The Proving Ground: Colombo Plan Fellowships and the Changing Landscape of Health Education in Canada, 1951-69.

This article examines the history of the Colombo Plan fellowship program in Canada during the 1950s and 1960s. It will argue that this program had a visible impact on Canadian institutions of learning and health care for three reasons. First, it brought an unprecedented number of students and health care professionals from South and Southeast Asia to Canada; second, it fostered a sense of mission within Canadian institutions about the role education should play in contributing to health and international development overseas; and third, it revealed the challenges and tensions inherent in fulfilling this mission in the context of differences between the objectives of Canadian officials and those of the fellows themselves. With its focus on South and Southeast Asia, the Colombo Plan fellowship program anticipated broader trends regarding the international migration of health workers from that region in later years.

Analysing public sector institutional capacity for health workforce governance in the South-East Asia region of WHO.

BACKGROUND: In order to analyse the institutional capacity for health workforce policy development and implementation in countries in the South-East Asia region, the WHO facilitated a cross-sectional analysis of functions performed, structure, personnel, management and information systems of human resources for health (HRH) units in Ministries of Health. CASE PRESENTATION: A self-assessment survey on the characteristics and roles of HRH units was administered to relevant Government officials; the responses were validated through face-to-face workshops and by the WHO staff. Findings were tabulated to produce frequency distributions of the variables examined, and qualitative elements categorized according to a framework for capacity building in the health sector. Ten countries out of the 11 in the region responded to the survey. Seven out of 10 reported having an HRH unit, though their scope, roles, capacity and size displayed considerable variability. Some functions (such as planning and health workforce data management) were reportedly carried out in all countries, while others (inter-sectoral coordination, research, labour relations) were only performed in few. DISCUSSION AND CONCLUSIONS: The strengthening of the HRH governance capacity in countries should follow a logical hierarchy, identifying first and foremost the essential functions that the public sector is expected to perform to optimize HRH governance. The definition of expected roles and functions will in turn allow identifying the upstream system-wide factors and the downstream capacity requirements for the strengthening of the HRH units. The focus should ultimately be on ensuring that all the key strategic functions are performed to quality standards, irrespective of institutional arrangements.

Cambodia's health professionals and the ASEAN Mutual Recognition Arrangements: registration, education and mobility.

BACKGROUND: From 2006, the Association of South East Asian Nations (ASEAN) has been developing Mutual Recognition Arrangements (MRAs) across key professions, including medicine, dentistry and nursing, that would facilitate the development of an ASEAN Economic Community, with shared regional standards and easier mobility of the workforce. This paper examines the interface between those agreements and the registration, professional education and mobility of health personnel in Cambodia. METHODS: This qualitative health policy analysis combined documentary and policy review with key informant interviews with 16 representatives of agencies relevant to the development and implementation of the MRAs in health. Thematic analysis identified three themes: registration, education and mobility. RESULTS: Cambodia is an active participant in the ASEAN MRA processes for doctors, dentists and nurses reporting progress annually. Education of health professionals has been increasingly formalised in the past 25 years, with nursing moving towards a 4-year bachelor degree. The private university sector has substantially increased, with English increasingly used as a language of instruction. Recent legislation provides for enforcement through fines and/or imprisonment to ensure all practising health professionals hold initial registration as a health professional and a renewable licence to practise as a health practitioner. Continuing Professional Development is a mandatory requirement for licence renewal. This is consistent with the MRA guidelines, though the capacity for enforcement appears limited. The Medical Council of Cambodia (MCC), and more recently, the Dental and Nursing Councils, have introduced continuing professional development initiatives, using them strategically as a positive reinforcer of registration. Midwifery education and registration in Cambodia does not conform with ASEAN guidelines. In education, course durations in medicine and dentistry are longer than regional counterparts, though anxiety around maintaining clinical standards has resulted in the introduction of a National Exit Examination and reluctance to abbreviate courses. The introduction of reforms appears to reference regional standards, though parity is still some way off. Mobility at present is infrequent and more likely to result from informal mechanisms than through the MRA mechanisms. CONCLUSION: The Royal Government of Cambodia is committed to the ASEAN MRA process. Developments in registration appear to use regional standards as benchmarks, as do reforms in the education of health professionals, though domestic factors appear to more directly impact on developments. Informal mechanisms facilitate the limited mobility currently occurring, with little formal application of the MRA provisions evident at this point.

