affects the development of the former. For example, well educated and skilled elite, which might be most valuable to the periphery,is lost to the center (Frank, 1970).
This theory presupposes that the labour force that is exported to the core or centre is surplus and that there are economic benefits that accrue from this labour force as they are expected to bring in remittances from their earnings as policy. Ahmed (1997) argues that such remittances sent to the periphery by those who migrate are rarely invested in production.
Other available options in theoretical terms which Hammar and Tamas (1997) describe are staying and not migrating or full immobility or some form of internal migration to another spatial unit (another area) within the country, as for example, in rural to urban migration, commuting, or internal refugee migration. The two explain that even in the case of forced or reactive migration, various factors may hinder people from crossing borders. An example that they cite is refugees who may have to remain as displaced people within their country of residence because they are given no opportunity to leave.
Hammar and Tamas (1997) argue that most people of the world remain within the borders of their country or even at their very place of birth.
Globalization promotes cross border
movements
Globalization &
international rules
\
Semi Periphery:
PULL & PUSH
-.
!
Semi Periphery:
PULL& PUSH
Semi Periphery: PULL
& PUSH
Semi Periphery: PULL
& PUSH
Globalization influences movement
of Nurses
Open economies &
trade
2.14.1 World Systems Theory
In the definition of international migration, the world is described as being divided into territories of sovereign states and that some migration goes across the national borders (Hammar &Tamas, 1997). Wallerstein and other proponents of the World Systems Theory see the world in a similar manner but divide it into zones. For the purpose of this study,the researcher has opted to select three zones namely the Core, Semi-Periphery and Periphery in accordance with Maresova (1999) instead of four zones (Wallerstein, 1974a) into which all regions of the world can be placed.
2.14.2 Assumptions from the conceptual framework as applied to the study
In international migration of nurses and other health care professionals, the assumptions according to this theory are as follows:
1) The Periphery countries are in the developing world and are the poorest with the greatest health care needs and demands with poorly managed economies. Africa has the highest disease burden of any continent (per population) but has the lowest numbers and ratios of health workers per population. In addition, despite higher maternal and child mortality than found anywhere else, Africa produces the lowest numbers of health workers (WHO, World Bank,and Rockefeller Foundation, 2004).
2) International migration thus, with reference to the above, is depleting the developing world of its meagre human resource for health, in this context the nurses.
3) Examples of Semi-Periphery countries are South Africa and Botswana with
2004). These are less rich than the Core countries,but attract nurses and other health care professionals from the poorer Periphery countries.
4) Core countries are the rich economies of the world. The remuneration gap between Africa and the countries that recruit its health workers is wide and cannot be readily met by government pay increases (Consten et aI., 1995)
5) All migratory movements lead towards one direction; to the Semi- Periphery, or through the Semi-Periphery (transitional or relatively rich economies) to the Core or wealthy countries. There are no migratory movements towards the Periphery or poor countries, according to this theory.
6) The Core countries are strong and supreme (Lechner, 2001) and are able to penetrate the rest of the countries in the world; thus the Periphery and Semi-Periphery countries, and influence'their life styles and desires' for better quality of life.
7) Migration, after all, is a natural outgrowth of disruptions and dislocations in the process of capitalist development (Massey et el., 1993). This is an acknowledgement of the impact of migration on the poor (periphery) and less poor (relatively rich or transitional economies) countries.
8) The Core countries are strong and may control the Periphery and Semi-Periphery.
Bond and Dor (2003) appear to support this and argue that the era of structural
adjustment and free market approaches to health care (imposed by the core countries) resulted in reduced public sector involvement in health including the loss of health workers through retrenchments and recruitment embargoes that may have deprived poorer and rural communities access to health services.
9) The large bulk of Africa's health professionals leave to work in just a few industrialised countries (WHO,World Bank, and Rockefeller Foundation,2004).
10) Factors within the World Systems and the Push and Pull conceptual framework result in migration of nurses to the relatively rich and rich countries.
11) Movements of nurses may be directed to the relatively rich countries only,like South Africa and Botswana or migrating nurses may go directly to the developed countries.
12) Nurses and others who migrate to the relatively rich countries may in due course, make further moves and migrate to the developed world.
2.14.2.1 Push and Pull Theory
The push and pull theory assumes that push factors within countries of origin force potential migrants,and in this study nurses,to leave their countries and that there arepull factors that attract nurses in the intended destination countries. Various studies on health worker migration in the Sub-Saharan Africa show the following push and pull factors:
Push factors
Nurses and other health care professionals are affected by push factors based on various studies within the Sub-Saharan Africa. These are economic difficulties, poor working conditions, low remuneration, poor leadership in health services, poor motivation, slow career prospects,perceptions of a high occupational risk from HIV/AIDS,among others.
