Jigmi Wangdi

The study titled ‘Factors Contributing to the Emigration and Retention of Health Workers in Bhutan’ sheds light on key reasons behind the attrition of health workers in the country.

However, the study also proposes essential best practices drawn from successful intervention measures implemented in both high-income countries and low- and middle-income countries (LMICs).

One significant measure identified by the study to address the attrition rate is the initiation of formal agreements between the source and destination governments.

The study emphasises, “It ensures that emigrating professionals receive comparable employment rights and benefits to domestically trained professionals.”

Such agreements, the study suggests, regulate the number and qualifications of emigrating professionals, mitigating negative impacts on the source country’s health system. The study provides evidence of successful bilateral agreements among different countries.

Task Shifting, as outlined in the study, involves transferring responsibility for simple tasks from high-skilled health workers to those with less expertise.

The study cites examples from countries such as the Netherlands, Canada, Australia, and the United States, where this method has resulted in higher patient satisfaction, reduced hospital admissions, decreased workload, and improved retention. Task shifting, the study suggests, can alleviate the workload and stress on health workers while enhancing retention and motivation.

The study also delves into the Circular Migration Programme, which allows migrants a degree of mobility between two countries. Instances highlighted include Irish nurses migrating to the UK for training and work experience, with the intention of returning to Ireland, and European doctors gaining work experience in countries such as the UK, Switzerland, and the United States.

The study indicates that this method ensures migrating health workers often return to their home countries, assuming leadership positions instead of staying in the foreign country.

Policies on ethical migration are underscored in the study, emphasising fair practices in recruiting and retaining health workers to prevent exploitation in source countries. Global and regional codes of practice, such as the WHO Global Code, are highlighted, with 64 countries incorporating code provisions into their national laws, policies, or international bilateral agreements.

The study suggests that effective implementation of such policies benefits both destination and source countries.

The study also explores the potential for dual practice, a common phenomenon among health workers, particularly in LMICs. It involves public sector-based health workers taking additional work in the private sector to supplement income and improve skills.

Conducted by Ugyen Tshering from the Ministry of Health, the study contributes valuable insights to addressing the challenges faced by Bhutan in retaining its health workforce.