One Health/EcoHealth capacity building programs in South and South East Asia: a mixed method rapid systematic review.

BACKGROUND: Although One Health (OH) or EcoHealth (EH) have been acknowledged to provide comprehensive and holistic approaches to study complex problems, like zoonoses and emerging infectious diseases, there remains multiple challenges in implementing them in a problem-solving paradigm. One of the most commonly encountered barriers, especially in low- and middle-income countries, is limited capacity to undertake OH/EH inquiries. A rapid review was undertaken to conduct a situation analysis of the existing OH/EH capacity building programs, with a focused analysis of those programs with extensive OH engagement, to help map the current efforts in this area. METHODS: A listing of the OH/EH projects/initiatives implemented in South Asia (SA) and South East Asia (SEA) was done, followed by analysis of documents related to the projects, available from peer-reviewed or grey literature sources. Quantitative data was extracted using a data extraction format, and a free listing of qualitative themes was undertaken. RESULTS: In SEA, 13 unique OH/EH projects, with 37 capacity building programs, were identified. In contrast, in SA, the numbers were 8 and 11 respectively. In SA, programs were oriented to develop careers in program management, whereas, in SEA, the emphasis was on research. Two thirds of the programs in SEA had extensive OH engagement, whereas only one third of those in SA did. The target for the SEA programs was wider, including a population more representative of OH stakes. SEA program themes reveal utilization of multiple approaches, usually in shorter terms, and are growing towards integration with the traditional curricula. Such convergence of themes was lacking in SA programs. In both regions, the programs were driven by external donor agencies, with minimal local buy-in. CONCLUSIONS: There is limited investment in research capacity building in both SA and SEA. The situation appears to be more stark in SA, whilst SEA has been able to use the systematic investment and support to develop the OH/EH agenda and strategize capacity building in the core competencies. In order to effectively address the disease emergence hotspots in these regions, there needs to be strategic funding decisions targeting capacity building in the core OH/EH competencies especially related to transdisciplinarity, systems thinking, and adaptive management.

Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services.

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.

Does the mutual recognition agreement on nursing services accelerate nurse migration in member countries of the Association of Southeast Asian Nations?

Aim: To clarify the situations of nursing education and activity, its affecting factors and the nursing educators' views on nurse migration relating Mutual Recognition Agreement on Nursing Services in the Association of Southeast Asian Nations. Design: Descriptive qualitative research. Methods: The individual semi-structured interviews with 11 nursing educators, analysed using thematic analysis. Results: Nursing educators acknowledged that the change in nursing was mainly due to the creation and amendment of laws, acts and regulations regarding nursing and improvements in nursing education systems. Some of these improvements occurred by this mutual agreement. The conceptualization of the progress indicated an improvement in the quality of nursing. Nurse migration to the outside of Southeast Asian countries might be accelerated due to concurrent improvements in the quality of nursing. New trends among nurses working as caregivers in surrounding countries such as China, South Korea and Japan to deal with demographic ageing should be considered.

Nursing qualification and workforce for the Association of Southeast Asian Nations Economic Community.

International nurse migration among Association of Southeast Asian Nations (ASEAN) countries has the potential to increase the effectiveness of health services and access for the ASEAN Economic Community. Providing equivalent nursing qualifications and licensure standards and increasing the availability of the nursing workforce has become a challenge for ASEAN members. The purpose of this study is: 1) to comparatively analyze information on nursing licensing examinations (NLE) across ASEAN countries; and 2) to present information on the human resources required for a successful nursing workforce. This study reviews all documents published on the subject within the ASEAN Economic Community. NLE systems exist in all ASEAN Member States (AMSs)s except Brunei, Vietnam, and Lao PDR. Nursing education systems also vary across ASEAN countries. Language as a means of general communication and nursing examinations also differs. The availability of a qualified health workforce at the regional level is above the threshold in some areas. However, at the national level, Indonesia, Myanmar, Cambodia, and Lao PDR fall below the threshold. Professional licensure requirements differ among ASEAN nurses as a part of the process to become a qualified nurse in host and source countries. Mutual Recognition Agreements on nursing services should address the differences in NLE requirements as well as the availability of nurses.

