Demand and Supply of Healthcare Workforce in Oman

Abstract

There has been continued indication of the shortages of physicians and nurses in hospitals across Oman and this is often seen in the media on regular basis. As a consequence, there has also been increased debate on the policy circles among scholars, stakeholders and researchers. Most of these debates often seek to establish whether the shortages are caused by lack of supply of the healthcare workforces or there is increased demand for the caregivers.

Besides, there could also be a problem of misdistribution. The analysts and other experts also debate as to whether the solution to this problem would be to build more training institutions for graduate physicians and increased the number of slots for the healthcare providers as well as create more incentives to attract people into the profession. The study will aim at identifying the factors that influence the availability of the healthcare workers as well as those affecting the demand. The second objective will be to investigate the impact the unbalanced demand and supply of these workforces has had on the service provision in the healthcare sector.

To attain these results, the research will use a literature search to identify these factors and categorize them and finally assess them for better understanding. There are a number of categories that these factors fall under and this study will offer an analysis which will be very important for the stakeholders to comprehend and then finally address the problem of deficient healthcare workforce. Essentially when the stakeholders comprehensively understand the factors affecting need and supply of the healthcare workforce, they will be able to find ways to adapt or use the means recommended by this study. The study is valid as it applied analyses, databases and the Country’s supply and demand model to study the existing profile and the future supply of service providers.

Introduction

Background

The global shortage of healthcare employees at the moment has become a problem for both the developed and the developed nations as the world continue to witness dynamic migration of these workers as indicated by the Joint Learning Initiative (JLI) 2004; International Council of Nurses 2006 and the World Health Organisation 2006 reports). In the countries that have sufficiently high income, there are international programs for recruitment used for addressing the problems of scarcity, enticing the physicians and nurses from the developing nations (Burchan et al, 2003, p. 67).

Over the recent past, there has been a lot of literature and research about this crisis from the perspective of the internationally qualified nurses who were recruited to the United Kingdom NHS and also in the United States of America (Smith, et al. 2006; Bach 2007; Brush and Sochalski, 2007, p. 38).

Oman has a unique healthcare workforce system. The country occupies a small area in Middle East and expatriates form at least over one quarter of its two million population. The statistics could be higher considering that this was based on a report from the census in the late 1990s (Ministry of Information 2006a).

In this study, the investigator exploits the trends that have been observed in Oman. The country has experienced unique trends of recruitment of the local healthcare workers as well as the international strategies. The researcher has suggested that probably the social, historical, economical and political factors are the main challenges to the process (Brush and Sochalski, 2007, p. 38). This is because these factors could be the ones creating impediments to the participation of the healthcare workers in employments hence affected the healthcare workforce supply and demand (El-Haddad, 2006, p. 284).

The world health organisation report of 2006 was able to establish the causes of the problems scarce human resources in the healthcare. The report also identified this as the main challenge to the attainment of the millennium development goals (MDGs). The shortages of healthcare professionals are on top of the list of agenda under discussion in Oman and just like other countries suffering a similar fate; the country has been seeking to set up a workforce initiative to address the shortage (Brush and Sochalski, 2007, p. 38). The reason why this is yet to be effected is because the solutions developed have always been short-term and at times inadequate.

One main challenge facing the country has been to create a workforce plan that would effectively address the demands of the healthcare sector and supply workers continuously (El-Jardali, et al., 2007, p. 78). Nonetheless, although this is a goal for many countries, very few of them have been able to set up proper strategic plans that can meet the healthcare resource needs. Rather, many developed countries have considered implementing other short-term policies like increased dependence on immigrant, at times this happens to the detriment of the developing nations (Brush and Sochalski, 2007, p. 38). This phenomenon has prompted the need for these developed nations to establish their own model referred to as self-sustainable program for dealing with the healthcare needs (Seboni, 2009, p. 129).

The major strategy of reaching the goals in this research was to investigate the definition and models of and other human health options. Self sufficiency model was a potentially effective strategy and discussing the implication on policy creation was a great platform for studying the healthcare in Oman (El-Jardali, et al., 2007, p. 78).

There is a wide range of agreements in the healthcare profession concerning the needs for the developed nations to make sure that they still have their local supply of healthcare service providers hence reducing the degree of their dependence on the developing nations for supply (Seboni, 2009, p. 129). When there is good and effective healthcare human resource plan, which address the issue strategically by encouraging investment in the creating and training of professionals in the sector. Such a sustainable strategy would probably meet the demands of each nation well.

In the year 2004, a study on the policy implication of the migration of caregivers, the nurses Aiken et al, 2004, p. 72 shows that the most promising strategy for attaining the global stability in the healthcare workforce so that every nation would have its own sufficient supply and sustainable plan for creating employees. That would include the developed nations being diligent in training workforce (Aiken et al. 2004, p. 76). In essence the dependence of the “developed countries’ on the foreign-trained professionals was a clear indication of their own failed workforce policy and poor investment in the healthcare systems.

The Joint Learning Initiative (JLI, 2004) reports present an argument that it would be a very wise idea for the developed nations to struggle to attain their self-sufficiency because their dependence on the immigrants was a very unstable, unbalanced and risky venture. The opposite which is self sufficiency was a much better option both sound and fair (Vujicic et al., 2009).

Problem Statement

In Oman there healthcare sector has been experiencing a reduction of labour supply and very high job turnover and this is a sign of a very dire weakness in the industry. The human resource management exercises in the healthcare organization seem to be dangerously out-of-date and not doing something about it would lead the system into irreversible damage (Sellgren et al, 2007, p. 172). For every problem there is a solution even though for this case, there is no quick fix, but the problem can be managed even though that would take some time, effort and determination (Seboni, 2009, p. 129).

The employee turnover has grown to extreme levels in the Omani healthcare sector; the rate is so high that it is almost reaching the double mark of the countries average in other sectors. This position is alarming and it is fast deteriorating. The statistics reveal that as a result, the healthcare sector loses millions of dollars each year and the problem is a direct danger to the sustainability of the healthcare systems at large (George et al., 2007, p. 106).

Hypothesis

The supply and demand of workforce in healthcare system in Oman is extensively influenced by social, economical and historical factors (El-Haddad, 2006, p. 284). The study will seek to specifically identify these factors and then to categorise them into themes that can be used for policy creation implementation to improve the current situation. It’s from such research that the scholars can develop recommendation based on the acquired knowledge hence allowing the decision maker to make informed decisions (George et al., 2007, p. 106). The reason in part as to why the previous strategies of dealing with the problems of turnover and supply have not worked well is because of lack of clear understanding of the problem and the factors behind the problem.

The Rationale

In Oman, the location of study or the case study that the researcher will be working on, the turnover rates among healthcare employees particularly the nurses, paramedical staff and the physicians is very high. Even though, there are hundreds of fresh healthcare professionals graduating from the universities and colleges each year, they are not able to meet the ever increasing demand hence causing an imbalance between the supply and demand of these healthcare service providers (Brush and Sochalski, 2007, p. 39).

The impact of the high turnover rates have great impact on the way these healthcare services are provided at the abovementioned levels. The quality of healthcare is very important and when it is affected, then the quality of care is compromised and this risks the lives of patients (George et al., 2007, p. 109).

Research Questions

The questions that will guide the study will focus on the description of the factors in recruitment strategies and the development of the new workforce as well as those issues affecting retaining of the workers. There are a number of factors that can cause this. Therefore the questions to guide the study will include;

1. What are the factors that influence the demand and supply of healthcare providers at the global scene?
2. What similar factors that affect the international market of healthcare practitioners also affect Omani systems? This will help to make comparison of the international situation and the Omani condition. Similarities and differences in Omani and the rest of the world especially the major players in health market.
3. Review the current impact of unbalanced demand and supply of the healthcare service provision at the various levels of provision and the quality of the services provided. This question addresses the current position of graduating numbers of practitioners and the number of those leaving the profession to other markets as well as those resigning from the profession or retiring. This will help to focus on the deficiencies and categorization of the causes of these shortages (Badrick, 2011, para. 3).
4. What are the possible solutions to the problem of imbalance of demand and supply of healthcare providers and how to manage oversupply of healthcare workforce as well?

For all intents and purposes, the above questions are for guidance purposes and the research will still be very extensive to cover a wide range of information necessary to address the issue and generate recommendation that can help to manage the problem by developing a sustainable and highly efficient system of preparing and retaining professionals in the industry (Dovlo 2005, p. 78).

Significance of Study

A strategy developed in 2003 by the World Medical Association says that a country should not entirely depend on immigrating personnel from other countries to supply its medical care service demands’ (Turoyanagi 2008, p. 23). In the current position of healthcare recruitment and retention practices can be figuratively related to the act of pouring water into a bucket with holes, then the analogy is very simple to understand. This concept however gets intricate when analysis of the concept is done critically (Brush and Sochalski, 2007, p. 40).

At a glance, the idea of pouring water in a bucket with holes seems to be an understandable exercise. Now as the water is poured, the holes work and the reality in the healthcare system becomes clear when the water supply diminishes and the holes become bigger. The concept is very obvious in Oman because the healthcare systems keep on recruiting in a manner similar to the bucket analogy and their decision of hiring are based on the deficiently informed sources, pitiable organizational intelligence and improperly defined considerations (Dovlo 2005, p. 78).

All the healthcare organization is the country are at a point where supply is very low yet the exit is very high just like the many holes in the bucket. At this level, it is cheaper and easy to mend the bucket which is like the healthcare market rather than affect the supply (El-Jardali, et al., 2007, p. 78). This study offer a good platform for the reinvention of the human resources management practices (Sellgren et al, 2007, p. 172), leverage of the organizational models, culture in the healthcare systems, development of competencies, and development of rewards systems to take care of the problem of egress.

