SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
May, 2011 - SUPPORT Summary of a systematic review | print this article |
Health professionals from LMICs constitute a substantial proportion of the healthcare workforce in certain HICs. The migration of health professionals from LMICs to these HICs contributes to a shortage of health professionals in LMICs. The resources used to train health professionals in source LMIC countries therefore, in effect, subsidise HICs that benefit from this migration.
People making decisions concerning interventions for controlling emigration of health professionals from low- and middle-income countries.
Peñaloza B, Rada G, Pantoja T, Bastías G, Herrera C. Interventions for controlling emigration of health professionals from low and middle-income countries. Cochrane Database of Systematic Reviews 2009, Issue 1 . Art. No.: CD007673. DOI: 10.1002/14651858.CD007673. See in Cochrane Library
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
| Review Objectives: To assess the effects of policy interventions to control the emigration of health professionals from LMICs to HICs | ||
| / | What the review authors searched for | What the review authors found |
|---|---|---|
| Interventions | Any interventions in source or recipient countries (or both) as well as international agreements that could have an impact on the outcomes. |
1 interrupted time series study on the effects of a modification to USA immigration laws (The American “Act of October, 1965” decreased barriers to emigration from countries outside the Americas to the USA) |
| Participants | Health professional nationals of a LMIC whose graduate training was in a LMIC. |
Nurses |
| Settings | Not restricted |
USA and the Philippines |
| Outcomes |
Proportion (or other measure of change in number) of health professionals that emigrate from a LMIC to an HIC. |
Annual number of nurses migrating from the Philippines to the USA |
| Date of most recent search: May 2010 | ||
| Limitations: This is a good quality systematic review with only minor limitations | ||
Peñaloza B, Rada G, Pantoja T, Bastías G, Herrera C. Interventions for controlling emigration of health professionals from low and middle-income countries. Cochrane Database of Systematic Reviews 2009, Issue 1 . Art. No.: CD007673. DOI: 10.1002/14651858.CD007673. See in Cochrane Library
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
One interrupted time series study was included. This examined the effects of a change to American immigration legislation on the migration of nurses from the Philippines to the USA.
No evidence was found regarding the effectiveness of interventions implemented in low-income countries to decrease emigration. Specifically, no evidence was found regarding:
- Strategies (financial or non-financial) to improve the working conditions and career prospects of health professionals
- Interventions for the education and training of health professionals, adjusted to the training needs and demands of local health systems (e.g. teaching methods, the use of local language training, or community-based curricula)
- The use of compulsory service schemes for health professionals
- Strategies to facilitate and support the return of health professionals working abroad
- Bilateral or multilateral agreements regulating the flow of health professionals from low- to high-income countries
Interventions controlling the emigration of health professionals |
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| Patient or population: Nurses in the Philippines Settings: USA and the Philippines Intervention: Modification in USA immigration laws Comparison: Before modification in USA immigration laws |
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| Outcomes | Impact | No of Participants (studies) |
Quality of the evidence (GRADE) |
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Annual number of Phil-ippine nurses migrating to USA |
First data point after intervention: |
(1 study) |
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| p: p-value GRADE: GRADE Working Group grades of evidence (see above and last page) | |||
| Findings | Interpretation* |
|---|---|
| APPLICABILITY | |
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| EQUITY | |
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| ECONOMIC CONSIDERATIONS | |
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| MONITORING & EVALUATION | |
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| *Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low and middle-income countries. For additional details about how these judgements were made see: http://supportsummaries.org/support-summaries/how-support-summaries-are-prepared/ | |
Related literature
Bach S. International migration of health workers: labor and social issues (Working paper #209). Sectoral Activities Programme, International Labour Office 2003.
Stilwell B, Diallo K, Zurn P, Dal Poz MR, Adams O, Buchan J. Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges. Human Resources for Health 2003;1:8.
Stilwell B, Diallo K, Zurn P, Vujicic M, Adams O, Dal Poz M. Migration of health care workers from developing countries: strategic approaches to its management. Bulletin of the World Health Organization 2004;82:595-600.
Willis- Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Improving motivation and retention of health professionals in developing countries: a systematic review. BMC Health Service Research 2008;8:247.
This summary was prepared by
Peter Steinmann, Swiss Tropical and Public Health Institute, Switzerland
Conflict of interest
None declared. For details, see: Conflicts of Interest
Acknowledgements
This summary has been peer reviewed by: Blanca Peñaloza, Chile and Elizeus Rutebemberwa, Uganda
This summary should be cited as
Steinmann P. Do interventions for controlling emigration of health professionals from low- and middle-income countries work? A SUPPORT Summary of a systematic review. May 2011.