Trade in health services in the ASEAN region.

Promoting quality health services to large population segments is a key ingredient to human and economic development. At its core, healthcare policymaking involves complex trade-offs between promoting equitable and affordable access to a basic set of health services, creating incentives for efficiencies in the healthcare system and managing constraints in government budgets. International trade in health services influences these trade-offs. It presents opportunities for cost savings and access to better quality care, but it also raises challenges in promoting equitable and affordable access. This paper offers a discussion of trade policy in health services for the ASEAN region. It reviews the existing patterns of trade and identifies policy measures that could further harness the benefits from trade in health services and address potential pitfalls that deeper integration may bring about.

Task shifting in maternal and newborn health care: key components from policy to implementation.

Task shifting in various forms has been adopted extensively around the world in an effort to expand the reach of lifesaving services to the women, newborns, and families who need them. The emerging global literature, as well as Jhpiego's field experiences, supports the importance of addressing several key components that facilitate effective task shifting in maternal and newborn health care. These components include: (1) policy and regulatory support; (2) definition of roles, functions, and limitations; (3) determination of requisite skills and qualifications; (4) education and training; and (5) service delivery support, including management and supervision, incentives and/or remuneration, material support (e.g. commodities), and referral systems. Jhpiego's experiences with task shifting also provide illustrations of the complex interplay of these key components at work in the field. Task shifting should be considered as a part of the larger health system that needs to be designed to equitably meet the needs of mothers, newborns, children, and families.

Role of the SEAMEO TROPMED Network in health human resources development. Southeast Asian Ministers of Education Organization. Tropical Medicine and Public Health.

The Southeast Asian Ministers of Education Organization (SEAMEO) is a chartered international organization for the promotion of regional cooperation in education, science, technology and culture. The Regional Tropical Medicine and Public Health Network (TROPMED) operates through four specialized Centers in Indonesia, Malaysia, the Philippines and Thailand, with a coordinating unit, the TROPMED Central Office in Bangkok, Thailand. In line with the overall mission of SEAMEO, the role of TROPMED is to promote health and to prevent or control disease, thus improving the quality of life of people in the Asia-Pacific Region. Toward this end, SEAMEO TROPMED serves to facilitate the strengthening of national and institutional capabilities in research and training through postgraduate academic programs; short-term training courses; scientific fora; publications and information dissemination and as such, has been in the mainstream of health human resources development since its inception in 1967. To date, a total of 3,353 TROPMED alumni have benefited from training in 26 regular course offerings; of these, 1,596 were females and 1,757, males. From 1991 to 1995, a total of 434 key health personnel have attended short-term training courses, with increasing attendance from Cambodia, Lao PDR and Vietnam. TROPMED's effectiveness comes from the collective strength of and the spirit of cooperation among its host institutions and partners. Faced with a health scenario of both developing and developed economies, SEAMEO TROPMED aims to further its role as an international forum for health development thus, addressing the need for effective strategies for health sector reform and advocacy of relevant health, environmental and development policies through its various programs and activities.

Teaching health professionals to teach.