If this has been the problems that why is it that the healthcare practitioners have not been doing so? One of the reasons is that there is time constraint as that would require greater sacrifice of time, resources and general awareness of the bad management of the human resources, turnover issues and the wasted returns (Paul et al, 2006, p. 53). This study is very important because it will expose the holes in the bucket or the factors that affect the supply especially the turnover factors and those that cause reduced supply. However the astronomical expenses the wasted (water) human resources have been taking away from resource base was also a factor to take into consideration (El-Jardali, et al., 2007, p. 78).

This study will offer simpler analyses for the managers of the healthcare industry to comprehend and acknowledge the dynamic. This is because without such, then it would be very impossible to effectively execute the management of the human resources. Research has shown that this is true since the incremental and refinements have not been able to provide concrete solutions to the problem and the revolutionary changes still need to have very high level of organization to manage successfully (Sellgren et al, 2007, p. 176).

Literature Review

Introduction

Healthcare service delivery is very important to any nation because a healthy nation is a thriving nation. However, there has been a problem of balancing between the supply and demand of healthcare workers in Oman. This study will therefore seek to identify the factors that affect demand and supply of health workers in the country. In order to achieve the objective of the research, a number of sources not more than ten years ago will be searched for previous literature on the topic and other related material.

This means the sources will not go beyond 2000. The databases and materials to be searched will include Association of American Medical College, Alliance for health reforms, medpac, paraprofessional institute, BMC Health Services Research, biomedcentral.com, UNICEF Oman, World Health Organization, and Regional Office for Eastern Mediterranean, Omanisation Policy and World Health Reports among other sources. The words ‘supply and demand of health workers’, ‘why health workers migrate’, ‘emigration of doctors and nurses’, ‘challenges of healthcare workers’, recruitment of doctors and nurses, need for healthcare workers, and working conditions affecting healthcare workers home and abroad will be searched.

The objective of conducting this research will be attained by developing a process that investigates how innovating and sustaining the core training capability in medical practice can be efficient in managing the dependence on the US, UK and other nations especially from the developed world (Alonso-Garbayo & Maben 2009). By mentioning the words like ‘core’ and moderation of the reliance of others implies that the problems of immigration among physicians and nurses was still hard to totally eliminate as there are a number of human rights also in play (Ahmad OB., 2005).

The ICN’s report (2006) indicated that it was important the countries build their own national self sufficiency for managing their local needs on terms of supply and demand of healthcare services providers. This was a need for the developed and the developing countries alike.

Against this backdrop, there is an increased use of the terminology “self-sufficiency” when addressing the issue of healthcare workforce in the world. This review will also seek to understand what exactly could be the meaning of this terminology. The term is used interchangeably with “self-sustainability” and there are many other aspects that relate to it (Al Dhawi et al., 2007). These phrases are also used in different contexts as well. Sometimes it is not clear what the phrase means and how it applies to the context of medical care workforce in Oman (ICN 2006).

There is no generally agreed concept that guides the process of planning on how self-sustainability could be reached or even how the concept could be generally be assessed, or whether it could in fact be achievable. Part of the literature review defines the term in the context of Omani healthcare workforce. In this context, the paper identified the factors affecting sustainability describing them in terms of those that enable it against those that impede its feasibility (ICN 2006).

There has also been extensive research from the developing nations from African and others like India and Philippines (Lorenzo, et al. 2007; Seboni 2009). Nonetheless, there has been very little done on the problems that have been encountered in the Middle East nations like Iraq, Iran, Saudi Arabia, Oman and Bahrain (Brush and Sochalski, 2007, p. 38: Maben, et al., 2010, p. 293). There are a number of high income areas in this region that have come to be very influential in terms of determining the dynamics of the workforces.

This is because these countries are rich and greatly depend on the international recruitment so as to staff their increasing healthcare demands. These also pose a great competition to the other countries in the world (Maben, et al., 2010, p. 391). Whereas demand for physicians and nurses is increasingly growing, the matching international supply on the other hand has been decreasing.

Why Healthcare Professionals Migrate

There are a number of possible causes of migration among professionals of healthcare service provision (Group Meeting on International Migration and Development in the Arab Region, 2006). These determinants include social unrest in their home countries, poverty, and war.

These are the main causes in the low and middle income countries (Stilwel, 2004). Middle income countries still suffer the problem of unemployment and this also pushes healthcare professionals away especially those from Middle East and Africa. The workers then tend to move to areas where there is still some hope of employment. As a consequence, countries like Britain, Canada, and the United States are the main destination of these migrating workers (Stilwel et al, 2004). The major attraction in this context is the lucrative pay and better working terms.

Systems that Encourage Migration

It has been also found that some nations like Philippines encourage its citizens to emigrate (Stilwel et al., 2004). In Oman and other Arab nations, migration of healthcare workers is mainly because of the obstacles of the institutional systems hindering their personal prospects for social mobility. Besides, many emigrating healthcare workers complain that they are not well rewarded for their skills and the type of work they do plus there were many obstacles in their efforts to advance their professions (Fargues, 2006).

By and large, the factors that have been found to cause migration of professional healthcare providers fall into two broad categories, namely the push and pull factors:

The Push Factors

The push factors include; dangerous working conditions and crime – many people in Arab countries in general have experienced crime first hand or they know someone who has suffered such fate (Lorenzo, et al. 2007). This is often a reason why healthcare professionals can choose to leave their country for fear of these violent experiences. They therefore opt to move and practice their profession in a place that is safer (Ahmad OB., 2005).

Another cause is often the low salaries given to professional health workers on their home countries. The developed countries have better pay for the foreign workers and at times it could be as much as over 20 times the country of origin (Buchan & North, 2009). This is the reason why counties like Nigeria and India have become grounds where doctors are trained and then exported to the international market.

The low wages and unguaranteed employment cause insecurity among the employees. This coupled with the fact that the cost of living is constantly increasing therefore very high expenditure; the workers are often unable to gain financial dependency (Buchan & Perfilieva, 2006). This often causes them to move to places where they are able to gain financial independence and even start a family as they are guaranteed of the job.

There are also a number of other job related dissatisfaction issues. The home countries offer very high workload for less pay, the health systems are dysfunctional, there are a lot of problems of deprived professional standards when interacting with workmates or handling patients and to make matters worse the rules that govern educational and professional advancement are unfair (Buchan & North, 2009). As a result there are many cases of nepotism in the recruitment programs and the employees lack motivation.

The home countries have very limited career options because of underdeveloped healthcare systems and specialization, as a result the qualifying doctors and nurses lack their desired type of specialty hence the zeal to work is affected (Dovlo 2005). As there are many qualifying professionals, there is very high competition for the limited positions in training and at work.

The Pull Factors

Most of the pull factors are just the opposite of the push factors. For instance, doctors, nurses, and paramedical personnel would migrate because of better pay and in search for better social and economic structures in foreign countries, something that they lack in their home countries (Buchan & North, 2009). Health professionals are also attracted to top foreign countries because there are able to access a wider range of career options and professional development to advance their careers.

This gives them the satisfaction and hope to better their lives. Foreign countries offer enough exposure to skills and the training focuses more on the procedural skills where the trainee are able to access more responsibilities and get trained on stick adherence to the set standards of care (Cutcliffe & Yarbrough, 2007).

The developed countries have well defined job responsibilities in the healthcare systems therefore present better working conditions. They also have regulated healthcare workload and the employees do not have to work under pressure. Workplace relationships are well managed and employees enjoy collegial relationships with each other. There are also better reward systems that are set in place for the healthcare workers for their dedicated and professional work (Cutcliffe & Yarbrough, 2007).

Regarding working conditions, the foreign countries offer lighter workload where employees work in functional health systems where there is better professional standard. The career advancements programs are based on the educational and research as well as teaching levels in the institutions of higher learning. Foreign nations especially the developed nations present a chance for continuous medical education and a guaranteed job security (Cutcliffe & Yarbrough, 2007).

Other pull factors in general include good living standards, easy access and availability of information, better communication technology, security and promise of better education for the children.

Recruitment of Professionals

The public sector depends on the private recruiting agents to this process and past research found out that the private practice did not depend too much on these agencies. These studies showed that for the recruitment agencies to maintain the ethical standards, they did not actively carry out the processes of recruitment in African countries since they were at the lower end of development (still developing countries) (Edward et al., 2008, p. 23). This is because the African nations still suffer the highest shortage of health service providers (International Labour Organization, 2005, p. 48). Work permit or licenses are only issued when the workers meet some eligibility criteria after which they would then be allowed to start working.

The study will seek to confirm or disapprove that the reasons for migration to and out of Oman were similar to those encountered in other GCC sates like the United Arab Emirates. The reasons behind emigration previously highlighted included the search for good salaries and work benefits, the search for better work conditions and wider career prospects (Buchan & North, 2009, p. 131), the search for a system that has international work standardization at the place of work and search for safer and stable job and also in pursuit of modern lifestyle where there are better infrastructure or social amenities and multi-cultural environment (World Health Assembly, 2006, p. 45).

Since 1970s many Omani graduates have been moving to the United States and European countries. Currently there are over 40% Omani medical graduates over the past 30 years working as nurses and doctors in the west (Martin, 2007, p. 49). This percentage is very high even though it basically seems to be very small but based on the country’s population size, Omani ranks among the highest countries exporting physicians and nurses to the US and the EU. These findings focused on the issues concerning the Omani medical graduated in the US and in the European nations (Bach, S. 2007, p. 387; International Labour Organization, 2005, p. 48).

