Health professionals and migration.

Migrant health workers are faced with a set of options that are a combination of economic, social and psychological factors and family choices (1). They trade decisions related to their career opportunities — and to financial security for their families — against the psychological and social costs of leaving their country, family and friends. The comments of health workers themselves reflect the “push and pull” nature of the choices underpinning these “journeys of hope” as, for example, those collected in Ghana by Dovlo (2). Demotivating working conditions, coupled with low salaries, are set against the likelihood of prosperity for themselves and their families (by remittances), work in well-equipped hospitals, and the opportunity for professional development. In this issue of the Bulletin, Saravia & Miranda (pp. 608–615) point out that young, well-educated individuals are most likely to migrate, especially in pursuit of higher education. Employers in the countries of origin have their own perspective. They are unable to fulfil their mandates to provide equitable access to health care because the necessary health workers are not available. In many cases, the country is losing its investment in the education of health professionals, as well as losing the contribution of these workers to health care. Governments have to compete for health workers by making their conditions of work more attractive; they may also highlight the imbalance in competition between themselves and the receiving employers. Arguments from this perspective will inevitably include ethical and moral dimensions. Employers in receiving countries take a different position, driven by their need to provide sufficient health workers to meet the demand for services within the constraints of budget planning and the imperfections of the labour market. Kupfer et al. (pp. 616–619) discuss Health professionals and migration Orvill Adams1 & Barbara Stilwell2