Migration of the healthcare workforce Macedonia

2015

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About Macedonia

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Located in the central Balkan peninsula in Southeast Europe

Bordered by Kosovo to the northwest, Serbia to the north, Bulgaria to the east, Greece to the south, and Albania to the west.

It is one of the successor states of the former Yugoslavia, from which it declared independence in 1991.

It has about 2,1 million inhabitants, and about 500.000 live in the capital city of Skopje

Ethnic structure: 64,2% Macedonians, 25,2% Albanians, 3,9% Turks, 2,7% Romani, 1,8% Serbs and 2,25 other. (2002 Census)

The GDP in 2014 is 3,8% and the unemployment rate is around 28%

Health care system: around 6.000 doctors, from which around 3.500 are specialists

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Involved researchers:

• Vladimir Lazarevik

Project Coordinator of the project

current working place: Healthgrouper

• Neda Popovska-Kamnar

Senior Researcher on the project

current working place: National bank of the R. Macedonia

• Blasko Kasapinov

Senior Researcher on the project

current working place: Healthgrouper

• Sanja Spasova

Junior Researcher on the project

current working place: Healthgrouper3/24/2015

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The main activities performed by the team:

Organized focus groups with doctors;

Interviews with policymakers, university professors, embassies and other relevant institutions;

Organized workshop in Skopje and Tirana;

Preparing the Survey on migration of health workers and distributed to the country teams;

Implementation of the Survey;

Analyzing the results of the Survey;

Preparing the country report.

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Focus groups

Group of young doctors;

Group of doctor with longer working experience;

Group of medical nurses (not achieved).

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Major points from Focus group with doctors General thoughts of leaving the countryMainly those who work at the hospital think of leaving, while those that work as general practitioners in their own practices do not, since they have put a lot in the practice.

The main reasons for migration abroadEconomic and professional reasons

Economic reasons for migration abroadBetter salaries

Professional reasons for migration abroadThere is no opportunity to upgrade and progress as a doctor.

Profession recommendation to younger generationNo, not in Macedonia

Political reasons for migration of health professionals from MacedoniaMostly important if you want to become a manager

What would they change if they couldInvest in equipment, education, training, better salaries for doctors, law on doctor’s rights.

The conclusion that is chosen as the best one in this focus groupDoctors said that their status of the doctors in Macedonia is as low as the lowest. They have to protect as a doctor, since the law only protects the patients. Doctors in Macedonia every day faced with threats from patients if they don’t give them what they ask for. In small country such as our Macedonia , health is centered in Skopje, there are very few specialists in the other towns. The most important reasons for which people are leaving the country are the inability of employment, poor working conditions and low wages.

Major points from Focus group with young doctors, both employed and unemployed

General thoughts of leaving the countryNo professional progressSizing the network of those who left the countryAlmost 20 % of the young doctors leave the countryThe main reasons for migration abroadOpportunity for professional upgrade and progressEconomic reasons for migration abroadBetter salariesProfessional reasons for migration abroadNo change to prosper here in MacedoniaPolitical reasons for migration abroadIf you are opponent to the government , you cannot get employed.Social reasons for migration abroadBetter status as a doctor thereProfession recommendations to younger generationNo, not in MacedoniaGeneral satisfaction with workThose that are employed are merely satisfied. Those that are on specialty training are not satisfied because they are not treated as trainees, but as techniciansWhat would they change if they couldThe enrollment policy and education systemCONCLUSION The education system in Macedonia needs to be changed regarding the training of doctors and medical staff. The enrollment policy needs to be planned in advance in order to keep the balance between the supply and demand. 7

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Conclusions from the interviews with policy makers

The main messages that left impression on you from the interviews:

About 300 young doctors left the country in the last 2 years.

Doctors are burdened with administrative procedures and under constant threat of punishments.

There is no strategy for enrolling new students in the medical faculties.

The society lacks planning of production and demand of doctors and medical staff.

The doctors that left to work abroad never come back.

Doctors leave because of economic and professional reasons.

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Conclusions from the interviews with Embassies

The main messages that left impression on you from the Ambassadors:

The Global Code of Ethical Recruitment is an important document that is very much respected in the recipient country.

The education system in Macedonia should change. There are too many universities in the country that do not contribute to quality in the education.

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RESULTS OF THE SURVEY

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Sociodemographic characteristics

Total participants: 573 (427 via web link and 146 via Facebook)

Duration: (December 2014 to February 2015)

201

162

49

41

potential migrants inner migrants migrants unemployed

89%

11%

live in the home country live in the foreign country

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

employed volunteer not employed

90.20%

0.98% 8.82%

0%5%

10%15%20%25%30%35%40%45%50%

46.3%

11.3%

33.7%

1.2% 0.2% 2.6% 4.7%

Factors influence the migrations

Salary, Working and Living conditions are the dominate factors that influence migration Career and employment opportunities are also highlighted by the migrants and

unemployed

0%10%20%30%40%50%60%70%80%90%

71.3%

85.6%81.5%

66.2%72.3%

81.5%

Very important

Important

Neutral

Not important

Not important at all

Potential migration: How important for you are the following factors to consider leaving your home country?:

0%

20%

40%

60%

80% 72.8%

56.2% 56.2% 54.9%

63.6%

75.9%

Very important

Important

Neutral

Not important

Not important at all

Inner migration: How important for you are the following factors to consider moving to another city in your country?