Studies show that these graduates were aggressive in seeking board certificate in order to work in the medical research profession just like the American and other international graduates from the developed nations. The study will be keen on investigating the supply of health care professionals in terms of the graduating students as well as retaining those already in the workforce. Addressing the issues that lead them to immigrate to the developed nations to work there (Alonso-Garbayo, & Maben, 2009, p. 45).

The push and pull factor across the world have include those that deal with pay, better life, career development and modern technology or advancement as already indicated in the literature review (World Health Assembly, 2006, p. 45). These factors will be assessed and then described and categorized into groups including financial concerns, social factors, professional career advancement and residency training.

Nurse migration in Oman has very little information but it is quite significant. There are very few studies conducted to investigate it and even fewer have been done to assess its enormity as well as the predictors of the possible migration out of Oman (International Labour Organization, 2005, p. 48). Studies in the Arab countries indicate that at least one out of five nurses obtained a Bachelors of Science in Nursing Degree (BSN) in one to two years following graduation (El-Jardali et al. 2008b). In order for the nurses to qualify for assignment abroad, they are required to have at least one year of professional experience before they could be granted employment opportunity by an international employment agency.

The reasons for migration among nurses were mainly from the push factors and they basically included deficient career development opportunities, meagre salaries, and inequality with other workers and not being appreciated as health professionals (International Labour Organization, 2005, p. 54). Causes for leaving the countries were very varied across different careers. For instance, the financial reasons were the major factors causing the nurses to leave the Middle East.

While in the European Union region the factors influencing migration were mainly continuing education and career prospects. Even though most nurses intending to leave the country did not have intents of returning home, others indicated that both financial and non-financial enticements could encourage them to come back and practice at home (Bach, S. 2007, p. 387).

Most nurses reported that the main pull factors to encourage their stay in Oman or cause them to return would be better salaries, improvement of the work benefits, appreciation of their effect and support from the management, improved workplace polices and environment as well as better social infrastructure and technology to improve performance of the nurses (Pond & Barbara, 2006, p. 1453).

Self Sustainability in Oman

Defining Self Sustainability

Self sustainability means that the system should be able to produce the solutions or meet its needs independently (Merriam-Webster Online dictionary 2010). Applying this definition at workplace is somehow intricate particularly in the planning of the healthcare workforce.

Transferring the concept of having enough supply to meet the demand in healthcare results in a reasonable definition of the self-sustainable concept (Al Dhawi et al., 2007); This means that the healthcare system in Oman should have enough domestic ‘stock’ of physicians and nurses who can meet the requirements or needs of the industry (Akl, et al., 2008). The concept has not however incorporate wider elements in Oman like the quality of care, the productivity of the practitioners, the employee mix and retention strategies. This breeds a broad range of policy alternatives for attaining self sufficiency that range far beyond mere increment of enrolment of the student nurses and doctors (Seboni, 2009).

Policy implication would translate into issues of reduction of student attrition and increasing the productivity of the employees. Increasing the participation is a tricky venture and can be achieved by bettering the available technology, elimination of the non-nursing duties, increment of the full-time working rates and increment of the participation rates in the profession.

Omanisation Program

In the year 1998, the Omani government developed a program termed ‘Omanisation program’ (Al Dhawi et al., 2007). The Omanisation campaign was not only intended to ensure that the citizens found jobs but it would also decrease the country’s reliance on the foreigners for service provision and in the process it would be able to achieve self-reliance in human resource, (Ministry of Information, 2006a).

This meant that the country would be able to produce its own doctors and nurses to supply the growing demand of healthcare professionals. The program was a government’s top priority venture and it had set the goals of ensuring that the government services would have at least 72% of the employees as Omani citizens in six years (Ministry of Information, 2006a). The government also set a stipulation that the private sector would do the same in so as to be allowed to operate in the country.

The program was however without obstacles though ministers came out with in-depth analyses on working papers, identifying the impediments facing Omanisation and some strategies of getting around the obstacles (Ministry of Information, 2006a). The Sultan of Oman also urged the youth at the same time not to sit back and wait for the government but they should strife diligently and altruistically to build their country since working in whatever field was a virtue.

Oman has a unique structure considering that it is one of the oil producing nation in middles east. Since the finding of oil and the development of commercial export trade in the 20^th century there have been significant developments in Oman other nations in the Gulf region especially in the area of healthcare sector. Many of these developments are recorded in terms of the number of hospitals being constructed, the number of beds or potential bed capacity in the medical facilities (Alonso-Garbayo & Maben 2009).

There is also statistics of growing number of healthcare centres and the numbers of medical practitioners in the country. In terms of the technology development, the members of the Gulf Cooperation Council (GCC) which Oman, Saudi Arabia and Bahrain constitute the countries that boast of having the most modern health care facilities and also use the most sophisticated medical technologies presently on the market (Maben et al., 2010).

These factors together with the Omanisation Program have placed the country in a strategic position that requires investigation since all these factors seem to be pushing the industry towards a workforce that is self sustainable yet in reality there has been a trend where the healthcare workers are reducing at a faster rate than they are replaced hence causing a deficiency (Badrick, 2011).

Omani Healthcare Needs During Omanisation

It can also be said that the rapid social and economical development that Oman experienced increased the life expectancy of its citizens and the morbidity patterns changed. Besides, the use of new technologies and superior medical services has promoted population increase (Ghosh, 2006). This coupled with the fact that there are many people now going to school and increasing their awareness in terms of caring for themselves and the need for better quality of life have put more pressure on the healthcare services in Oman (Maben et al., 2010).

Oman has a very young population and it is also very small. Therefore differentiating it from other developed nations which have the older generation as the majority citizens is very important. Oman’s population is increasing very fast as most of the people are in their reproductive years (Maben et al., 2010). It is estimated that the young people occupy over 40% of the population and those are aged below 20 years. This percentage is almost double that of the developed nations in the West like Britain, Germany, France, US and even China (De Boer, 2008).

The healthcare systems in Oman also face increased demand of healthcare practitioners because of the new lifestyle adopted by the Omani people. There has been increasing prevalence of the conditions like obesity, diabetes, hypertension and road accidents. This means the demand for care givers is constantly going up (Mensah et al., 2005). The road traffic accidents are now considered an increasingly dire public health crisis and this means that the healthcare system faces double tragedy and need (Bener et al, 2003). It is very tricky to provide services to the fast increasing population which in turn is experiencing complex healthcare needs. Besides the policy makers are also under pressure to develop plans that produce enough and adequately trained workforce to meet their needs (Akl, et al., 2007).

There was a committee set up to monitor and make follow up on the program of Omanisation to assess the progress of the project. The committee had powers to help and determine the needs of the country in terms of healthcare providers needs, developing and implementing investment and recruitment plans for the project Omanisation. In conjunction with other agencies, the committee was also responsible for making reports on the progress of the project. The reports written after 1999 indicated that the project was a success and the target of 72% Omani in the workforce had been exceeded by 14% (Ministry of Information 2006a).

The Omanis alone accounted for over 61% of the total workforce. Since the year 1998 to the year 2003, there have been about 500 Omanis who have graduated from the health institutes with courses in post basic qualification. Of all these, 44 had graduated with courses of health management, 115 graduated with specialization in renal dialysis, 74 graduated having specialized in intensive care and the country had 25 physiotherapists graduating in the same period. The rest qualified in health education and midwifery courses. All these careers in healthcare system have been very important in the Omanisation of the healthcare sector (Ministry of Information 2006b).

The project of Omanisation had some important developments that are seen in the current system today. There has been an increased demand for the higher education in Oman over the recent past (Wilkinson & Alhajri., 2005). Nonetheless Wilkinson and Alhajri (2005) indicated in their paper that the increased pursuance for the higher education has not been developed to a degree that is sufficient enough to cater for the demand of the healthcare practitioners (Maben et al., 2010).

The Omani government had already established a strategy of dealing with the problem by encouraging establishment of more private universities and colleges where it will help provide about half of the capital costs for constructions and purchase of equipments for these learning centres. This was initiated by the government to ensure that there was increased college attendance because of the ease of access for those students who would otherwise have not managed to join the colleges (Ministry of Information 2006b).

Additionally, there are attempts to deal with the education quality because there has been a very high proliferation of schools. There is need for quality assurance profile or guidelines for this (Wilkinson & Alhajri., 2005). The education system needs an accreditation system that would ensure the quality of care.

The government also initiated programs to increase the number of people that meet the goal of Omanisation at all levels of learning. The government has strategies in place to address the cases of dropout and so far there has been reduced number of student leaving school or college before they complete their studies (Wilkinson & Alhajri., 2005). Even though there have been several investigations of the Omanisation impact on the countries supply of employees, there has not been a comprehensive report of the project on healthcare up this point. There it is very difficult to even determine which strategies were used and which one were effective and which ones failed and so on.

Who are the Providers of Healthcare Services in Oman

Healthcare services in Oman are provided by both the private and public systems where all the citizens and immigrants can access the public health services. As already mentioned, these are often referred to as expatriates of guest workers and they work for the government (Ministry of Information 2006b). However, the private healthcare systems have been growing very fast in the recent decade and it has been utilized by the citizens and immigrants as well. The primary healthcare providers particularly the general practitioners are challenged with the responsibility of providing diagnosis and detection of communicable diseases among other medical problems (Ministry of Information 2006b).

