Identifying the role of the sending state in the emigration of health professionals: a review of the empirical literature

Abstract

There is a growing research interest in how sending states manage the emigration of health professionals. While the ‘push’ and ‘pull’ factors depict sending states as passive actors in this process, emergent studies are revealing them to be active actors with an articulated policy agenda. Using a variety of examples from the empirical literature, this paper identifies the multiple roles that sending states play in the emigration of doctors and nurses. The current findings contribute to the international migration literature in three ways. Firstly, this paper emphasizes that sending states are active actors in the health professional migration. Secondly, it shows that sending states adopt one of the three strategies: (1) introduce restrictive measures to delay the mobility of health professionals; (2) respond to market demands by producing and promoting emigration; and (3) implement a combination of these two strategies. Lastly, this paper highlights how sending states institutionalize gendered emigration through a bilateral cooperation in nurse migration. Missing from the extant literature are studies on competing beliefs, motivations, and technical information informing the strategies of sending states. This paper concludes by presenting a research agenda to further examine how and why sending states are active actors in the health professional migration.

Keywords:

• doctors
• health professional migration
• nurses
• sending countries
• state

Disclosure statement

No potential conflict of interest was reported by the author.

Acknowledgement

I would like to thank Meng-Hsuan Chou and Lucie Cerna for their helpful comments and suggestions on the previous drafts of this paper. I am also grateful to the valuable comments of the two anonymous referees.

Notes

1. Please see Massey et al. (1993) for a critical review and appraisal of the theories of migration across disciplines.

2. Some literature introduces the concept of transit countries (e.g. Collyer, Düvell, & de Haas, 2012). Collyer et al. (2012) refers them to countries that have borders connected to the rich and developed countries of the European Union (e.g. Turkey, Morocco) which belongs to another set of literature that mostly focus on unauthorized migration.

3. See for example the migration trend of foreign-trained nurses in the UK in Buchan (2006) and the global trend of doctors and nurses in OECD (2015).

4. See also Tumbe (2012) for a historical account of migration culture using district-level data within the context of remittance-based migration in India.

5. The GNCC is an expanded framework of global care labor that originates from Hochschild’s Global Care Chain (GCC) concept. Hochschild (2000, p. 131) defines GCC as ‘a series of personal links between people across the globe based on the paid and unpaid work of caring’. Yeates (2009b, p. 176) interprets this concept as a productive framework that explains ‘how processes of outsourcing, commodification and commercialisation of care in the richer countries were drawing women from poorer parts of the world to emigrate to provide a range of social care services for women, men and children’. Hochschild (2000) develops this concept from the perspective of domestic helpers as a form of low skilled labor. Yeates (2009b, p. 176) argues that nursing falls from the professional category of ‘care’ acquired through formal education and training; hence the birth of GNCC.