Hiding in Plain Sight: The Absence of Consideration of the Gendered Dimensions in ‘Source’ Country Perspectives of Health Worker Migration
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AbstractBackground: Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. Methods: A Canadian-led research team with co-investigators in the Philippines, South Africa, and India examined the causes, consequences and policy responses to the international migration of health workers from these ‘source’ countries through documentary, interview and survey data with workers and country-based stakeholders. Here we undertake an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3,580 health workers. Results: The literature on health worker migration from South Africa, India and the Philippines reveal that gender can mediate access and participation in health worker training, employment, and migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stakeholders in South Africa described female health workers as “preferred” for “innate” personal characteristics and cultural reasons, and in India that men are directed away from nursing roles particularly because they are considered only for women. That inadequate remuneration was identified as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, may be linked to the impact of underlying gender-based pay inequity. The literature suggests that migration may improve social status of women nurses, but it may also expose them to deskilling, as a result of intersecting racism and sexism in their destination country. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses.Conclusion: An explicit gender-based analysis on health worker migration could offer useful insights for health and social policy responses and emphasize the importance of equity considerations to their decisions in these countries.