Medical facilities at secondary level on the other hand offer services to the diagnosed cases and may make referrals to the public health care systems for follow up. The tertiary level care provision also offers referral and deeper assessment and treatment option for diseases once they are referred from the secondary care. Migration is a major challenge to the provision of healthcare services in Oman (Ministry of Information 2006b). This is because even though the country has low incidences of communicable diseases, it receives many immigrants from prone areas like India.

Healthcare Workforce Profile in Oman and Other GCC Countries

The United Nations databases (2005) indicated that there were about 12.8 million immigrants living in the Gulf Cooperation Council (GCC) and this population was estimated to be about 36% of the 36 million people. Saudi Arabia hosted about 50% of the immigrants whereas the United Arab Emirates (UAE) had the higher proportion at about 71% (Zachariah et al, 2007). Other nations like Oman had lesser number of immigrants.

There is limited data on the massive immigration from and to the gulf region and even the population statistics that are given by these countries are limited in terms of analysis (Kaushik et al., 2008). The Arabs constitute the minority immigrants in Oman and GCC nations with a percentage of 38 in Saudi Arabia, 25 percent in Qatar and less than 10 percent in Oman. The non-Arabs are the majority immigrants and also constitute the majority of the healthcare workforce in Oman and GCC.

The GCC countries are experiencing a booming economy and Oman is considered an Upper middle income country and that position alone had increased the demand for healthcare. The increased awareness makes the clients to demand more qualified practitioners so that they can meet the needs of the population (Kaushik et al., 2008). The domestic production of these service providers is insufficient to provide a workforce for the growing needs.

This has made the countries to become reliant on the foreign workers from EMR like Egypt, Lebanon and Jordan among others. The market has also attracted workers form beyond like from Pakistan and India. Generally the profile of the healthcare workforce is defined by the destination countries and the source countries. In the Arab world, the countries in the GCC are destination countries as they have better work conditions compared to their immediate neighbours (Kaushik et al., 2008). Nonetheless because they are middle income countries, they also lose their own workforces to the developed countries in the west.

Healthcare Professional Recruitment

In the Arab countries, the public sector greatly depends on the private agencies for recruitment whenever they needed to conduct employment processes. The key informants gave reports that indicated that the private sector did not depend on the private recruitment agencies as much as their public sector counterparts. Rather they in most cases engage in recruitment trips and this involves sending their recruitment agents to the source country and then conducts the process of recruitments (WMA, 2003).

The informants also stated that for these agencies to be able to maintain an ethical recruitment standard (WMA, 2003). As a result there are no active recruitment processes being conducted in Africa because these countries face the highest shortage of healthcare professionals (Badrick, 2011). Nonetheless, the African healthcare professionals volunteering to go to the Arab countries are given a chance to be employed.

The public hospitals or healthcare facilities operating under the ministries of health sometimes ask for assistance from recruitment agencies to help in recruiting medical professionals on the international scene (El-Jardali et al., 2007).

The reason for this is that the fact that Ministries of Health do not want to make great expenses on the recruitment process particularly when they required to interview applicants. Theses recruitment agencies make up for this reduction in expenses by charging the prospective employees for the recruitment services (El-Jardali et al., 2007). This strategy transfers the burden for the ministries of health to the people seeking the job. During healthcare professional recruitment process, the healthcare facilities or hospitals send delegates from the MOH to the source country.

Contracting Healthcare Experts

Health professional who want to be employed in the Arab nations like Oman and the UAE are required to have license of work before they are allowed to begin practicing in these countries (Labonte & Packer, 2006). The license is normally given to the experts when they meet a certain set of eligibility criteria and also pass a test exam administered by various authorities concerned with practice of medicine (Kaushik et al., 2008).

Each of the examining authorities could have a different examination altogether. The studies conducted in UAE show that re-licensure happens on yearly basis and therefore the work contracts are required to be renewed annually as well. The workers are not limited to the number of years that they can live in these countries and hence the contract is not limited by the years worked (El-Jardali et al., 2007). The choice of whether to practice for a short period of time or work as visiting professors, then their contracts are given a special deal where they are renewed after two years.

The process of renewing the contract is dependent on the re-licensure and this in turn relies on the professional or expert completion of certain minimal number of Continuing Medical Education (CME) hours. Statistics show that the government sometimes conducts rigorous appraisal on a yearly basis and the CME credit hours that the healthcare professional accumulate are evaluated to determine whether or not they qualify based on the requirement (Kaushik et al., 2008).

For the public institutions, when the medical experts fail to meet the required credit hours, they are not terminated immediately from work neither is their license revoked immediately. In such instances, the employees are warned and given a second chance but they are graded lower on their performance appraisal or some form of penalty is given (Kaushik et al., 2008).

Vacancies

Since there are a number of authorities in Oman and the UAE, and this coupled with the fact that there has been very minimal coordination among these authorities, then the exact number of vacancies in Omani medical and nursing sector cannot be accurately determined (El-Jardali et al., 2007). Nonetheless, there are several vacancies in the Ministry of Health facilities since the government is actively expanding its medical care industry. The exact number of vacancies in Oman could probably be well determined in future when the healthcare structure is properly constituted with clear communication among the healthcare agencies in the industry (Kaushik et al., 2008).

At the moment, researchers can only rely on estimated from the Ministry of Health. The need for nurses and midwives could be about 400 and 150 for physicians. It is important that anybody reading these figures must interpret them with caution since they only reflect what the Ministry of Health has in its databases and maybe few other agencies it got in touch with. There are some other data concerning vacancies in Oman and they come from the major hospitals in Muscat with a good number of physicians, paramedics, nurses and midwives.

There are a number of factors that are thought to have caused this demand or shortage of healthcare professionals (Buchan, et al., 2003).

Healthcare Professionals Turnover

The increased rates of turnover of healthcare professionals wield direct and indirect expenses on the healthcare systems of the affected nations (Labonte & Packer, 2006). Among the direct expenses are the money spent on advertising and conducting the process of recruitment. Among the indirect expenses, there are the cost for termination of work, reduced productivity in health facilities and the impact of the reduction of practitioners on the quality of care (Alotaibi, 2007).

Studies in Arab countries report that there are very high turnover rates in their health facilities and this is caused particularly by the low salaries given by the government facilities compared to the private sector. There are also poor working conditions like very poor work environment, lack of constant salary increment programs, very high cost of living and the experts finally find that they are unable to pay for the increased costs of continued medical education course and seminars (Buchan, et al., 2003). All these compounded with the fact that the few worker experience very intensive workload, the employee turnover increases as the practitioners are left with no option but to seek better working conditions.

Many of the healthcare experts in Oman and UAE consider these countries in the middle income category as transit countries. This means that they find employment in these countries as a way of progressing to the developed nations like in the EU, USA and Canada (Buchan, et al., 2003).

Many of the healthcare employees chose to work in Oman so that they can get an opportunity to gain experience required to make them attain eligibility qualifications for better positions in the developed nations. The opportunities in the developed countries in the west not only offer better salaries but also other work related benefits (Buchan & North, 2009). Furthermore there is also the lure of these experts gaining the citizenship of their destination countries like the US green card. Basically this does not happen so in Arab countries.

Migration of Experts: Implication on Policy

The previous sections have addressed the factors causing the unbalanced supply and demand of healthcare experts. They have also addressed the causes of migration to the developed nations and the impact on the source countries. This is majorly instigated by the poor working conditions, meagre wages and lack of wider range of career prospects (Ahmad OB., 2005). All these factors are seen to be better in the developed nations have a great attraction to the professionals from the developing countries (Buchan, et al., 2003).

Provided that there is still very limited data and there is also the problem of incompatibility among the agencies operating in the Arab countries workforce, it’s impossible to create an accurate and a detailed overview of all the flows of the nurses among countries (Ross et al., 2005). There are also the characteristics of the healthcare professional migration being quite dynamic hence very little can be deduced as there are many gaps. The process of international recruitment caused disruptions in the source countries, caused disputes in the destination countries and sometimes caused undefined challenges to the individual practitioners (Buchan, et al., 2003).

There following are some of the possible opportunities that are created when practitioners are internationally mobile:

The destination countries currently experience opportunities to solve their deficiency in skills and healthcare staff shortages (Martineau & Willets, 2005). On the other hand they also face the challenges of determining how to be efficient and exercise ethical standards in their recruitment programs (WMA, 2003; Martineau & Willets, 2005).

The source countries are presented with opportunities to exploit their remittances in terms of the Up-skilled returners in case they actually come back home. The same possibility will offer a chance for these countries to reduce the cases of unemployment in certain areas. The source countries face the challenge of experiencing serious shortages of workers and this can have a very dire consequence of quality and efficiency of healthcare service delivery (Badrick, 2011). The personnel themselves also encounter opportunities to get better pay, develop their careers and have quality higher education with better use of current technologies (Buchan & North, 2009). Besides, these nurses and doctors would have a challenge of experiencing equal treatment as citizens for the destination countries.

The policy issues have been raised across the globe because of the increased migration of healthcare practitioners. Both the source and destination countries are affected by this phenomenon. For research purposes, the study of the policy implication was very important as the research would inform policy makers on important issues based on evidence and current knowledge (El-Jardali et al., 2007). These information and data would greatly help decision makers and policy developers in understanding what hinder clear understanding of the healthcare professionals’ migration dynamics (Buchan, et al., 2003).

Important questions that have been raised in relation to this include: for the sources countries – whether or not the outflow of the healthcare practitioners should be encouraged as a way of stimulating remittance and decreasing oversupply (Ahmad OB., 2005); there is also the question as to whether the outflow should be restricted to cut down the phenomenon called brain drain? If so then how that would be achieved without breaching ethical values? Were the recruitment agencies to be regulated as well or what was the effective measure against them? These are some of the issues that are yet to be answered in Oman and many other Arab countries because they remain contentious.