0%10%20%30%40%50%60%70%80%90%

75.5%

61.2%

77.6%83.7%

55.1%

69.4%

Very important

Important

Neutral

Not important

Not important at all

Migrants: How important were the following factors for your decision to leave your country and work abroad?

0%

5%

10%

15%

20%

25%

30%

35%

40% 37.0%

24.0%

29.0% 28.0%

21.0%24.0%

Very important

Important

Neutral

Not important

Not important at all

Unemployed: How important for you are the following factors to consider leaving your home country?:

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Economic reasons-part I

0%

10%

20%

30%

40%

50%

60%

How important were theeconomic reasons for youto migrate?

How important were theopportunities to earn andsave more money for yourdecision to migrateabroad?

Migrants

0%

10%

20%

30%

40%

50%

60%

70%

How important are theeconomic reasons for youto consider migrationabroad?

How important is theopportunity for additionalincome for you to considermigration?

How important are theopportunities to makesavings for you to considermigration?

Potential migration

0%

10%

20%

30%

40%

50%

60%

How important is theeconomic situation in yourtown for you to considermigration?

How important is theopportunity for additionalincome for you to considermigration to another city?

How important are theopportunities to makesavings for you to considermigration to another city?

Inner migration

0%

10%

20%

30%

40%

50%

60%

70%

How important are theeconomic reasons for youto consider migrationabroad?

How important are theopportunities to earn andsave more money for youto consider migrationabroad?

Unemployed

• Around 60% of the respondents consider the economic reasons as very important.

• Opportunities for additional income and to make savings-between 40-50% of respondents consider them as very important

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Economic reasons-part II

• MigrantsFor most respondents better salary is not the solution

• Potential migrantsIncrease of over 100% of the salary as possible solution

• Inner migrationsIncrease between 50-100% of the salary as possible solution

• UnemployedFor most respondents job proposition is not the solution

0%

10%

20%

30%

40%

50%

Yes Maybe No

18.4%

36.7%

44.9%

Would you consider returning to your home country if you were offered a better salary than you currently have?

Response Percent

0%5%

10%15%20%25%30%35%40%

up to 20% 20-50% 50-100% Over100%

No, I willmigrateanyway

Other

1.0%3.0%

35.2% 38.7%

15.1%

7.0%

Would you be over thinking migration if your monthly salary is increased for:

0%5%

10%15%20%25%30%35%40%45%

up to 20% 20-50% 50-100% Over100%

No, I willmigrateanyway

Other

2.0%

17.4%

40.9%

28.2%

9.4%

2.0%

Would you be over thinking moving to another city if your monthly salary is increased for:

0%

10%

20%

30%

40%

50%

Yes Maybe No

17.1%

41.5% 41.5%

Would you consider overturning migration, if you were offered a job in your home country? Response Percent

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Political reasons-part I

• Around 50% of the respondents consider the political situation as very important

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Very important Important Neutral Not important Not important atall

Migrants: How important was the political situation in your home country for your decision to migrate abroad?

0%

10%

20%

30%

40%

50%

60%

Very important Important Neutral Not important Not important atall

Potential Migrants: How important is the political situation in your home country for you to consider migration?

0%

10%

20%

30%

40%

50%

60%

Very important Important Neutral Not important Not important atall

Unemployed: How important is the political situation in your home country for you to consider to migrate abroad?

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Political reasons-part II

• Most of the respondents had experience of political influence in order to gain employment and less in professional promotion

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Yes No

Have you experienced anypolitical influence in yourhome country in order togain employment?

Have you experienced anypolitical influence in yourhome country in order togain professionalpromotion?

Migrants:

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Yes No

Have you experienced anypolitical influence in orderto gain employment?

Have you experienced anypolitical influence in orderto gain professionalpromotion?

Potential migrants:

40.0%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0%

54.0%

56.0%

Yes No

Have you experienced anypolitical influence in orderto gain employment?

Have you experienced anypolitical influence in orderto gain professionalpromotion?

Inner migration

0.0%

20.0%

40.0%

60.0%

80.0%

Yes No

Unemployed: Have you experienced any political influence in your home country in order to gain

employment?