PIP: One of the most pressing problems in the health system is the lag between modern knowledge and its use in the community. This is caused by the inadequate scientific study of methods to apply this knowledge to society, and the poor training of health personnel to apply these methods. These failures are illustrated every day by the death of 50,000 people, mostly children under 5 years, from causes that are preventable at low costs. The medical education system is primarily responsible for what is taught and how it is taught, and yet less than 1% of the this education is related to community health and broad health education. Social organization is the key to efficiency of health protection and use of medical knowledge. The mass media and increasing communications development with modern marketing have allowed social organization at reasonable cost. Changes in human behavior can prevent most health problems and premature deaths. There are examples of how growth monitoring, oral rehydration therapy, breast feeding promotion, immunization, family planning, and female literacy have saved millions of children. There is now a global recognition that healthy children and healthy families are the foundation for national development. International goals are to reduce mortality rates for children under 5 to 70/1000, eliminate polio, have universal primary education, have less than 1% malnutrition, and promote water supply expansion and sanitation. There is also a need for better recordings of births and deaths and, especially in developing countries, low cost methods of collecting data are needed. Medical education needs to use the full range of resources, and students need to learn to promote health as well as treat diseases. Medical schools in consideration of primary health care must revise curricula to achieve a balanced education in the community, and students should be taught in a variety of environments from rural health areas to urban institutions.^ieng

Labor migration in Asia.

"A recent conference sponsored by the United Nations Center for Regional Development (UNCRD) in Nagoya, Japan examined the growing importance of labor migration for four major Asian labor importers (Japan, Hong Kong, Malaysia, and Singapore) and five major labor exporters (Bangladesh, Korea, Pakistan, Philippines, and Thailand).... The conference concluded that international labor migration would increase within Asia because the tight labor markets and rising wages which have stimulated Japanese investment in other Asian nations, for example, have not been sufficient to eliminate migration push and pull forces...."

Overseas workers' remittances in Asian development.

PIP: In recent years, overseas workers from Asia have been sending remittances of about $8 billion annually to their home countries. These remittances are an important source of precious foreign exchange for the major labor-exporting countries. The overall development impact of remittances, however, has not been well established. Remittances are spent primarily on day-to-day consumption expenditures, housing, land purchase, and debt repayment. Although only a small proportion of remittances are directed into productive investments, this does not warrant the conclusion that the developmental value of remittances is negligible. In fact, remittances spent on domestic goods and services Asia provide an important stimulus to indigenous industries and to the economies of the labor supplying countries. It is these broader macroeconomic benefits of remittances which seem to have been largely ignored in the literature, and this perhaps explains the pessimistic view of the developmental value of remittances. Reservations concerning the effects of remittance on the sending countries include the fears that 1) expenditure patterns of remittance receiving households may create a demonstration effect whereby nonmigrant households may increase consumption, 2) remittance inflow will increase income and wealth inequalities, 3) remittance expenditures may result in inflation, 4) remittances may produce only short-term fluctuations in long-term economic development, and 5) remittances may adversely affect agricultural development.^ieng

Migrant labor absorption in Malaysia.

The use of migrant workers to ease labor shortages caused by rapid industrialization in Malaysia during the twentieth century is examined. "This paper will focus on: (1) the extent, composition and distribution of migrant workers; (2) the labor shortage and absorption of migrant workers; and (3) the role of migrant workers in the government's economic restructuring process."

The migration transition in Malaysia.

"Exploring the unique experience of migration transition in Malaysia, this paper identifies the turning points in relation to the level and nature of economic and labor market developments in Malaysia. Examining the development dynamics that mark the passage from exporting labor to depending on foreign labor, the paper concludes that such dynamics are influenced not only by economic but also sociocultural, demographic and policy factors. Several lessons from the Malaysian experience are drawn at the end to be utilized by other countries that still have to reach the turning points of the migration transition."

Foreign domestic workers in Singapore.

"This paper discusses the regulatory and economic context of Filipina migration into domestic waged labor in Singapore. It places this migration in the history of female rural-urban migration as well as the history of domestic labor in Singapore. Finally, it raises the question as to why domestic waged labor has persisted in the global capitalist economy."

The migration transition in Asia.

"This theoretical discussion of the migration transition in Asia develops a framework to understand the turning point from labor exporter to labor importer experienced by the Asian NIES [newly industrialized economies] (Hong Kong, Korea, Singapore and Taiwan). The author concludes that the NIEs' demand for labor curve shifted rapidly, primarily due to export-led growth of a labor-intensive character. Because these economies are well integrated, improvements in labor market conditions in individual sectors are transmitted to all workers, discouraging emigration."