The staff of the University of KwaZulu-Natal, Faculty of Health Sciences, School of Nursing, for their support. This impacts the ability of healthcare systems to respond to the challenge of providing healthcare to the population, as nurses constitute the largest healthcare workforce in most countries.
CHAPTERFOUR:HNDNGS
Figure 4.9: Age of applicants who were interviewed during the search for certificates 116 Figure 4.10: Number of dependent family members living with respondents at the time of application.
LIST OF ABBREVIATIONS
CHAPTER ONE
INTRODUCTION
- BACKGROUND TO THE PROBLEM
- PROBLEM STATEMENT
- PURPOSE OF THE STUDY
- OBJECTIVES OF THE STUDY
- RESEARCH QUESTIONS
- SIGNIFICANCE OF THE STUDY
- OPERATIONAL DEFINITIONS
- CONCLUSION
The biggest problem in this study was therefore that the extent of the problem with nurses. Healthcare workers - means all persons working in healthcare facilities or institutions at all levels of healthcare.
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
Even then, there was concern about the impact of the migration of health workers to poorer countries. In the 1970s, it was estimated that approximately 135,000 nurses (or 4% of the world's total) were outside their country of birth or education, 92 percent of whom were in Europe, North America, and the developed countries of the Western Pacific (Mejia and Pizurki 1976).
INTERNATIONAL MIGRATION: AN OVERVIEW
Another source of data is from checks, which is when a check is made to confirm that an individual's name is on the professional register. These data indicate that the individual intends to register and work abroad.
INTERNATIONAL MIGRATION OF NURSES
- Trends and dimensions
Most of the world's migrants live in Europe (56 million), Asia (50 million) and North America (41 million), of which 60–65 million are described as economically active (United Nations Population Division, 2003). It has even been suggested that doctors retrain as nurses due to greater employment opportunities abroad (Sison, 2003).
FORCES BEHIND MIGRATION OF NURSES .1 Influence of colonial powers
Professionals have more opportunities for overseas employment than an unskilled worker and are more likely to be better informed about opportunities abroad and have greater access to financial resources needed to migrate. In such situations, the individual's urge to move to another country or region is likely to be extremely strong, especially in the case of concrete threats to life or safety. The researchers perceive the situation of involuntary migration as extreme and therefore the decision to leave is self-evident, and the need to decide when and where to move is in principle the same as for voluntary migration.
MIGRATION TRENDS IN AFRICA: AN OVERVIEW
In sub-Saharan Africa, many doctors work overseas and the numbers of nurses are higher. This was twice the number that graduated from the training institutions in the country that year (Zachary, 2001).
INTERNAL AND RURAL TO URBAN HEALTH WORKER MIGRATION
For example, in 2000, more than 500 nurses left Ghana alone to work in other industrialized countries. Available data also shows an increase in the number of countries sending nurses to industrialized countries.
GENDER AND HEALTH WORKER MIGRATION
By 2000, the proportion of women among international migrants in Asia (43 percent) was lower than that in Africa (47 percent), but in all other major regions, female migrants accounted for more than 50 percent of international migrant population. This resulted in a steady decline in the number of temporary migrant workers and an increase in the proportion of women in the overall stock of international migrants.
HEALTH WORKFORCE SHORTAGES
OTHER CAUSES OF HEALTH WORKFORCE ATTRITION .1 HIV/AIDS and the health workforce in Africa
The report goes on to state that the HIV/AIDS challenge to the workforce goes beyond increasing workloads and new knowledge and skill needs, and highlights that evidence from some of the worst-affected countries indicates an increased drain on the health workforce. Projections proposed by Kinoti (2003) in his review of UNAIDS and World Bank data indicate that health systems in Africa are likely to lose a fifth of their workforce to HIV/AIDS in the next few years, and based on his calculations, he argues that given 15% of adults in the country HIV-positive, health services may lose between 1.6 and 3.3% of workers annually.
THE ZAMBIAN CONTEXT
- National Health Reforms
The vision of the Ministry of Health in Zambia is “to provide Zambians with equal access to cost-effective, quality health care, as close to the family as possible” (MOH, 1991). MOH, 2004a). The report cited the national tertiary hospital, the University Teaching Hospital (UTH), where more than 75% of nurses had left.
FACTORS CONTRIBUTING TO INTERNATIONAL MIGRATION
- Globalization and health
The globalization of health services is reflected in the increasing cross-border provision of health services through the movement of staff and consumers (by electronic and other means) and in the increasing number of joint ventures and cooperative arrangements (Chanda, 2002). Similarly, it was estimated that more than 10,000 medical and biotechnological professionals from Egypt emigrated from that country (Khalil, 1999) and of the 1,200 doctors trained in Zimbabwe in the 1990s, only 360 in 2001. worked in the country.