There is a problem of knowledge gap that needs to be filled by research and this include; determining the main destination countries that are taking away the workers from Oman. This can be found easily as some of the lucrative healthcare systems in the world are known and these are the main ones that attract practitioners (Smith, 2008). There is also need to conduct a study that would determine which is the appropriate rate of outflow? Which one could be temporary or which level was permanent?. In case there are some cases that are regarded as temporary, then the strategies of encouraging returners need to be developed and implemented. The impact of the outflow need to be clearly evaluated and the data profiled and disseminated for scholars and stakeholders (Smith, 2008).

The countries which experienced the greater migration of the healthcare practitioners should be able to investigate why that happens and then assess the impact on service provision in healthcare (Smith, 2008). The use of the complete data or statistics and compatible information collected from various sources in most cases implies that having or gaining accurate profile of the trend in the migration and turnover of medical practitioners.

It is pertinent that the current information base allows policy makers to evaluate the virtual loss as a result of the migration of healthcare workers or other countries compared to the few migrations into the country (Ahmad OB., 2005). This will provide information like when physicians and nurse move from the private sector to the public services and vice-versa. Besides, it should offer information of practitioners leaving the professional totally to join other venture as well (Smith, 2008).

There are also movement of nurses and doctors from the developing countries or lower income nations to middle income countries like Oman and this information is equally important in the policy development (Khaliq et al., 2008). The flow of professionals could be visible on the international scene yet it has very minimal numerical impact because of being replaced by employees from the private sector or from the colleges.

Uncontrolled or unmanaged movement of health workers outside the country could cause bad impact on the health systems efficiency or even erode the existing and future potential functionality of the country’s workforce pool (Khaliq et al., 2008).

A number of countries have already set in place some policy reactions like developing programs that help the nurses to bond with their home county’s employment systems for a certain period of time after their graduation from the colleges (Khaliq et al., 2008).

Does not seem to be efficient in curbing unnecessary migration of workers since the compliance is very wanting. The processes of monitoring have not been able to help the government to tract down the graduating students getting into the workforce. Some strategists suggest that the use of tactics involving the use of money incentives and regulatory barrier would be more efficient in terms of policy response. However the challenge is that this does not have a way of alleviating the push factors which cause the practitioner to want to leave the country (Smith, 2008).

These strategies also act as impediments to the free movement of people discriminatively against the healthcare practitioners. However, some of the developing countries are striving to counter the push factors by addressing issues of poor pay for the health workers and increasing the courses in the higher learning institutions as well as developing more diverse care facilities so as to increase the career prospects in the field of healthcare (Smith, 2008; Khaliq et al., 2008). Even though governments try to institute policies to deal with poor working conditions and overworking the employees, job security issues and advancing as well as increasing the educational prospects, these are huge programs that are a great challenge to manage.

The Position Abroad

Buchan and Terrace (1999) noted that at least one out of five nurses in the UK workforce is aged above 50 years. This means that in the next few years, many of them will be lost to retirement. This is often the trend in most other developed nations. The importance of such workforce profile to the policy makers is that there are two important outcomes. Firstly, it is very obvious that a good number of practitioners are reaching retirement age and will soon reach. Secondly, many practitioners are reaching middle age years and their attitude towards work or ambitions are likely to change. The paper by Buchan and Terrace (1999) studied this change in attitude.

The results indicate that health professionals working in the National Health Service (NHS) were younger based on mean age while these working in nursing homes were older. Nonetheless the general age profile of practitioners is that they are older whereas the pool where to draw new ones are reducing (Buchan & Terrace., 1999). The aging workforce demands a great change in policy like working hours should be flexible and reducing provision of pension in flexibility concerns.

Buchan and Mario (2002) show that the world health report of 2000 indicated the right ways of determining the correct mix of health workers and the main obstacles. The healthcare systems are labour intensive and the leaders struggle to find the most effective mix of staff that can be compiled from the resources available. Skill mix describes these occupations (Buchan & Mario, 2002).

The healthcare systems abroad have a diversified skill mix. There are a number of issues important to this topic. When responding to skill shortage, countries should find substitutes and how to improve the existing ones. In terms of managing the cost of care, there needs to be a reduction in the unit labour expenses and/or improved productivity by varying the skill mix (Buchan & Mario, 2002). Improving the healthcare quality would mean better utilization and deployment of the staff skills. To institute reforms, the staff duties need to be adjusted and new responsibilities introduced as well as new types of employees (Buchan & Mario, 2002).

Buchan (2007) says that providing more money to the health workers and employing more staff to solve the current problems is not the best solution for developing a sustainable health workforce. There needs to be a process of cultural change where the management systems of the healthcare sector makes good use of the existing staff and that they should be up skilled properly. Buchan (2007) gives an illustration of how the NHS in UK invested over the past decade. It made huge investments in the NHS management and the workforce rose by 20-30 percent which was impressive.

The government had realized that the nurse shortage was impeding service improvement. More money was allocated to the workforce growth and the staff targeted was met. There was active recruitment, attempts to improve retention and return to work (Buchan 2010). The plan also included more training enrolment, more international recruitment and bringing back professionals wanting to return to work. However, this funding has been reducing. Consequently the number of those enrolling for training is reducing and the international recruitment is also low and retention rates are worse.

The best way to have handled the issues was not to offer a quick fix as it does not continue, says Buchan (2007). To have a sustainable staff, there needed to be better communication, for the right staff at the right time, there needed to be cultural and incremental changes and cost benefit analyses conducted. Dean (2011) notes that the bottom-line is that there need to be enough workforces at the right place. All evidence in UK shows that in the next few years, there was going to be an even worse shortage of health workers. Combined with attrition from retirement and redundancy, this reduction calls for hard decisions.

The contrast: The developed countries have a different healthcare structure compared to the developing nations like most of African countries and even the middle income nations like Oman. The age of the practitioners in Oman Middle East in general and Africa is much lower. There are younger people venturing into the profession because of the opportunities that are abroad. The professionals here are more ambitious to seek better work conditions outside their countries as already implied in the push and pull factors. There is very little specialization and skill mix in home countries. This makes professionals to seek diversity in countries that offer a wider range of opportunities in the healthcare field.

Aims/Objective of the Study

The main aim of this study will be to investigate the factors that pulled health practitioners into joining the Omani health care systems as well as those factors that pushed practitioners away into migrating to other countries. Essentially, the study will be termed as an investigation of the factors that affect the healthcare workforce in Oman in terms of supply and demand.

To meet to intent of the research, the investigation will seek to answer the main questions which include; what attracts healthcare workers to join Omani health system? What factors contribute to their Leaving? Which factors have caused them to stay? What possible changes in the policy or work situation can make them to stay?

Methodology

Introduction

The study will be set to investigate the factors that determine the demand and supply of healthcare practitioners (availability or scarcity) in Oman. This basically means that the study will examine the employees’ attitudes and perception about the Omani healthcare systems. The research will be conducted over a period of a year. And it target to investigate the relationship between the destination and source countries (Maben, et al., 2010, p. 293). As a middle income nation, Oman is experiencing mixed activities where it is a destination country, to the low income countries’ expatriates and a source country to the developed nations.

The results from previous research have presented very insightful information about the healthcare systems in Middle East particularly its structure and process of demand and supply of employees. The discussion will help to present the following information. Oman is a very fast growing nation that greatly depends on expatriates to provide services in its healthcare system even though the Omanisation program has seen this trend change gradually (Smith, 2008, p. 82).

Even as there are more Omani nationals joining the healthcare workforce, many still find their way out by immigrating to other developed nations where they deem to get better opportunities than in Oman. Therefore healthcare professional from the developing nations still flock Oman to seek employment in the medical sector (Khaliq et al., 2008, p. 67). The percentage of expatriates in Oman remains higher at 84%. This had exceeded the target set by the omanisation program of attaining a percent of 72% Omani nationals in the workforces by 2003 (Barbara et al, 2010, p. 122). However the numbers keep fluctuating because of the problems of retention of these workers and also training them to join the employment pool.

Research Design

The study will be both a quantitative and qualitative descriptive study which will employ survey and experimental designs for data collection, and analyses. Employees in the Omani healthcare sector will be selected at random but for study of immigrant living in Oman, will apply targeted selection as it is necessary (Rabbie, 2010, p. 211). Depending on the data that the research will be collecting, the study is subjective and this type of design is very appropriate for this type of research. Literature review will be the first to be conducted. Information and statistics from the previous studies will be done by the researcher through reading materials from the library and other secondary sources like searching databases on the internet (Cohen et al., 2007, p. 34).

These previous studies will be very important in providing backup information about the trends of healthcare workers migration in and out of the country. This information will also be important in making comparisons with the neighbouring countries which share the same kind of healthcare structure as the GCC nations (Saudi Arabia and Bahrain, etc) (Maben, et al., 2010, p. 293). After the literature review, a survey will be conducted to investigate the practitioners’ perspective of the medical care system Oman in comparison to what they perceive the developed nations could offer.

Participants

The target group for the study will be healthcare practitioners in Oman. The researcher will select a sample group from different healthcare facilities across Oman in a random manner and from both the private and public practice (Rabbie, 2010, p. 211).

