School of Sociology and Anthropology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
Gender, Work & Health Lab, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
Hum Resour Health. 2021 Mar 24;19(1):40. doi: 10.1186/s12960-021-00571-6.
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.
A Canadian-led research team partnered with co-investigators in the Philippines, South Africa, and India to examine the causes, consequences and policy responses to the international migration of health workers from these 'source' countries. Multiple-methods combined an initial documentary analysis, interviews and surveys with health workers and country-based stakeholders. We undertook 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 3580 health workers.
The documentary analysis of health worker emigration from South Africa, India and the Philippines reveal that gender can mediate access to and participation in health worker training, employment, and ultimately 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. Stereotypical views were evident amongst stakeholders; for example, in South Africa female health workers were described as "preferred" for "innate" personal characteristics and cultural reasons, and in India men are directed away from nursing roles particularly because they are considered only for women. The finding that inadequate remuneration was as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, was not necessarily linked to underlying gender-based pay inequity. The documentary data suggest that migration may improve social status of female nurses, but it may also expose them to deskilling, as a result of the intersecting racism and sexism experienced in destination countries. 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.
An explicit gender-based analysis of health worker emigration, which may help to emphasize important equity considerations, could offer useful insights for the health and social policy responses adopted by source countries.
性别角色和关系不仅影响卫生工作者迁移的驱动因素和经历，而且政策反应很少考虑这些性别维度。这种缺乏来自原籍国视角的明确关注可能导致政策反应不足。
一个由加拿大牵头的研究团队与菲律宾、南非和印度的合作研究者合作，研究这些“来源”国家的卫生工作者国际迁移的原因、后果和政策反应。多方法结合了初步的文献分析、对卫生工作者和国家利益相关者的访谈和调查。我们进行了明确的基于性别的分析，突出了从 2005 年至 2015 年期间发表的文献和政策文件中出现的与性别相关的影响和影响；对 117 位利益相关者进行了深入访谈；并对来自南非、印度和菲律宾的 3580 名卫生工作者进行了调查。
对南非、印度和菲律宾卫生工作者移民的文献分析表明，性别可以调解卫生工作者培训、就业以及最终移民的获取和参与。然而，我们对来自南非、印度和菲律宾的护士、医生和其他卫生工作者的调查数据进行了分析，并对政策利益相关者进行了访谈，结果显示，性别如何调解卫生工作者迁移的问题令人好奇地没有得到体现。利益相关者存在刻板印象；例如，在南非，女性卫生工作者因其“天生”的个人特征和文化原因而被描述为“首选”，而在印度，男性则被引导远离护理角色，尤其是因为他们被认为只适合女性。调查结果显示，在印度和菲律宾，薪酬不足是调查对象的主要迁移驱动因素之一，在我们的样本中，护士居多，这并不一定与潜在的基于性别的薪酬不平等有关。文献数据表明，移民可能会提高女性护士的社会地位，但也可能使她们面临技能退化，因为她们在目的地国家会经历种族主义和性别歧视的交织。无论在移民决策中存在这些潜在影响，性别在政策反应中很少被视为重要的背景影响或分析类别。
对卫生工作者移民进行明确的基于性别的分析，这可能有助于强调重要的公平考虑因素，可以为来源国采取的卫生和社会政策反应提供有用的见解。