MIGRATION THEORIES
Wallerstein (1974c) developed a theoretical framework for understanding the historical changes involved in the rise of the modern world. Frank (1970) advanced the argument and theorized that the structure of the world economy was such that surplus produced in the periphery was appropriated by the center.
THEORETICAL FRAMEWORKS AND THEIR APPLICATION TO
For example, a well-educated and skilled elite, perhaps most valuable to the periphery, is lost to the center (Frank, 1970). Ahmed (1997) argues that such remittances sent by migrants to the periphery are rarely invested in production.
THE STUDY
- Impact ofnurse migration on the health care system: assumptions
- Assumptions about globalization
- TRANSNATIONAL MIGRATION
- CONCLUSION
This theory assumes that the labor force exported to the core or center is surplus and that there are economic benefits derived from this labor force as it is expected to bring in remittances from its earnings as a policy. The existence of transnational social spaces confirms the ability of people who migrate to creatively shape their professional and personal experiences and other forms of connections.
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
RESEARCH DESIGN
The survey design was used in this study to facilitate the collection of data on nurse migration and its perceived impact on the public health care system from a wide range of sources or cases. The quantitative approach was used to generate and quantify data on the extent of nurse migration and its perceived impact on the public health care system in numerical terms generalized into numerical representation (Babbie and Mouton, 2002) while the qualitative approach sought to understand the phenomenon from the participants' perspective, not the researcher's (Hardon . 1995).
STUDY POPULATION
Nurse educators were included in the study to determine their perception of the impact of nurse migration. The health facilities where the nurses work are spread across the country's nine provinces.
SAMPLE AND SAMPLING PROCEDURE
- Sample
This method was used to increase the representation of the nurses in the study. Systematic sampling was used to select nurses and nurse educators who participated in the study.
DATA COLLECTION PROCESS AND INSTRUMENTS .1 Data collection instruments
This instrument had sections on respondents' demographic data, family responsibilities in terms of number of children and dependents to demonstrate the respondent center in data collection. The instrument aimed at migrant nurses who were in Zambia at the time of data collection was tested on the first two visiting respondents.
DATA COLLECTION PROCEDURE
The researcher was aware of the way in which information about nurses seeking verification was recorded by a person trained in recording and record keeping. These interviews were conducted in one of the GNC offices because the setting was convenient for the participants and the researcher.
DATA ANALYSIS
Informed consent was obtained from all the nurses and policy makers who participated in the study. The researcher also mentioned that the same would apply to people who would refuse to participate in the study.
LIMITATIONS OF THE STUDY
To increase confidentiality, addresses and names were not recorded on the questionnaires, instead identification numbers were used with a master identification file created to link numbers to names to allow correction of missing or conflicting information, this information however, they were confidential (Babbie and Mouton, 2002). The study was based on the assumption that migrant nurses who visited the country or returned without the intention of returning to their destination countries would still provide the same information about their migration in terms of why they left the job and left and what attracted them to the destination countries.
CONCLUSION
INTRODUCTION
The first part of the results focuses on the findings from the quantitative data followed by the results from the qualitative data analysis. In the main results from the qualitative data analysis, the data are presented in narratives, elaborating on themes and sub-themes from the findings and supported by relevant illustrative quotations and excerpts to enhance the clarity and understanding of the findings, where available.
PRESENTATION OF RESULTS .1 Quantitative data
- Datafrom verifications records
The data in Figure 4.2 shows gender and age of the nurses in the sample of records. The highest number (235) of nurses with sent verifications were among those who had 6-10 years of experience, accounting for 197 (21%) and 38 (18%) of the registered and enrolled nurses, respectively.
Country of choice for nurses applying for verification
As indicated in Figure 4.23, however, 62% of the respondents had dependents under their supervision while living outside the country. The basic qualifications of the respondents who migrated and visited Zambia are as shown in Figure 4.29.
Other Countries Respondents had worked in
Perceivedimpact ofnurses leaving/or greener pastures
This part of the study focuses on the perceived impact of nurses leaving for greener pastures on the public healthcare system. Only 12% responded that nurses leaving for greener pastures had had no effect on nurse recruitment in their workplace.
How workload has been affected by nurses leaving for greener pastures
Respondents were also asked to answer questions regarding the impact on management oversight in light of nurses leaving for greener pastures in terms of supplies that enable nurses to do their jobs. Thirty (11%) indicated nurses should work for 2-5 years before being allowed to leave the country, while 20 (6%) that there should be no rules at all for nurses who are going to leave for greener pastures.
Countries where nurse educators wish to go
What has made you stay
Issues for policy
Nurses seeking verification
Some of the respondents' expectations for their salaries included having some money left over for personal use after doing the essentials, as well as saving for possible future cases. Most respondents expressed a desire for working conditions that included more money.
