title: A mixed-methods study of health worker migration from Jamaica.
abstract: This study sought to better understand the drivers of migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been 'sources' of health workers migrating to other countries. The aim of this paper is to present the findings from the Jamaica portion of the study.
  
  
  
  Data were collected using surveys of Jamaica's generalist and specialist physicians, nurses, midwives, and dental auxiliaries, as well as structured interviews with key informants representing government ministries, professional associations, regional health authorities, healthcare facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Multiple stakeholder engagement workshops were held across Jamaica to share and validate the study findings and discuss implications for the country.
  
  
  
  Migration of health workers from Jamaica continues to be prevalent. Its causes are numerous, long-standing, and systemic, and are largely based around differences in living and working conditions between Jamaica and 'destination' countries. There is minimal formal tracking of health worker migration from Jamaica, making scientific analysis of its consequences difficult. Although there is evidence of numerous national and international efforts to manage and mitigate the negative impacts of migration, there is little evidence of the implementation or effectiveness of such efforts. Potential additional strategies for better managing the migration of Jamaica's health workers include the use of information systems to formally monitor migration, updating the national cadre system for employment of health personnel, ensuring existing personnel management policies, such as bonding, are both clearly understood and equitably enforced, and providing greater formal and informal recognition of health personnel.
  
  
  
  Although historically common, migration of Jamaica's health workers is poorly monitored and understood. Improved management of the migration of Jamaica's health workers requires collaboration from stakeholders across multiple sectors. Indeed, participating stakeholders identified a wide range of potential strategies to better manage migration of Jamaica's health workers, the implementation and testing of which will have potential benefits to Jamaica as well as other 'source' countries.
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada.
authors.forename: Gail
authors.initials: G
authors.lastname: Tomblin Murphy
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada. adrian.mackenzie@dal.ca.
authors.forename: Adrian
authors.initials: A
authors.lastname: MacKenzie
authors.affiliation: Ministry of Health, Kingston, Jamaica.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Waysome
authors.affiliation: Ministry of Health, Kingston, Jamaica.
authors.forename: Joan
authors.initials: J
authors.lastname: Guy-Walker
authors.affiliation: Ministry of Health, Kingston, Jamaica.
authors.forename: Rowena
authors.initials: R
authors.lastname: Palmer
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada.
authors.forename: Annette
authors.initials: A
authors.lastname: Elliott Rose
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Rigby
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Labonté
authors.affiliation: Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ivy Lynn
authors.initials: IL
authors.lastname: Bourgeault
mesh_terms: D003695:Delivery of Health Care; D003797:Dental Staff; D003813:Dentistry; D003906:Developing Countries; D004641:Emigration and Immigration; D005260:Female; D005551:Foreign Professional Personnel; D006282:Health Personnel; D006801:Humans; D007563:Jamaica; D008297:Male; D009042:Motivation; D009721:Nurse Midwives; D009726:Nurses; D010559:Personnel Management; D010820:Physicians; D011365:Professional Practice Location; D012924:Social Conditions; D014171:Transients and Migrants; D017132:Workplace
keywords: Dental auxiliaries; Doctors; Health workers; Human resources for health; Jamaica; Midwives; Migration; Nurses; Policy