title: Causes, consequences, and policy responses to the migration of health workers: key findings from India.
abstract: This study sought to better understand the drivers of skilled health professional 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 Indian portion of the study.
  
  
  
  Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically.
  
  
  
  Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration.
  
  
  
  Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.
authors.affiliation: Balsillie School of International Affairs, 67 Erb Street West, Waterloo, ON, N2L 6C2, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Walton-Roberts
authors.affiliation: Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, ON, K1G 3Z7, Canada.
authors.forename: Vivien
authors.initials: V
authors.lastname: Runnels
authors.affiliation: Centre for Development Studies, Prasanth Nagar, Medical College P.O, Ulloor, Thiruvananthapuram, 695 011, Kerala, India.
authors.forename: S Irudaya
authors.initials: SI
authors.lastname: Rajan
authors.affiliation: Centre for the Study of Regional Development, School of Social Sciences, JNU, Delhi, India.
authors.forename: Atul
authors.initials: A
authors.lastname: Sood
authors.affiliation: Athiyara Madom Devi Temple Lane, Vanchiyoor, Thiruvananthapuram, 695035, Kerala, India.
authors.forename: Sreelekha
authors.initials: S
authors.lastname: Nair
authors.affiliation: College of Nursing, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Philomina
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, ON, K1G 3Z7, Canada.
authors.forename: Corinne
authors.initials: C
authors.lastname: Packer
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: MacKenzie
authors.affiliation: WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, School of Nursing, 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: School of Epidemiology, Public Health and Preventive Medicine Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, ON, K1G 3Z7, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Labonté
authors.affiliation: Telfer School of Management, University of Ottawa, 1 Stewart Street, Ottawa, ON, K1N 6N5, Canada. ivy.bourgeault@uottawa.ca.
authors.forename: Ivy Lynn
authors.initials: IL
authors.lastname: Bourgeault
mesh_terms: D000488:Allied Health Personnel / Q000600:supply & distribution; D003695:Delivery of Health Care / Q000592:standards*; D003815:Dentists / Q000600:supply & distribution; D004641:Emigration and Immigration; D006282:Health Personnel; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D008880:Midwifery; D009042:Motivation; D009726:Nurses / Q000600:supply & distribution; D010559:Personnel Management; D010595:Pharmacists / Q000600:supply & distribution; D010820:Physicians / Q000600:supply & distribution; D011365:Professional Practice Location; D013038:Specialization
keywords: Causes; Consequences; Doctors; Health worker migration; Human resources for health; India; Nurses; Policy responses