The researcher therefore intends to interview about 129 health care providers. There researcher will also try to manage the sample so as to have a balanced gender representation at 50% men and 50% women. These participants will be drawn from various ethnic backgrounds or nationalities including Omani and non-Omani like Emirati, Africans and Indians. The researcher will also try to manage the random sampling from each hospital and healthcare facility so as to reflect the true picture of diversity and what actually happens in the public and private sector (Rabbie, 2010, p. 211). In The public sector, it will be easy to identify the potential participants since the information can easily be obtained from the Omani Ministry of Health.

Sampling Strategy

The participants will also be drawn from different health service backgrounds including general practitioners, paramedics, nurses and physicians. The potential participants will be required to have had enough experience working in the Omani healthcare system for at least a period of four years. They will also be required to show great interest and knowledge of the international recruitment protocol (Barbara et al, 2010, p. 122).

The participants will also be required to be having a better understanding of other healthcare systems across the world especially in the developed countries. The researcher hopes that most of the participants will be specialists and some will be those seeking to become specialists of certain fields in future. Therefore they will be having great interests in career developments and alternatives for career advancement beyond national borders.

Ideally, determining the actual position of workers’ issues and those concerning the Omani healthcare system will a very challenging encounter; basically because many workers in the system hope for better and may not appreciate what has been done by the government. Some participants could actually provide offer unreal information or information they perceive the researcher wanted to hear. Therefore in order to provide very valid information, the researcher should have conducted study from the returners and those already working outside Oman (Barbara et al, 2010, p. 122).

Materials

The research will employ semi-structured questionnaires for collection of data as the main strategy. This will be done in order to evaluate the behaviours of the healthcare workers based on their career facilities (Smith, 2008, p. 82). To assess the factors that determine the migration of healthcare practitioners’ supply and demand, the researcher will use the semi-structured format questions to evaluate the pull and push factors into the health system noun.

The major factors to be assessed in this research will include the employees’ attitude towards the Oman healthcare system, perception of the international healthcare in terms of continued education, variety in career prospects and functionality. The questions will take the format of Likert type questions with a scale of 1 to 5 with 1 as lowest score, 3 medium and 5 the highest score.

Data Collection

The researcher will introduce the questionnaires to the participants by giving them a brief explanation of the reason for conducting the study. The participants will be then requested to respond to the questions during the day and then send filled questionnaires back. The self administration strategy will be applied since it allows the respondents enough time for them to think and react (Rabbie 2010, p. 221. however, the precision of filling the questionnaires will be seen as the possible threat. the respondents being learned, they will be quite effective in responding properly. Only very few will be expected to get spoilt because of poor filling.

The questionnaire will be classified into different sections to help integrate the responses and to allow easy analyses (Cohen et al., 2007, p. 31). The first section will be set to collect demographic information about age, gender and nationality of country of origin. The questions in the section will be 10 questions designed in the likert format to encourage respondents to give their responses. The questions will be very short enough to encourage participation. The third section will have open ended questions. Completion of the questionnaires is not expected to take more than thirty minutes each.

The researcher and his assistants will distribute 129 questionnaires to the respondents and most of them are expected to be fully answered and returned. These completely filled questionnaires will be used for the process of analysis. The emails and the techniques of delivery will be used. The questionnaires that will be sent through emails will be easy to administer and collect since it takes only the effort of accessing the email account.

The process will be cost effective because of time saving and also saving on transport for movement. The emails will also guarantee that the participants will be a representation of the general populations since they will be randomly obtained. The strategy will have the benefits of being more secure in terms of controlling the study, accessing the data and reaction from the participants (Smith, 2008, p. 87).

Being a quantitative study, the researcher will also select some professionals from the employment agencies for focused group discussion to provide the in-depth understanding and assessment of the supply and demand of health workers in Oman.

Persistent Shortage of Staff

Despite of the country conducting excessive international recruitment of expatriates in healthcare services, the country still faces serious shortages of healthcare service providers. Furthermore, the country has not set up or gotten full involvement in any bilateral agreements for the processes of recruiting the foreign trained experts (Barbara et al, 2010, p. 123). This is why the country lacks accurate data on the real stock of nurses, paramedics and physician. Nonetheless, the researcher will only use the closest estimates for these workers found in the Ministry of Health databases.

Data concerning the estimates of nurses, paramedics, midwives and physicians in addition to the number of trained potential workers graduating from the medical colleges and schools of nursing will be collected from various sources besides MoH. Additionally, cases of heavy shortage problems are expected to be reducing. Nonetheless study of Oman will still show that healthcare systems experienced very high employee turnover rates. The reason behind it being that the country generally practiced very poor strategies of employee retention.

The data to be collection and the responses to the questionnaires will actually reveal that there is probably very little or poor retention strategies across the healthcare systems in Oman at a national level. However, this is not certain yet since the research is yet to be done but these anticipations are merely based on speculation and what previous studies in countries with similar structure and culture have shown.

The strategies used for the Omanisation were generally applicable to all workforces and may be did not blend well in the healthcare sector which is quite unique in nature. Another reason may be the lack of compliance and enforcement initiatives, therefore causing the program to have less influence or power over healthcare systems. Nonetheless, some strategies to retain workers are being initiated by the healthcare facilities themselves at the organizational level. The facilities try to deal with the problems of losing workers and having to seek other for replacement in very short spans of time. This process greatly contributes to the higher turnover rates in Oman. Based on the statistics, it was on the verge of exacerbating the exiting shortages.

The key informants from recruitment agencies to be involved in the focused group discussion will give responses regarding sustainability of Omani workforce in health. Because there have complaints of shortage, it is very likely that Oman was not actually self-sufficient. This is still attributable to the high turnover rates in the healthcare sector and training of fewer professionals. This implies that the country was facing a threat of always depending on foreign expatriates to meet its national healthcare demands. A number of challenges concerning the healthcare workforce in Oman have been documented but some are incomplete and others are very outdated (Barbara et al, 2010, p. 122).

There are a number of impediments into attaining the accurate data and include lack of proper healthcare employee strategy (Aldossary et al., 2008, p. 126); lack of cooperation among the healthcare agencies; problems from recruitment and retention processes for the citizens and expatriates coupled with very high turnover rates; there is constant if not an increasing influx of expatriates into the country; the country explicitly packed a suitable program or strategy for self-sufficiency; and lastly there were many challenges of cultural diversity of the healthcare employees (Buchan et al., 2005, p. 24).

It is hoped that the key informants will also outline a list of recommendations that could possibly offer appropriate remedy to the current challenges facing Oman. The major one based on previous similar studies is a health care workforce plan for Oman. Others measures may include programs for recruitment and retention of health workforce (Pond & Barbara, 2006, p. 1452); provision of better interaction and collaboration among the agencies and authorities working and dealing with healthcare workers and involvement educational sector as well as improving the nursing and medical training programs in Oman (Aldossary et al., 2008, p. 127).

Limitations

The main limitations of the research are anticipated to include the type of method used for study. In terms of the sample strategy the sample could be a limitation as well. In order to differentiate and assess the sample diversity, people from different nationalities or immigrants will also be included in the study. Demographic data like gender and age will also be factored in the study (Cohen et al., 2007, p. 13).

This will set to help the sample to be more representative of the population. The assessment and analysis will be tricky because the study will sample people from different backgrounds and with different ambitions and demographic information (Cohen et al., 2007, p. 13). The study is intended to provide insights and axes of study instead of conducting an exhaustive representation of the healthcare employees conduct.

Instead of distributing questionnaires at random locations in major hospitals, visiting the facilities will be much better since this would have given the researcher a personal feel of the environment the employees work rather than rely on the reports in the questionnaire (Cohen et al., 2007, p. 13).

Data Analysis

The process of analyzing data will be conducted by use of computer and statistical software. The responses in the questionnaires will be categorized into two groups. There are those which will make sense to be analyzed as qualitative responses and those that will require quantitative analyses. The qualitative responses will be coded and described into themes and factors affecting supply and demand of healthcare professionals (Cohen et al., 2007, p. 13). They will then be quantified since this will be majorly a quantitative study.

The quantitative data was analyzed by the use of Statistical Package for Social Scientists (SPSS) software. A number of software are currently available for analysis of quantitative data. Regarding the practical knowledge of the researcher concerning data analysis and statistics, SPSS was the most appropriate and therefore data was interpreted by use of this software. The initial step included designing the questionnaires to allow a matrix that could be used by the SPSS. The information collected was then coded for easy analyses. After the preparation of data and filling into the tables, the analyses were then carried out.

Coding of data will conducted putting it not consideration the type of layout, the time consumed during the process and the values that were missing (Rabbie, 2010, p. 212). Once the information will be filled, an assessment for possible mistakes will also be carried to check and correct any mistyping that could possible affect the analysis and even cause misinterpretation of the outcomes. There is expected to be very few mistakes found and to be corrected.

Ethical Approval Process

The ethical approval is pertinent for the research in order to help protect the investigator and the participant as well as the university as a learning and research institution at large. Since the researcher intents to collect data by use of interviews, surveys and questionnaires, then he will have to fine ethical approval before beginning the study. The approval will be obtained from the university’s ethics committee where the researcher will obtain information to the participants note or the letter of introduction as well as the consent form. Studies that involve health systems and human participation like this require approval of the research ethics committee (REC) which will be obtained by the researcher before commencement.

Validity & Reliability

Without rigor, a research would be worthless and hence loses its utility and benefit to the academic society at large. There researcher will hence apply a great deal of attention to ensure that the study is validated and relatable as far as the research methods are concerned (Kuzel & Engel, 2001). The challenges to this quantitative researcher rigor parallel the statistical packages often used in research. Lack of p values and other factors like confidence level can affect validity.

