Lead Supervisor: Prof. Richard Smith (LSHTM)
Co-Supervisor: Dr Moses Oketch (IoE)
Prof. Felicity Smith (SoP)
Background
The 'brain drain' has been a prominent concern in many developing countries since the 1960's. In recent years, with the greater movement of people under globalisation there has been a growing concern for health system capacity in developing countries if a substantial proportion of workers migrate, particularly in the ability to achieve health-related MDGs. The developments in international trade that affect migration, such as under the World Trade Organization, have also highlighted the vacuum of understanding of issues associated with migration (1). The focus is often upon pecuniary aspects, but there is evidence that training opportunities are also of importance, with the intention to move overseas for training and then to return, but in many cases return not eventuating (2).
Thus, development in the wider context of education and training, which may include e-learning, suggest that it may be possible to meet the needs of workers for further education and training, without necessarily generating conditions to encourage migration. If so, it is possible that policy may be more effectively focused on aspects of education/training than other areas. However, there is currently no evidence to inform this.
Aims
The primary aim is to fill this knowledge gap by establishing the role of professional education in the decision of health professionals whether or not to migrate, on either a temporary or permanent basis. A secondary aim is to illuminate issues such as non-tariff barriers to migration (eg. professional recognition) that will inform discussions of liberalizing markets in these areas.
Research Questions
1. What do health professionals value about education in their country of domicile?
2. What do health professionals value about overseas-based education?
3. What is the relative importance of education/training opportunities and experience on the decision to remain in, or return to, their country of domicile, vis à vis other factors (eg. pecuniary)?
Methodology
The project will focus upon pharmacists in the UK (a developed, importing country) and Ghana (a developing, exporting country). Ghana has been identified as being particularly at risk of negative effects of health worker migration, and one where we have prior collaboration with pharmacists (2,3). The sample will comprise both migrant workers (those who have come to the UK or left Ghana to work). and non-migrant workers (those in Ghana who have elected to remain at home)
The first two research questions will be addressed through following the methods of Kangasniemia et al (4). A large postal/web-based survey will be undertaken to gather a minimum set of data on a large sample of around 1,000 across both countries. this sample will provide breadth and suggest how representative the more in-depth information to be collected will be. Information collected from respondents will concern the issues of importance to them in their decision to migrate or not. Information from this sample will also be used to generate a more specific instrument for use in the smaller in-depth survey.
A selection of 200 respondents from the 1,000 who will have undertaken this initial survey will then be subject to personal interview for a more in-depth survey. This survey will probe the issues identified in the initial survey in more detail, and will also involve a quantitative component to address the third objective of the relative importance of these factors in determining the migration decision, using a discrete-choice experiment (5).
Candidates should have a quantitative background, preferably in health economics, economics or other quantitative social science.
In addition to undertaking the PhD studies, the successful candidate will be encouraged to undertake courses relevant to the project from across the colleges, such as in aspects of survey design, analysis or presentation skills, and to move on to further research in this area, for which the supervisors will provide support in the preparation of further proposals.
Key References
1. Blouin C, Drager N, Smith RD (2005). International Trade in Health Services and the GATS: Current Issues and Debates. World Bank, 2005.
2. Owusu Daaka F, Smith F, Shah R (2008). Addressing the workforce crisis: the professional aspirations of pharmacy students in Ghana. Pharmacy World and Science, published on line ahead of print 2008
3. Buabeng K, Duwieuja M, Matowe L, Smith F, Enlund H (2008). Availability and choice of anti-malarials at medicine outlets in Ghana. Clinical Pharmacology and Therapeutics, published on line ahead of print July 2008.
4. Kangasniemia L, Winters L, Commander S (2007). Is the Medical brain drain beneficial? Evidence from overseas doctors in the UK. Soc Sci & Med; 65: 915-923.
5. Louviere J, Hensher D, Swait J (2000). Stated Choice Methods. Cambridge: Cambridge University Press.
Further details about the project may be obtained from:
Lead Supervisor: Prof. Richard Smith; richard.smith@lshtm.ac.uk
http://www.lshtm.ac.uk/people/smith.richard
Co-Supervisor: Dr Moses Oketch; m.oketch@ioe.ac.uk
http://ioewebserver.ioe.ac.uk/ioe/cms/get.asp?cid=4458&4458_0=9721
Prof Felecity Smith; felicity.smith@pharmacy.ac.uk
http://www.pharmacy.ac.uk/felicity_smith.html
Further information about PhDs at London School of Hygiene & Tropical Medicine is available from:
Dr Arnab Acharya; arnab.acharya@lshtm.ac.uk
http://www.lshtm.ac.uk/prospectus/research/
Application forms and details about how to apply are available from:
http://www.lshtm.ac.uk/prospectus/howto/research_guidelines_2009-10.pdf
Tel: +44 (0) 20 7299 4646
Karen Clarke, karen.clarke@lshtm.ac.uk
+44 (0) 20 7927 2431
The closing date for the applications is: 25 February 2009