Key messages
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Like other regions, many countries in southeast Asia suffer from problems in the health workforce related to shortages, skill mix imbalances, and maldistribution of skilled staff.
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Low-income countries face common problems of health-worker density and distribution due to low production capacity, restricted capacity for employment of graduates, and low pay in the public sector. But use of health services is also low, as a result of poor-quality services, financial barriers, and cultural factors. Because of the low quality of services and training, migration of health workers is not yet a major issue, but wealthy and middle-income patients often seek care elsewhere in the region.
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Health-worker density and production varies substantially among middle-income countries, but all face difficulties in attracting health workers to remote areas, because of fiscal constraints and inadequate financial and non-financial incentives for health workers.
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A distinctive feature of southeast Asia is its high level of engagement in international trade in health services, including migration of health workers and provision of services to international patients.
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Although international trade in health services is not the main cause of health-worker shortages or maldistribution in southeast Asia, it clearly affects health-worker production and employment patterns, particularly in middle-income and high-income countries.
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The rapid growth of export-oriented private training in the Philippines and Indonesia has mitigated the effect of migration on the total stock of health workers, but poor regulation of private training has compromised quality and contributed to overproduction of health workers with scarce employment prospects.
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Medical tourism has grown rapidly in Singapore, Thailand, and Malaysia, and has emerged as an important source of revenue. The effects of medical tourism on domestic health systems have been small so far, but are contributing to a brain drain of highly skilled specialists to private hospitals serving foreign patients.
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National policy coherence is needed to balance benefits gained from trade in health services, while maintaining the health of the population. This balance will require a combination of policies, including careful human-resource planning and strengthened oversight of private training institutions, improved quality and accreditation systems, public-partnership arrangements, and measures to improve retention and recruitment of staff in rural areas.