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Professional reasons

• Above 60% of respondents consider the working conditions, improving the skills and professional promotion as very important, and the interpersonal relations as less important

0%

10%

20%

30%

40%

50%

60%

70%

80%

Veryimportant

Important Neutral Notimportant

Notimportant

at all

How important were the workingconditions (infrastructure, medicalequipment and workload pressure)in your home country for yourdecision to migrate abroad

How important were theopportunities for improving yourskills and knowledge for yourdecision to migrate abroad?

How important was the opportunityfor professional promotion for yourdecision to migrate abroad?

How important were theopportunities for additional work foryour decision to migrate abroad?

Migrants

0%

10%

20%

30%

40%

50%

60%

70%

Veryimportant

Important Neutral Notimportant

Notimportant

at all

How important are the opportunitiesto gain new experience and upgradequalifications (more training) for youto consider migration?

How important is the professionalpromotion for you to considermigration?

How important is the management atthe institution where you work foryou to consider migration?

How important are your currentworking conditions (infrastructure,medical equipment, workloadpressure) for you to considermigration? How important are the interpersonalrelations at your workplace for you toconsider migration?

Potential Migrants

0%

10%

20%

30%

40%

50%

60%

Veryimportant

Important Neutral Notimportant

Notimportant

at all

How important are the opportunitiesto gain new experience and upgradequalifications (more training) for youto consider migration to another city?

How important is the professionalpromotion for you to considermigration to another city?

How important is the management atthe institution where you work foryou to consider migration to anothercity?

How important are your currentworking conditions (infrastructure,medical equipment, workloadpressure) for you to considermigration to another city?How important are the interpersonalrelations at your workplace for you toconsider migration to another city?

Inner Migration

0%

10%

20%

30%

40%

50%

60%

70%

Veryimportant

Important Neutral Notimportant

Notimportant

at all

How important are the opportunitiesto gain new experience and upgradequalifications (more training) for youto consider migration?

How important was the opportunityfor professional promotion for yourdecision to migrate abroad?

Unemployed

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Personal reasons

• Most of the respondents are not too optimistic about their home country, and the reason that they didn’t left yet is the family

• Above 60% of those who left are not considering coming back

6.3%

33.3%

60.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Yes Maybe No

Migrants: Have you considered returning to your home country

35.7%

8.5%3.5%

23.6% 22.6%

14.6% 13.1% 10.6%

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%

Fam

ily

circ

umas

tanc

es

Hav

en't

foun

d jo

bab

road

Pro

blem

s w

ith

docu

men

ts

Opt

imis

tic

that

the

thin

gs w

ill

get

bett

er

Don

't w

ant

to s

tart

from

the

beg

inin

ng

Lon

g an

d di

ffic

ult

proc

es o

f di

plom

are

cogn

itio

n

Lac

k of

appr

popr

iate

lang

uage

ski

lls

Oth

er

Assumed migrants: You haven't left your country yet because:

44.6%

24.3% 22.3%15.5%

6.1%

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%50.0%

Fam

ily

circ

umas

tanc

es

Hav

en't

foun

d jo

bab

road

Opt

imis

tic

that

the

thin

gs w

ill

get

bett

er

Don

't w

ant

to s

tart

from

the

beg

inin

ng

Oth

er

Inner migrants: You haven't left your city yet because:

61.0%

29.3%

9.8%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%

Str

ongl

y ag

ree

Agr

ee

Und

ecid

ed

Unemployed: Do you think your family members will have better future abroad if you

decide to move in other country?

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Satisfaction index

• Around 50% of the respondents are not satisfied of their work as a doctor and would not recommend their profession to the younger generations

13.6%

17.3%

13.6%

24.4%

31.1%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

Defenitely would

Probably would

Undecided

Probably wouldn't

Defenitely wouldn't

Would you recommend your profession to the younger generations?

8.9%

28.3%

16.2%

33.0%

13.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

Very satisfied

Satisfied

Neutral

Unsatisfied

Very unsatisfied

How would you rate your overall satisfaction of your work as a doctor at the place where

you work now?

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Conclusions:

• Salary, Working and Living conditions are the dominate factors that influence migration, as same as the Career and employment opportunities from the aspect of migrants and unemployed

• The economic reasons are considered as very important, and also opportunities for additional income and to make savings

• Increase of over 100% of the salary as possible solution

• Most of the respondents had experience of political influence in order to gain employment and less in professional promotion

• Most of the respondents consider the working conditions, improving the skills and professional promotion as very important, and the interpersonal relations as less important

• The respondents are not too optimistic about their home country, and the reason that they didn’t left yet is the family. The ones that left, are not considering coming back

• Most of the respondents are not satisfied of their work as a doctor and would not recommend their profession to the younger generations3/24/2015

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Future plans:

Preparing the Country Report with the Survey Results

Preparing two publications: Publication with comparative analyze between the countries base on the survey results and Publication of Literature review on migration

Policy brief -prepare and deliver to the Ministry

Round table-presenting the results of the Project

Media coverage - press info

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Thanks for your attention

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