For validity testing, the process for data collection will be piloted by the researcher with help of doctoral students and supervisors who will assess the project. They will update the terms of literature review, clarify the confusing facts and make comments on the process as a whole which will be revised by the investigator (Kuzel & Engel, 2001). The themes will be assessed by factor analysis technique and the SPSSX package software.

Reliability will be assessed by the Pearson Correlation analysis based on the outcomes of the factor analysis. This process will be conducted when the factor analysis shows a simple regress to evaluate the total scores (Kuzel & Engel, 2001).

How to Test/Pilot The Questionnaire

A pilot study will be carried out among the doctoral students to assess whether the questionnaires will actually test the objectives intended by the research. Therefore pilot questionnaires of five questions will be administered by the researcher to a number of students and evaluate their responses to determine how the final questionnaires will be done or structured.

Retention Strategies

One of the main challenges that face the Ministry of Health in Oman in the high turnover rate in the country as the research indicates. The study reveals that this is partly because of lack of retention strategies and also lack of work incentives for the healthcare workers. The participants indicated that salaries and benefits were very attractive in Oman in the 1970s when omanisation was being initiated than they are today (Bach, S. 2007, p. 392).

The salaries have continued to reduce and they are now getting lesser and lesser as economy continues to grow and suffer inflation. As already mentioned the health workers also seek to gain more knowledge and experience when they move to Oman and this is seen as a transition step (International Labour Organization, 2005, p. 62). When they attain the required experience to move to North America and Europe, they often do so very fast (Buchan, 2007, p. 7). The 2000s experience very high rates of movement to America and Europe.

The low salaries and lack of work benefits are disincentive to the healthcare workers. As already indicated, foreign medical workers who seek to gain the necessary experience required to work outside the country often get better jobs in America and in Europe (Buchan & Evans, 2008, p. 51). The research found that, in the 2000s, there was the highest shortage of healthcare workers in the Arab world. The Western nations had sent representatives in many of these nations to recruit medical experts including doctors and nurses (Pittman et al., 2009, p. 102).

Countries in the West attracted more foreign employees for a number of reasons and the major one remained to be the higher salaries and work benefits (Buchan & Evans, 2008, p. 51). This therefore translates to mean the efforts to retain workers in the force and even to attract more depended on the countries pay policy and benefits (Aiken & Cheung, 2008, p. 5). Encouraging more people to join the healthcare workforce would be a very difficult process in the effort to deal the shortage.

Some studies even suggested that the government should encourage and discuss the importance of healthcare personnel in schools and training institutions to inspire young people to endeavour to get into the project. In light of this approach, there was also the need to couple this effort with financial incentives to attract more nationals (Hayes, et al., 2008, p. 238). Even though citizen nurses got higher salaries than the non-citizens, their salaries were still lower as compared to other professionals and the amount of work that did. In the previous years, the healthcare profession particularly nursing has not been a well respect job in the Middle East region because of its nature (Hayes, et al., 2008, p. 238).

Nursing was often regarded and unclean and unattractive job. In the same line, the nurses are considered inferior member in the society. Nonetheless physicians who are in the same line of work are just treated as better and high ranking people in the society.

Some of the immigrants in Oman get better salaries than in their home countries, but these rates are still lower compared to other professions and the rates are lower than in the past. As the cost of living continues to increase in Oman and Middle East region in general, financial compensation is a serious challenge to the employees (Hayes, et al., 2008, p. 239). Therefore having programmed financial incentives for the workers will be very beneficial and important when addressing the problem of workforce shortage and retention (Cowen & Moorhead 2006, p. 160).

In the related studies in the United Arab Emirates, Younies et al 2007 investigated the financial incentives that can help to retain workers in both the public and the private sector and even across different countries. As a matter of fact, Younies and colleagues in 2007 noted that the financial and non-financial incentives were equally important in attracting employees as well as motivating them.

There are three most important material rewards which are mostly appreciated and recognized by the employees. They include the paid vacation, provision of health insurance and financial benefits. The most favourable non-financial inducement t for the workers hat were identified in the study included a balanced pay to the performance at work, provision of training and educational programs, application and implementation of modern technology, provision of flexible working hours and organizational authority (Cowen & Moorhead 2006, p. 160). The discrimination of women healthcare employees mostly depend on the non-financial incentives like manageable working hours whereas the men were mainly focused on power and authority in the organization.

The Arab speaking people have a strong desire for authority and autonomy. The doctors on their part are more interested in getting better education and training and have less interest in the new technology or having flexibility at work. This means that the healthcare workers were keen on linking the job performance to the rewards. When developing a system of rewarding the professionals or recognizing their efforts, it is pertinent to think about the diversity of the healthcare career prospects and options (Younies et al., 2007).

This is very important in a society that is multicultural just like the Middle East is growing to become. Because of the fast growing economy and inflation, the healthcare personnel in the UAE and Oman were discovered to like financial rewards more.

Many of the healthcare facilities are currently implementing mitigation strategies and organizational or institutional level even as the government strives to set up national standards. The initiatives are intended to reduce the number of reported challenges in the healthcare system, offer retention strategies and also reduce the turnover outcomes (Tomblin et al., 2009, p. 229). The commonest strategies used for retaining workers in the hospital and the healthcare facilities include implementing financial rewards and offering work benefits, recognition of performance (Younies et al., 2007 ), bettering relationship between management and the employees as well as provision of opportunities for advancement (Buchan et al., 2005, p. 24). Other strategies like educational program and staffing were also important but were not expressively practiced.

Kaushik et al examined the qualification of the physicians who were leaving India to go the developed nations for better work benefits. Under this investigation, the authors used the entry assessment and the graduation qualification as the measures of the preparedness and qualification of the doctors. They also investigated whether the physician were enrolled into the medical school because of affirmative action initiative or not.

Just as in this study, the research also found that males presented higher probability of migration compared to the women. The graduates who got enrolled in the learning institutions had a double probability of emigrating compared to those who got enrolment as a result of affirmative action. The graduates who had been awarded at least one award had higher chances compared to those who got no award at all.

This study may also find similar results to Kaushik’s and colleagues findings where the physicians admitted to medical schools because of the affirmative action did not have so much conviction of leaving. This could be a very important finding considering that this study will be providing recommendations for better policies. There has been some debate as to whether the medical training institutions should increase their affirmative action intake to boost the number of workers, Oman National HRH Observatory, 2008.

Discussion

Introduction

Professional nursing and practice of medicine as a doctor in Oman is growing fast. The upward growth begun in the 1970s, when Omanization program in Oman was originated and it inspired modernization of its system sectors like healthcare (Ghosh, 2006, p. 12). In the last decade, healthcare as a profession has been found to be the most developed and fastest growing sector in Oman (World Health Organization, 2006).

Before then, nursing was basically a vocational training; however, today those nurses who graduate with a diploma in nursing are allowed to get registered so that they can work as Registered Nurses (RN). Regardless of the many efforts intended to improve the nursing education and physician practice, the medical profession still suffers obstacles and it is way much behind in trying to catch up with the developed nations in the west (World Health Organization, 2006).

The findings from Middle East GCC countries are an indication that these countries Oman included still struggle with managing their resources to serve their rapidly increasing populations. This therefore causes serious deficiency of well-trained professionals needed to serve all these people (Little L & Buchan J., 2009, p. 47) The Ministry of Health has already set up important steps to support the healthcare employees’ educational preparedness.

The government has in place a funding program for the education of the medical practitioners (World Health Organization, 2006). There are suggested initiatives to offer free education to the students venturing into practice of medicine as nurses or as doctors. The Ministry of Education has however made some notable steps in terms of supporting the education for nurses and financing the institutions which train these nurses (El Sayed MK., 2008, p. 23).

The sultanate of Oman is a very important country in the Middle East. First, it’s because of its strategic location being bordered by Yemen to the West, and by Saudi Arabia and United Arab Emirates. Second, the political climate in the country has been a peaceful one therefore it has had better economic development. This is an area that is peaceful despite Middle East having constant conflicts. Besides it is becoming an open way to the rest of the Middle East and Far East. This is a very important factor and coupling it with the discovery of oil has made Muscat city to become the economic and commercial hub in the region.

As an Arabic Islamic country, religion plays a very significant role in the development of the Omani healthcare system in terms of its regulation, management, development and professional responsibilities (Maben, et al., 2010, p. 293).

Culture in general was also a great factor in determination of the way the healthcare system would be like (Shukri, 2005, p. 87). Many hospitals and health facilities therefore have some sections divided into male and female sections. The outpatient section has men being sent to the male sections and the women to their own section. Inpatient has similar structure and arrangement with men and women being sent to different wards (Shukri, 2005, p. 87). Nonetheless, there are still some exceptions especially in the critical care needs like the dialysis section, intensive care and cardiovascular sections.

Why the problem

The pull factors had the greatest influence on the healthcare workers to emigrate. The developed nations in most cases find themselves having a very high number of aging populations compared to the younger people. This kind of population profile makes the countries to have a great need of extra nurses and doctors. These nations also have well developed programs designed for providing healthcare services to these older people (Buchan, 2006, p. 21).

The USA alone is projected to suffer a deficit of about 500,000 nurses by 2015. Other developed nations like Canada and Australia, about 25% of the healthcare practitioners, physicians to be specific are said to be from foreign countries (Arah et al., 2008, p. 149). Out all these, 75% of them came from low income and middle income nations.

The United States and other develop nations are greatly dependent on the foreign expatriates for supply of healthcare graduates to their systems. This is because there are significantly more residency positions compared to the number of people graduating from the US medical school (Buchan, 2006, p. 21). The US had in fact declared it wanted to employ over one million healthcare employees in a period of 15 years. This is uniquely equal to the number that the countries in the sub-Saharan region need in order to attain their millennium development goals.

