Michael Clemens

 
Michael Clemens
Profile
Research Fellow Michael Clemens leads CGD’s Migration and Development initiative. This work investigates how rich countries’ regulation of international movement by people from poor countries shapes the lives of the people who move as well as those who do not.


Full Bio
http://www.cgdev.org/content/expert/detail/2570/

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January 14, 2009

Way to Go, WHO! Ethical Recruitment of Health Workers That Is Truly Ethical

By Michael Clemens

The World Health Organization got it right.

Next week the WHO Executive Board will meet to discuss a new code of practice for health worker recruitment. Initially I was sure that this would include urging limits or bans on recruitment from most developing countries, as the code of practice for the British National Health Service does.
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July 5, 2007

Africans Need Doctors, But They Need Health Even More

By Michael Clemens

Mozambique’s Minister of Health Dr. Paulo Ivo Garrido is worried about the shortage of doctors in his country. He recently declared that “The main problem in the Ministry of Health is the shortage of [medical] staff. We need specialized doctors, not just general practitioners.” He has a plan to encourage the migration of 8,000 doctors from other African countries into Mozambique over the next decade. Minister Garrido’s colleagues in health ministries across his continent will not be happy with this plan, since nearly all are fighting the emigration of doctors from their countries. They will likely complain that Mozambique is aggravating the “main problem” in their own ministries.

But let’s take a step back. I spent a couple of days at the Ministry of Health in Mozambique last year, and I met many smart and dedicated people working there in frustrating conditions. I believe Minister Garrido’s claim that a shortage of highly-trained staff could be a large problem for the ministry. But is this the “main problem” for health in Mozambique?

If we want to know what additional specialist physicians would do in Mozambique, the best guide is not what we wish they would do, but what those currently on the ground are doing. They are working hard and doing good, but they are not reaching the vast majority of the population. In the latest available figures (p. 67), 77% of specialist physicians in Mozambique lived and worked in the capital city of Maputo – more than 1,000 miles from the impoverished northern reaches of the country. There is no reason at all to believe that the marginal specialist physician added to the country would tend primarily to reach the least-served populations.
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August 17, 2006

Is health worker migration a disease or a symptom?

By Michael Clemens

The World Health Organization has launched a new report, Taking Stock: Health worker shortages and the response to AIDS (.pdf), which states that the “reasons for the health workforce shortage include poor pay and conditions, lack of training and migration.” Among other things the report praises “ethical recruitment” — a euphemism for “rich countries should not tell African women about the lucrative nursing jobs available to them overseas, nor explain to them how to get those jobs.”

Note that the report says the problem is “poor pay and conditions” and “migration,” as if these were separate. But they are not. Migration is a result — a symptom. It is not a cause of the problem. African health workers migrate precisely because conditions are so difficult for them there. Would we prefer that African nurses (mostly low-income women) could not get better jobs to escape those awful conditions? If not, then migration per se is not bad; it is not a “problem” in and of itself.

Is it “ethical” to give African women no alternative to facing their fate simply because they didn’t happen do be born in a country with good working conditions for health professionals? Defining migration as part of “the problem” is like saying that the cause of a police officer shortage in the US is 1) low wages and dangerous working conditions and 2) the fact that young working-class men can get safer, higher-paying jobs outside of law enforcement. Who would want to reverse the latter? We need to stop discussing “migration” as a problem that must somehow be handled. Solving the real problem would vastly reduce or eliminate migration.

Those interested in health worker migration will want to have a look at a new CGD database that systematically measures the emigration of African-born doctors and nurses for the first time. Data like these, far better than what has heretofore been available, will allow us to make progress on clear and objective assessment of the causes and consequences of health worker migration.

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