Nursing Shortage in the English-Speaking Caribbean Hinders the Region’s Development, Says World Bank Report

March 2, 2010

KINGSTON, Jamaica, March 2, 2010 - Nursing shortages across the English-speaking Caribbean limit access and quality of health services and affect the region’s competitiveness, says a new World Bank report.

According to “The Nurse Labor and Education Markets in the English-Speaking CARICOM* - Issues and Options for Reform,” the region is facing a rapidly growing shortage of nurses as demand for quality health care increases due to an aging population, and high numbers of nurses emigrate drawn by higher paying jobs in Canada, the UK and the US.

These shortages have tangible impacts that may compromise the ability of English-speaking CARICOM countries to meet their key health care service needs, especially in the areas of disease prevention and care. In addition, the shortage of highly trained nurses reduces the capacity of countries to offer quality health care at a time when Caribbean countries aim to attract businesses and retirees as an important pillar of growth.

The World Bank estimates that there are 7,800 nurses working in the English-speaking CARICOM, or 1.25 nurses per 1,000 people, roughly one-tenth the concentration in some OECD countries. In addition, demand for nurses exceeds their supply throughout the region: 3,300 or 30 percent of all positions in the sector were vacant at the time of the study.

Nurses are the bedrock of highly functioning health systems in all countries,” said Evangeline Javier, Sector Director for Human Development in the World Bank’s Latin America and Caribbean region. “Our research suggests English-speaking countries in the Caribbean must adopt policies that aim to train more and at the same time retain quality nurses.”

In the coming years, demand for nurses in the English-speaking Caribbean will increase due to the health needs of the aging population. Under current education and labor market conditions, however, supply will slightly decrease. The World Bank expects that unmet demand for nurses will more than triple during the next 15 years — from 3,300 nurses in 2006 to 10,700 nurses in 2025.

At the same time, data suggests that the number of English-speaking CARICOM trained nurses working in Canada, the UK and the US is about 21,500, that is, three times higher than the workforce in the English-speaking CARICOM. Between 2002 and 2006, more than 1,800 nurses left the region to work abroad. Analysis indicates that the recent decline in emigration is the result of changes in immigration policies abroad rather than lessened interest in working abroad.

The new World Bank report also points to high demand for nurse education but low completion rates (55 percent) as a challenge and opportunity in tackling nurse shortages. Having more nurse tutors available, maximizing completion rates and accepting more students into programs would significantly bolster the number of new nurses entering the health system.

The report highlights that the costs and benefits associated with training a nurse in the English-speaking CARICOM are unfairly distributed among nurses, countries of origin, and countries where some nurses choose to live and practice their profession. Given current migration patterns, the report estimates that for every nurse trained in Jamaica, for example, prime destination countries reap benefits between US$3,800 (Canada) and US$26,000.

English-speaking Caribbean countries need to examine their policy responses towards the migration of health workers,” said Christoph Kurowski, World Bank Sector Leader for Human Development and lead author of the report. “Ideally, countries in the region should adopt a joined approach that balances the rights and interests of nurses and governments, as well as poorer and richer countries within the broader framework of the Caribbean Single Market Economy.”

Key Policy Recommendations

To meet the demand for nurses in the English-speaking Caribbean, the report suggests the following strategies:

  1. Increase training capacity. With an average regional graduation rate of 55 percent, dropouts represent a tremendous loss. Establishing national systems to monitor retention, increasing the flexibility of the curriculum to accommodate different schedules and interests, creating smaller learning groups, and identifying peer mentors have all been shown to effectively address student retention. Cost estimates for increasing retention and doubling the number of graduates to meet demand fall into the order of US$30 million. The report also suggests assigning costs more fairly to those who benefit, including the nurses themselves who express the willingness to pay for their education.
  2. Manage migration. Current approaches are limited to creating barriers to migration, recruiting from abroad and mutual recognition agreements. In addition, countries need to carefully consider policy options that range from leveraging the expatriate community, mentoring, staff exchange, and codes of practice for international recruitment.
  3. Strengthen data quality and availability. Information on the nurse labor and education markets remains scarce and sporadic. Given the current situation, it is critical that countries more closely monitor trends of key indicators such as vacancies, migration levels, and completion rates.
  4. Adopt a regional approach. Given the size and the linkages of local nurse labor markets, no country in the region is in a position to efficiently tackle the challenges ahead on its own. Therefore, countries ideally join forces and adopt a regional approach to increasing training capacity, managing migration and strengthening the evidence-base, if possible, with technical and financial support from countries where a large part of their nurse workforce will tend to migrate, Canada, the UK and the US.

* NOTE: The English-speaking CARICOM includes the following countries: Antigua and Barbuda, Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Montserrat, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago.

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