization for Economic Co-operation and Development alone and is expected to rise to US$ 4 trillion by this year,2005 (Zarilli & Kinnon,1998;UNCTAD, 1997). The globalization of health services is reflected in the growing cross-border delivery of health services, through movement of personnel and consumers (by electronic and other means), and in an increasing number ofjoint ventures and collaborative arrangements (Chanda,2002).
One of the modes through which health services are traded is via the movement of health personnel, who include physicians, specialists, nurses, paramedics, midwives, technicians, consultants, trainers, health management personnel and other professionals.
The movement of health care professional includes both temporal and permanent flows, each having legal, social and economic implications for both source and host countries.
According to Chanda (2002), short-term flows of health professionals have been mainly driven by conscious strategies to promote health services exports, in order to earn foreign exchange and foster cooperation between governments. He gives examples of China and Cuba who send their health personnel abroad on short term remunerated contracts to countries in Africa, under government supervision.
Short-term flows of health care professionals exist from Ghana to Jamaica and from India to the Eastern Mediterranean. The later is an important host market for physicians, nurses, X-ray technicians, laboratory technicians, dental hygienists,physiotherapists, and medical rehabilitation workers from many developing countries. Chanda (2002) points
out that permanent migration of health care providers on the other hand occurs mainly from the developing to the industrialized countries and is driven by wage differences between countries and a search for better working conditions and living standards, better training possibilities and demand-supply imbalances in the health sector between the sending and receiving countries.
A 1998 United Nations Conference on Trade and DevelopmentIWHO study estimated that 56 per cent of all migrating physicians flow from developing countries to industrialized countries, while only 11 per cent migrate in the opposite direction; the imbalance was even greater for nurses. The most prominent source countries for health personnel were India, the Philippines and South Africa, whose nurses, physicians and technicians emigrate to Australia, the Eastern Mediterranean, the United Kingdom and the USA (US Government, 1997).
Studies (Kaplan et al., 2000; Cohen, 2003) show that the bulk of cross-border flows of health care professionals do take the form of permanent migration. For example, an estimated 10,000 health professionals emigrated between 1989 and 1997, and between one third to one half of the health profession graduates emigrate each year, mainly to the United Kingdom and the USA. Similarly, it has been estimated that over 10,000 medical and biotechnology experts from Egypt have emigrated from that country (Khalil, 1999) and out of 1200 physicians trained in Zimbabwe during the 1990s, only 360 were practicing in the country in 2001. A large number of nurses also emigrated from Zimbabwe to Australia, New Zealand and the United Kingdom prompted by low wages,
poor working conditions and political instability in their home country (Nyati, 2000).
Some 60 per cent of Ghanaian physicians trained locally during the 1980s have also left the country. In Sudan, an estimated 17 per cent of physicians and dentists left the country between 1985 and 1990.
Recent decades have coincided with the rapid globalization of the nursing profession.
During the periodI995/6-1999/2000 , Australia saw an additional 11,757 permanent or long-term overseas-qualified nurse arrivals. Nursing in that country is ranked as third target profession in Australia's skill migration programme, in the context of continuing attrition among local nurses. Globalization of nursing is not only reflecting western demand but the growing agency and participation of women in skilled migration, their desire for improved quality of life, enhanced professional opportunity and remuneration, family reunion and adventure (Hawthorne L,2002).
2.12.2 Factors contributing to globalization
Giddens (2004) states that some important advances in technology and the world's telecommunications infrastructure have facilitated the explosion m global communication. Although the telecommunication infrastructure is not evenly developed around the world, a growing number of nations can now access international communication networks in a way which was previously impossible. This development has resulted in a reorientation in people'sthinking from the country to global levels.
Giddens (2004) explains that individuals are now more aware of their interconnectedness with others and more likely to identify with global issues and processes than was the case in the past. He indicates that one dimension of people shifting to global outlook is that as members of a global community, people increasingly perceive that social responsibility does not stop at national boarders, but extends beyond them. The other dimension is that people are increasingly looking to sources other than the nation-state in formulating their own sense of identity, and that this is a phenomenon that is both produced by and further accelerates processes of globalization. Inaddition, local culture identities in various parts of the world are experiencing powerful revivals at a time when the traditional hold of the nation-state is undergoing profound transformation.Held and his colleagues (Held et aI., 1999) assert that transnational corporations are at the heart of economic globalization;
they account for two thirds of all world trade and are instrumental in the diffusion of new technology around the globe,and they are major actors in international fmancial matters.
Political changes have also contributed towards the intensification of globalization. An example is the formation of the international and regional growth of government. The United Nations and European Union are the two most prominent examples of international organizations that bring together nation-states into a political forum. Others with the driving force are international governmental organizations (IGOs) and the international non-governmental organizations (INGOs) (Held et aI., 1999).
2.12.3 International migration and immobility
Hammar and Tamas (1997) argue however that the majority of the people do not migrate
migrate,and according to these researchers, the behavior of these migrants under most circumstances is not the normal one, but a deviant case. They maintain that all
disciplines,within their framework, focused on the explanation on"why do people migrate",neglecting the twin question"why do they not migrate". They explain that the distinction between international and internal migration may be regarded as formal and legalistic but it has an impact of great significance on the relations between individual migrants and the countries on both sides of the boarder,as well as between these countries. They pointout that international migration is more or less regulated by the destination countries and to some extent also by the countries of origin. Furthermore, they point out that when migrants leave the country where they are citizens and enter another country where they are aliens (as well as vice-versa when they return),this implies a major change in their legal status,their right to take up residence and work, theirsocial, economic and political rights.