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Hi Forgive me if I have brought this subject up earlier, but I am seeking input from nursing and medical professionals on this. If you could read my ideas below and give feed back, it would be welcome. However, as the subject also seemed relevant to recent discussions here, I wanted to see if people were interested in discussing the topic for its own merits.
Please remember, the ideas being offered are focused at a population or group level of analysis, this is not meant as an attack on individual practitioners. It structured as a way to work out ideas.
I am in the process of writing a paper to be presented at the African Studies Association as part of the roundtable called "Medicine on the Move: Interrogating the Direction and Meaning of Mobility in Global Health Discourse on Africa". My paper is, admittedly, part of an effort to further the conversation about what we value in care.
There are many regulations that limit international migration of nurses, pharmacist and physicians from Africa to OECD countries, particularly the US. The reason for limiting foreign educated health professionals’ practice in the US is typically centered on concerns about adequate education, knowledge of the US health system and other qualifications. Is this reasonable given our discussion medical and nursing missions; from those and other related conversations and indeed my own experiences, it is clear that there are no firm regulations for those who practice in these missions. Nursing and medical schools are implementing guidelines, but outside of those groups and a few large NGOs, screening and preparation of European health professionals and US for missions is uneven at best.
What does this mean to people who are served by the missions? The implication is that because we have a superior system, there is less need for a country to verify our qualifications to practice. Is that always the case? The Institute of Medicine recently released a comprehensive report that illustrated the weakness of that assumption: though the United States spends more on health care than any other country on the planet, almost double that of the second highest spender, we have the worst health outcomes of the 17th wealthiest countries in the world. Our outcomes remain poor regardless of access to and use of insurance, ethnic background, income, and engagement in healthy behaviors, or education. The countries we visit are had great improvements in health indicators, because of external funding and training initiatives but also due to incredible efforts from direct care workers, government and members of civil society to improve care and the right to health. At some point in the near future some "developing" countries will surpass us in terms of population health.
Given our poor health outcomes, a number of questions come up when considering cross-country practice of health professionals:
Should health professionals from countries with poor outcomes have more regulations when they practice outside their setting (home country)? And for those who do not provide direct care on missions but teach - do you think that given our health system, that we may be teaching practices, which may lead to more rather than fewer problems within a health system?
Should the US loosen up regulations on access to practice for foreign educated health professionals?


Maggie Sullivan
Replied at 6:30 PM, 14 Jul 2013

Elizabeth - this is something rarely, if ever, raised. A vestige of self-importance that requires shedding. I would love for you to attach the IOM report to which you refer. Also, I came across this publication from the IOM on nursing, which I didn't realize existed.

You are correct. It does not make any sense, that a country with a global ranking of 37 (between Costa Rica and Slovenia) is imbued with a mandate to export its methods of health care, yet rigidly limit the importing of health care methods (and personnel) from countries with much better health outcomes. But what to do? I wonder what would happen if there was one standardized exam we all had to pass before being allowed to provide/teach healthcare outside one's country of origin.

I don't know that anyone should loosen up regulations. Seems to me like everyone should have rigorous standards, instead. How pratical this is, I don't know. But it's inadequate to leave the system that's been created by the path of least resistance as is.

Attached resources:

Bistra Zheleva
Replied at 1:57 PM, 15 Jul 2013

I have couple of comments on this topic. Most countries have some type of process for acquiring temporary medical privileges for visiting medical and nursing professionals. I don't have experience with many African countries but many lower middle income countries do. Increasingly, the mode advanced the country is, the more likely will be that they will have a system for handling that. It is another question how well it is enforced. I also feel that when the primary purpose of the visit is teaching, there should not be any need for medical privileges, just like there is no need for those during conferences. So it is up to the NGOs themselves to decide what their purpose for those visits is. In my organization we intentionally decided to not call our visits "missions" because the word did not reflect the training aspect at all. So now every exchange, whether it is there or in the US (UK, Singapore, Canada, etc.) is called a training visit, because the purpose is training, not treatment. The same is valid when we do exchanges between institutions that are in the same region.

My second comment is on what people coming from the US are teaching and if we should be teaching at all. It's true our system has a lot of problems, but the level of clinical services is still great so we can offer a lot. Again, to illustrate this with an example from my work - we are very selective about how we choose our volunteers. We get requests from a lot of students, fellows, people who have the best intentions but have little experience. It's is hard but we always have to turn them down because we look for volunteers that can make a long-term commitment and can offer not only clinical knowledge but also mentorship and professional peer relationship. Such people hopefully also would have some academic appointments. And uniformly, all of the people who volunteer with us say they learn as much as they teach. It is important to emphasize that this is a two-way partnership.

Finally, I thought some international guidelines or agreements on limiting unethical recruitment of health professionals from LMICs to prevent brain drain but if I remember correctly, with poor enforcement. I aimagine the strict regulations in the US at least "help" with that.

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