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Presented to the All Party Parliamentary Group on Population, Reproductive Health and Nutrition, Madrid, Spain on February 25, 2013. A WHO Code of Practice on the international recruitment of health personnel exists since 2010, though the first reporting by Member States in 2013 is very poor. The issue of international migration is often the immediate reaction when discussing migration ("brain drain"). However, evidence points to the fact this is less of a problem than internal migration, which leaves communities, families and women without access to the necessary health personnel and health services. This presentation explores these issues with respect to the midwifery workforce, and in particular midwives. It uses data from the State of the World's Midwifery 2011, and the H4+ High Burden Countries Initiative to highlight the concerns. The evidence confirms that without due attention to the availability, accessibility, acceptability and quality of healthcare professionals and other MNH health workers, there is a lack of effective coverage for women. Further information is available from www.integrare.es
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Impact of migration on access to maternal and newborn health services
V Parliamentary Meeting on Global Health: The migration of the health workforce and its impact on global health
Madrid26 February, 2013
Jim CampbellDirector, ICS Integrare, Barcelona, [email protected]
Impact of migration on access to maternal and newborn health services.
Source: Ferreres, June 2008
Impact of migration on access to maternal and newborn health services.
2010 2011J F M A M J J A S O N D J F M A M J J A S O N D
2. A historical look: HRH for MNH 2010 - 2012
2012J F M A M J J A S O N D
```
Global Strategy for Women’s and Children’s Health
```
Commission on Information and Accountability for Women’s and
Children’s Health
```EWEC
launch
```iERG
```
WHA 64
```
WHA 65
```SOWMY 2011
```
London Summit on Family Planning
```
UNFPA International Parliamentarians
Conference
```
HBCI
```Women Deliver
Midwifery Symposium
```
```
Rio+20
UN High-Level Panel Post-2015
```ICPD Global CSO
consultation
Impact of migration on access to maternal and newborn health services.
2013 2014Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
ICM Congress
Women Deliver
LancetEWEC
FINAL (En)For copy layout, translation etc
CONCEPT ENDORSED LAUNCH
CONCEPT DEVELOPMENT
$ Mobilisation
Prince MahidolHRH Forum
GBC Health
``` SOWP
3. A forward look: HRH for MNH 2013 - 2014
GMHC EWEC
DATA COLLECTION
75 Countdown DRAFT REPORT
STATE OF THE WORLD’s MIDWIFERY
ICPD Human Rights
High-level meeting on
MDGs
``
USAID 50X2035
Impact of migration on access to maternal and newborn health services.
4. The State of the World’s Midwifery Report 2011. High Burden Countries
Impact of migration on access to maternal and newborn health services.
4. The State of the World’s Midwifery Report 2011.
Impact of migration on access to maternal and newborn health services.
4. The State of the World’s Midwifery Report 2011. Profile on Bolivia.
Impact of migration on access to maternal and newborn health services.
4. The State of the World’s Midwifery Report 2011. Profile on Bolivia.
Impact of migration on access to maternal and newborn health services.
Summary messages (with caveats)
1. Practising workforce (and quality) not known
2. Inadequate numbers – inequitable coverage
3. ‘Triple gap’ – competencies, coverage, access
4. Education, regulation, professional association – weak
5. Policy coherence – missing
“Failed to reach” NOT “Hard to reach”
4. The State of the World’s Midwifery Report 2011.
Impact of migration on access to maternal and newborn health services.
“Ensuring that every woman and her newborn have access to quality midwifery services demands that we take bold steps”
Ban Ki-moon, Secretary-General of the United Nations
Impact of migration on access to maternal and newborn health services.
2010 2011J F M A M J J A S O N D J F M A M J J A S O N D
2. A historical look: HRH for MNH 2010 - 2012
2012J F M A M J J A S O N D
```
Global Strategy for Women’s and Children’s Health
```
Commission on Information and Accountability for Women’s and
Children’s Health
```EWEC
launch
```iERG
```
WHA 64
```
WHA 65
```SOWMY 2011
```
London Summit on Family Planning
```
UNFPA International Parliamentarians
Conference
```
HBCI
```Women Deliver
Midwifery Symposium
```
```
Rio+20
UN High-Level Panel Post-2015
```ICPD Global CSO
consultation
Impact of migration on access to maternal and newborn health services.
5. High Burden Countries Initiative: Midwifery Workforce Assessments
Afghanistan Bangladesh
DR Congo
Ethiopia
IndiaMozambique
Nigeria
Tanzania
Completed:2012-2013
In progress: 2013
onwards
Impact of migration on access to maternal and newborn health services.
5. Assessing need – pregnancies per year
Afghanistan Ethiopia
Tanzania
“If you miss the poor, you miss the point”
“Your place of birth should not determine your right to life”
Impact of migration on access to maternal and newborn health services.
5. Assessing supply: Health labour market analysis
Healthcare education and training
High School graduates (male/female)
Qualified healthcare workers
UnemployedEmployedExits
Public
Other
Private
Health sector
‘potential supply’
‘participation’
‘supply’
Source: adapted from Vujicic and Zurn, 2006
Impact of migration on access to maternal and newborn health services.
5. Assessing supply: urban/rural distribution - equitable?
Impact of migration on access to maternal and newborn health services.
5. Modelling future supply: if we use Tanahashi?
Target population who do not contact services
Availability CoveragePeople for whom service is available
Target Population
Accessibility CoveragePeople who can use service
Acceptability CoveragePeople willing to use the service
Contact CoveragePeople who use the service
Effective CoveragePeople who receive effective care
Service Delivery Goal
Proc
ess
of s
ervi
ce p
rovi
sion
Impact of migration on access to maternal and newborn health services.
5. Evaluating effective coverage in Afghanistan
Impact of migration on access to maternal and newborn health services.
For further information:
Please contact
Jim Campbell ICS IntegrareBarcelona, Spain
Twitter: integrare Website: www.integrare.es
