Co-development The Emerging Approach to Managing International - PowerPoint PPT Presentation

Co-development The Emerging Approach to Managing International Labor Mobility in the Global Economy Rudi Robinson Senior Researcher Globalization, Migration, Health and Development (GMHD) The North-South Institute November 2009

Introduction 1. The effects of globalization on healthcare labor markets in poor countries and the consequent impacts on their health systems and economies 2. The three main stakeholders affected are origin countries, destination countries, and the immigrant health professionals themselves

The Development Problem 1. The migration of health professionals from poor to rich countries is a zero-sum game � The brain drain concept of the migration of skilled and highly skilled persons � What is the scale of this problem? � What are its dimensions? � What have been the policy responses? � Is co-development a workable alternative to these responses ?

Main Argument • Globalization has highlighted the persistent disparities in income and career opportunities that exist between healthcare labor markets in developed and developing countries. Given these disparities “stay-at-home” strategies for managing the international mobility of health professionals will not always be effective

Argument (cntd.) • A policy approach that seeks to maximize the benefits for the three stakeholders and minimize the costs creates a “triple-win” solution and turns what is traditionally thought to be a zero-sum game into a non-zero sum game . • I propose the co-development approach as an alternative to “stay-at-home” and other strategies for managing the international mobility of health professionals from poor to rich countries

The Scale of the Problem: Selected SSA Countries, 2000 1. Table 1: Emigration Rates (ER)– The international mobility of physicians and nurses compared with All Professionals 2. The effect on the human resource capacity of SSA health systems � Table 2: ER for Physicians � Table 3: ER for Nurses

Dimensions of the Problem 1. Human resource 2. PHC Equity 3. Human security 4. Human rights 5. Economic 6. Political

Policy Responses 1. Developing Countries � Restrictive policies � Retention policies � Reparation policies � Skills substitution policies � Education sector & Econ. development policies

Policy Responses (cntd.) 2. Collaborative Policy Responses: International Organizations and Developing countries � Return migration programs � D iaspora engagement programs

Policy Responses (cntd.) 3. Collaborative policy responses: developed and developing countries � Ethical recruitment � Bilateral Agreement

Limitations of Policy Responses 1. Restrictive policies � Generally ineffective in reducing the negative effects of international migration of health professionals on the human resource capacity of health systems � Raises human rights issues

Limitations (cntd) 2. Incentive-based retention schemes � Aid-funded retention schemes are usually success stories; but they lack domestic financial sustainability when foreign aid comes to an end 3. Reparation policies � Denounced as another form of taxation � Difficult to implement � Raises human rights issues

Limitations (cntd.) 4. Skill-substitution strategies � Promotes better fit between population health needs and workforce skills � Creation of a cadre of health workers whose qualification is a disincentive to emigrate � Workforce-deskilling � Reinforcement of a two-tiered healthcare workforce

Limitations (cntd) 5. Return migration strategies � A popular brain-drain reversal and brain circulation strategy, particularly when the return is resource value adding � But benefits are not clear-cut - depend upon motives or intentions, time pattern, timing, nature of return, and conditions at home � Largely funded by international aid agencies – raises questions of ownership, and therefore long- term viability and sustainability

Limitations (cntd.) 6. Ethical Recruitment (Codes of practice) � Instrumental in focusing attention on ethical and labor rights issues involved in health worker migration � Not a treaty and therefore not legally-binding � Government recruitment agencies may comply; but for private ones compliance is discretionary

Limitations (cntd.) 7. Diaspora engagement policy � Focuses mainly upon financial remittances flows for “productive” investment purposes � Largely ignores technology transfer, trade, investment, and other channels through which the diaspora can and in some cases does transfer value-adding development resources from rich to poor countries without necessarily returning home physically and permanently

Co-development: turning a zero-sum game into a non-zero-sum game 1. Definition of co-development � An emerging policy approach at both the EU, and global levels to managing migration flows from poor to wealthy countries in a manner that produces outcomes in which: � destination countries meet their labor needs from these flows through effective integration of immigrants, � origin countries gain from migration through brain gain circulation, circular migration, trade, investment, technology, and financial flows � Immigrants improve their economic and social welfare

Co-development as a strategy to manage health worker migration 1. Evolution of concept: � EU’S strategic thinking in the international development cooperation field � Sami Nair (1997 ) introduced the concept into European discourse on immigration policy to link migration and development in a way not always explicitly stated before � Initially implemented as a migration control strategy - limiting development aid to those countries willing to implement policies to control irregular migration outflows and re-integrate repatriated migrants � Shorthand for a balanced and comprehensive approach to managing international migration flows

Co-development at the global level 1. Adoption of the co-development approach by UN, IOM, ILO, OECD, WB,AU � Offers both destination and origin countries a new approach to the policy question: How can the migration of skilled and highly skilled labor from poor to wealthy countries be effectively managed so as to maximize benefits and reduce the negative effects and impacts on poor countries? � Endorsed as a concept that provides a common understanding and organizing principles for a planned, balanced, and comprehensive approach to the management of international migration from developing to OECD countries � “Mobility”, which does not imply the notion of “brain drain” replaces the word “migration” in the migration and development policy research agenda

Basic Principles of the Co- development strategy 1. Migrants are central actors in the development of destination and origin countries and their contributions should be recognized, reinforced encouraged, and promoted 2. Integration at destination and development at origin 3. Mutuality of benefits and risks

Basic Principles (cntd) 4. Transforming brain out flow into brain inflow` 5. Breaking the monopoly of wealthy countries’ domestic agenda over integration policy 6. Gender mainstreaming 7. The rights of immigrants 8. Human resource development 9. Coherence of policy and action 10. Cooperation, partnership, and dialogue

Policy Areas for Co-development Programming 1. Integration at destination a) Effective integration of immigrants is the critical determinant of their capacity to simultaneously contribute to the destination country’s prosperity, engage in the development of their country of origin, and improve their socioeconomic welfare independently of government transfers b) Dominant integration paradigms � Cultural Assimilation � Multiculturalism � Economic (Labor market) assimilation

Integration and destination (cntd.) c) The co-development approach to immigrant integration: shifts the integration paradigm from exclusion to inclusion by emphasizing the holistic concept of immigrant integration � A balancing of rights and obligations � Capacity building of immigrants � Protection of human rights � An inclusive process, which flows from the totality of policies and practices….

2 . Development at Origin : The Diaspora Option a) Evolved largely from diaspora-led homeland development initiatives b) Emerged in the 1990s as a brain gain strategy that differs from the return and “stay-at-home” options in the sense that it does not aim at the physical repatriation of poor countries’ nationals living in rich countries, and that migration generates significant net positive externalities of which origin countries should position themselves to take advantage

Diaspora Option (cntd .) c) Fundamental Premises � Individuals thrive in an environment that enables them to develop their technical and professional capabilities further through collaborative activities, knowledge and information sharing, research, networking, and strategic alliances. Industrial countries tend to provide such an environment for diasporas, thereby adding value to their technical and professional capabilities in ways that their home countries cannot