Human resources in health: an analysis of costs of training, certification requirements & migration issues in Belize

INTRODUCTION: The terms of reference required, inter alia, an analysis of the dynamics of the formation of health professionals in Belize, including available information on the immigration and emigration of these personnel into Belize and the resultant impact on HRH production, deployment, absorption, retention, performance and motivation. METHODS: To undertake the study, it was initially required to focus on the existing clinical science training institutions locally to obtain completion rates for health care professionals, the costs of training, the systems for certification of these professionals and issues regarding migration as a prime determinant of the existing stock of these health care professionals. Acknowledging that there are multiple categories of health care workers, the study focused mainly on nurses and doctors. The former are trained locally at the University of Belize in Belmopan, where after a four year course of study conservatively costing some $20,000 and sitting a regional examination, a student qualifies to practice as a nurse in Belize. Being a national university in receipt of a government subsidy that forms the single largest component of its budget, UB's student fees are deliberately maintained at below market costs. These costs exclude ancillary costs related to academia, such as boarding and lodging, which are substantially more market determined, and when included, costs are easily doubledthe various school fees. Doctors are not trained at UB, though Government does provide scholarships for locals to study medicine at the University of the West Indies, a regional institution also supported by GOB due to its membership in CARICOM. Globally, the market for health professionals is fluid, unregulated and largely undocumented, and Belize is impacted by its fluidity. Belizeans have a long history of emigrating mainly to the USA and while it is believed that health professionals have been among the migrants, there is a paucity of data in this regard. For these professionals immigrating into Belize though, a CSME Skills Certificate must be sought if the person is from any CSME country and if not, then a work permit must be sought. CONCLUSIONS: Most recent data from the Labour Department indicate that various categories of health professionals from as many as twelve countries spanning four continents are an integral component of Belize's existing health workforce. The reasons for the migration of health professionals continue to be many and varied, and there is an active and targeted recruitment programme in the USA. While the migration of these professionals must be regarded as a loss of much needed and scarce human resources in health, there are some positives. Capacity strengthening canoccur as the local health system can be enhanced by partnerships that contribute in specific areas, for example the DangrigaCancer Centre is owned and operated by a Belizean doctor who practices in the USA and occasionally brings fellow specialists to provide treatment services at minimal costs. Acknowledging though that health workers have an inherent right to migrate, the Government of Belize is advised to adopt the WHO's 2010 Code of Practice on the International Recruitment of Health Personnel. The Code of Practice seeks to regulate the migration of health personnel in a way that mitigates the damage to developing countries such as Belize. Other main recommendations focus on increasing the production of HRH. This can be accomplished via the provision of bursaries to students in these areas. Retention strategies are also required to provide pathways for these health professionals. Also being recommended is technical assistance to the Ministry of Health, the Belize Medical and Dental Council and the Nurses and Midwives Council to strengthen the regulatory framework so that they are all able to better keep abreast in tracking their members. At the present time, should a nurse or a doctor leave public employment, the Ministry of Health is not mandated to inform the respective council. Under a strengthened regulatory framework, this would be mandatory. Also mandatory would be the health professional informing in writing the respective council of any changes to his/her employment status or location of employment. This would greatly assist in tracking private doctors and nurses as they relocate to other areas of the country as well as if they migrate abroad. Finally, given Belize's focus on a primary health care model as the basis of its health care system, some consideration ought to be given to further strengthening of the Community Health Workers. These health volunteers are at the base of the local health system and are the most widely dispersed health worker. Consideration is justified because these unheralded workers are most unlikely to migrate since destination countries are selective in their recruitment efforts and exclusively require credentialed professionals as migrants. (AU)

Instrument N° 1: Inventory of National Programs. HRH Program evaluation questionnaire: core questions. Belize

The objective of this instrument is to register the programs that countries have implemented to address human resources for health (HRH) problems and to establish an inventory of HRH programs that can be analyzed and studied in­depth and provide new knowledge on how to respond to the challenges facing HRH policies and management in our region. This document should be completed by the Director of HRH or the equivalent person in the Health Authority, who has access to national information and is in consultation with the national institutions. (AU)