[Migration patterns of health professionals].

The past three decades have seen the number of international migrants double, to reach the unprecedented total of 175 million people in 2003. National health systems are often the biggest national employer, responsible for an estimated 35 million workers worldwide. Health professionals are part of the expanding global labour market. Today, foreign-educated health professionals represent more than a quarter of the medical and nursing workforces of Australia, Canada, the United Kingdom and the United States. Destination countries, however, are not limited to industrialised nations. For example, 50 per cent of physicians in the Namibia public services are expatriates and South Africa continues to recruit close to 80% of its rural physicians from other countries. International migration often imitates patterns of internal migration. The exodus from rural to urban areas, from lower to higher income urban neighbourhoods and from lower-income to higher-income sectors contributes challenges to the universal coverage of the population. International migration is often blamed for the dramatic health professional shortages witnessed in the developing countries. A recent OECD study, however, concludes that many registered nurses in South Africa (far exceeding the number that emigrate) are either inactive or unemployed. These dire situations constitute a modern paradox which is for the most part ignored. Shared language, promises of a better quality of life and globalization all support the continued existence of health professionals' international migration. The ethical dimension o this mobility is a sensitive issue that needs to be addressed. A major paradigm shift, however, is required in order to lessen the need to migrate rather than artificially curb the flows.