Pull factors
These include active recruitment by recipient countries, more job vacancies, lack of recipient country efforts to mitigate their own health worker needs, vast remuneration gap between Sub-Saharan countries and the industrialized ones (Vujicic et aI., 2004), rich recipient countries making it easier for nurses and doctors from Africa to work in their countries for affluent life, attractive working conditions including remuneration, better working environment,better quality of life, and respect for nurses.
2.14.2.2 Impact ofnurse migration on the health care system: assumptions
The assumption is that migration impacts on the health care system.
2.14.2.3 Assumptions about globalization
Globalization is a catalyst for migration of nurses through open economies, promotion of their free movements across borders, assisted by technological advances, particularly in communication.
2.15 TRANSNATIONAL MIGRATION
Literature shows that there are mechanisms by which people who migrate still maintain links with their countries of origin. Transnational migration has been defined as 'the process by which immigrants build social fields that link together their country of origin and their country of destination' (Glick Schiller, Basch,and Blanc-Szanton, 1992,p. I).
According to these researchers, transnational migration should be viewed as a specific area within the broad field of transnationalism, one that focuses on 'the social process in which migrants establish social fields that cross geographic, cultural and political borders.' However, Mahler (1999) bemoans the overwhelming focus on adult migrants with little regard paid to children and the youth. While acknowledging the availability of abundant literature on migrant children who are viewed as resettled in a second country, Mahler (1999) advocates for the same to be applied to children whose lives are transnational.
2.15.1 Concepts linked to transnationalism Faist (1997) describes these concepts as follows:
1) Transnational social space - a concept in which the issues of social, political and cultural change in international migration converge. 'Transnational social spaces'
are defined as relatively permanent flows or movements of people, goods and services across international borders that tie slayers and movers in both areas. Both regions are sending and receiving at the same time.
2) Transnational social spaces suggest that even more permanent settlement in the receiving country does not necessarily imply a complete rupture or break of social ties.
The existence of transnational social spaces attests to the ability of movers to creatively pattern their occupation and personal experience ties and other forms of linkages.
3) There is also theglobal elite (Beaverstork 1996) whose movement is often shaped by employment in sectors such as financial services; and also the movement and temporal migration of individuals and families from the 'developing' world to the industrialized west, such as the Mexicans who work in California and the Filipino nurses who work in Britain (Smith and Guarnizo, 1998)
4) Transnational Migrant s- It is thus appropriate to talk about transnational migrants
instead of emigrants and immigrants to facilitate development of concepts that cannot only be applied in either the sending or receiving regions but can also refer to emerging transnational social linkages. Examples are those between Algeria and France, India and the United States, Turkey and Germany,Mexico and the Caribbean and the United states.
5) Transnational networks - Exchange relationships partly account for network formation. Migrant and refugee networks and organizations facilitate social and individual action in reducing information and transport costs as well as costs in the country of destination. Migrants may, for example, get information about prospective employment through various means of communication. These exchange relations decrease the risk of not finding a job and income in the country of destination (Faist 1997).The value of networks for international movers and slayers differ. For example,a study on young New Zealander migrants in London showed that what was more central
to them a sense of connection, shared values and times together, a sense of personal worth,etc
6) There are also transnational entrepreneurs who are actually brokers and facilitate international migration. These can be pioneer migrants or refugees who capitalize on their experience, professionals in organizations concerned with labor recruitment or respectable individuals in the sending or receiving communities. Exchange relationships can also be applied for sending community strategy chosen. For example, inhabitants in some Mexican villages can best expect to reap results from international migration if they all agree to sponsor individuals for graduate studies in the United States (Pries 1996).
7) While this concept helps to explain immobility (first time decision making),migration (once the process is underway), return migration and decline of migration flows seam to depend on the sending and receiving countries.
2.16 CONCLUSION
This chapter analyzed the concept of health workforce migration and nurse migration in particular. Migration trends with statistics at global, regional and country levels were critically addressed including the potential of the nurse and health worker migration on poor countries. A critical analysis of the migration theories was given showing how the conceptual framework for this study was arrived at and adapted, with a detailed account of the theoretical assumptions as they relate to both the conceptual framework used and
the study. Generally, both the literature and conceptual framework formed the basis for the development of study objectives and research questions described in the nextchapter.