The developed nations have realized that recruitment from the foreign countries was a quick fix to that matter. Rather than spending money to build self sustainable healthcare system by investing in training more professional, encouraging them to enrol and offering better working conditions (Buchan, 2006, p. 21). The developed nations find it easier to provider better pay to the foreign nurses and doctors from developing nations. Definitely people coming from the poor countries would find it very difficult to turn these offers down.

In some cases, the developed countries have been observed to create regulation and requirements that are specially tailored to favour easy access of the health care professionals from foreign countries (Buchan, 2008, p 78). Even though countries like the US has a requirement that when the professional graduate they have to go back to their home countries after graduation. Nonetheless, the government has been waiving that requirement when these professional were allowed to practice in areas rated as ‘under-served” (Buchan, 2008, p 78).

Most of the countries are now implementing policies that specially target the experts in healthcare service provision. Australia for instance is famous for its occupation in demand list (Brush & Sochalski, 2007, p. 39). Other nations categorically apply the ‘selective’ immigration meant for their own benefit. There is currently competition among the developed nations to obtain the best minds and offer them jobs in their systems. For this reason many foreign countries are increasingly adjusting the immigration law in order to attain better economic developments (Juss, 2006, p. 83).

There is increasingly better transformation of students into emigrants. In most cases, doctors coming from the poor countries travel abroad to acquire advanced education and training. This is because the modern technology and current knowledge is only present in these developed countries (Brush & Sochalski, 2007, p. 39). However as much as their initial reason for leaving Oman was to study, after a few years, these students get established as emigrants. This cycle is then created where the people intended to train and go back train and remain in abroad to practice.

Education for Nurses

Currently, Oman has 12 major nursing institutions which provide nursing courses in three-year programs. The institutions work under the Ministry of Health which provides the course outline and other support. This is done through the Directorate General of education and training (Alghemini, & Denham, 2008, para. 6). In 2002, the country first launched the first baccalaureate nursing program. The Ministry of Health continues to struggle to make well prepared graduates. There are two important schools that provide Bachelors of Science nursing degree programs. The Sultan Qabos University (SQU) AND Niswa University are the main universities that offer nursing degree for four years (Alghemini, & Denham, 2008, para. 9). The universities also offer training to gain qualification as a registered nurse.

Oman does not offer advanced degrees in nursing like the doctoral programs and postdoctoral programs. However, there are plans underway by the government to begin offering the course very soon, Ministry of Health, 2006. Meanwhile, the nurses who attain a degree in nursing usually go ahead to study for masters degree (Alghemini, & Denham, 2008, para. 9). The Ministry of Health has a program where it usually sends a group 20 nurses to study graduate degree in the United State’s Villanova University.

The degree then takes two years where they socialize in different fields of nursing like paediatrics, mental health, surgical care and community health among others (Alghemini, & Denham, 2008, para. 9). This is s very good program since following graduation, the nurses return back home where they work for the Ministry of Health as administrators or in their other departments of specialization.

To the UK and Australia, the Ministry of Health sends those nurses who want to specialize in adult critical care, midwifery, nephrology, emergency care and paediatrics. Most of nurses from these field work as nurse educators and as clinical instructors.

Despite these improvements, Oman still does not have enough nurses who have advanced degrees to handle the Oman’s increasing demand for more nurses. The severe shortages have caused the educators to try and promote education enrolments (Kingma, 2006, p. 56). These educators are in fact about 50% comprised of expatriates from other nations like England, India, and Philippines.

The Top Destination Nations

The assessment of the Arabs living abroad and working in healthcare profession reveal that were about nine destination countries that were mostly preferred by the emigrants from Middle East. These destinations included the united state, Canada, United Kingdom, Spain, France, Portugal, Germany, Belgium and Australia. These nations were identified as being mentioned more frequently as the countries that the Omani would love to work in (Juss, 2006, p. 83). These statistics were identified for the purposes of providing wide and adequate data on for the purposes of policy creation (Aiken & Cheung, 2008, p. 5).

The Significance of Motivation

It was quite significant to note that the healthcare practitioners were powerfully guided by professional conscience and ethos that saw them progress. Besides, the healthcare workers were frustrated, dissatisfied and got de-motivated whenever they were exposed to conditions that were unfavourable for performance (Tomblin et al., 2009, p. 229). Poor management and uncertainty in their career progress also stopped them from performing and providing their best output or even apply proper care.

Actually, job satisfaction was a crucial factor when considering recruitment of new workers and retaining them (Lu., et al 2005, p. 221). This played a very crucial role where there was need for better performance and some intent of leaving (Tomblin et al., 2009, p. 232).

As already mentioned, there were some important financial incentives as well as non-financial incentives needed to encourage worker to get into Omani health system and also encouraging them to stay at home or even come back after training abroad (Lu., et al 2005, p. 221). Appreciation, continued training and evaluation, better management and opportunities for development are some of the better motivations that were noted as being effective (Buchan & Seccombe, 2006, p. 45; Buchan, 2007, p. 41).

Recommendation and Conclusion

Introduction

There are a number of recommendations that can be derived from previous studies and applicable to this study of healthcare service provision in Oman. The Omani government can get insights on how it can manage its supply and demand for healthcare service providers. These recommendations include the following issues:

Recommendation

Management of migration: previous research has indicated that there was need for urgent measures to be taken so as to develop a system of managing the high migration of healthcare employees (Kingma, 2007, 1282). These studies highlighted the significance of the better facilities and having proper structure of managing human resources in Health (Chen, 2007). Such strategy needs to be applied at national level so that the impact is felt on the entire Omani system (World Health Organization, 2009).

Developing a Human Resource for Health plan – research has shown that having a plan provides better implementation. As such, it is suggested that the countries needed to have a very strong national plan for managing its Human Resource for health (Dean E., 2011, p. 12; Meija & Pizurki, 2005, p. 88). To develop the plan, that would mean that conducting a needs assessment to ascertain the exact needs of the system was necessary.

That would then be followed by devising a plan that provides exact solution to the needs of the population. The plan should be very effective in perceiving or anticipating the needs of the human resource for health in Oman. Creation of a national database for the HRH which can be regularly be updated would be a step in the right direction (Ghosh 2009, p. 14). The database would be able to provide precise information required to make sure estimated of the existing workforce and even the needs that could arise in future (Kabene, et al., 2006, p. 20).

Rectification of Human resource Imbalances: in order to alleviate shortages of healthcare workers, studies indicate that Oman should still allow non-Omani to work as nurses and doctors in the health facilities (World Health Organization, 2009).

However, they should revise the laws that govern and regulate nursing and practice of medicine to encourage more Omani to enrol and retain them as well. The government should also recognize different medical degree especially nursing degrees which find recognition in other nations (Smith et al., 2006, p. 78). Finding alternative opportunities for the healthcare professionals not employed would encourage these workers to stay at home and be as a supply in case of deficiency (Joseph & Omaswa, 2008, p. 23). Besides they would be encouraged to work in Primary Health Care.

Revise educational and training curricula: this is the main source of healthcare workers and therefore determines the supply, domestic supply. However, the education system and the nursing as well and medicine training school do not produce enough worker or they do not have the variety that Oman healthcare demands (Nullis-Kapp., 2005, para. 3). Therefore it is important that the Ministry of Health should seek to evaluate and revise its system of producing healthcare personnel (World Health Organization, 2009).

The new curricula should be designed to adopt the internationals standards and also address the health needs of its people (Abualrub, 2007, p. 119). The education system should be designed also to produce professionals with a wide variety of specializations. This would ensure that the country has a diverse resource in health therefore greatly reducing the need to seek professionals from abroad (WHO, 2009).

Provision of continuous education and career development programs: according to the healthcare service providers who were interviewed, there was dire need to address the importance of developing a continuing education program for the medical practitioners of all kinds (WHO, 2009). For this cause they suggested that providing career advancement programs would enable the professionals to build their career and find attachment to their country. This opportunity to advance is likely to be an incentive for them to stay at home rather than emigrate to seek similar opportunities (Nullis-Kapp., 2005, para. 3). Besides, provision of opportunities to advance would satisfy the need of the professionals to improve or better their practice and progress in terms of career ladder.

Developing financial and non-financial motivation: the major obstacle to attaining a sustainable healthcare system has been ability to retain the healthcare workers. Many of them leave the Omani system to seek better options abroad (Nullis-Kapp., 2005, para. 5). In order to retain top quality health experts, retaining and incentive system has to be developed nationally. There needs to be very effective financial and non-financial incentives to retain workers in the domestic health system. The Ministry of Health in Oman should strive to offer better salaries to compensate worker for their work as well as offer attractive allowances (Cowen & Moorhead, 2006, p. 23. The non-financial motivation that is mainly desired is the improved work environment, reward and performance recognition systems (Smith et al., 2006, p. 78).

When addressing the healthcare services issue, medicine and nursing are the main options that are being talked about. These two field have however different problems facing them even though they both comprise the healthcare service system (Buchan et al., 2006, p. 56). The attitude against these professionals in Oman is already highlighted. Nursing definitely does not have the same status as medicine in the society. The Omani citizens look at it as being an unclean job (WHO, 2009: Simoens et al., 2005, p. 43).

These people need to be educated on this and students need to be encouraged. Studies in Saudi Arabia showed that high school student had a negative attitude towards the job and there was very little interest among them to join the career. However, the number of those wishing to join medicine was excessively high (Nullis-Kapp., 2005, para. 7). The students cited that the working hours were irregular, they would have to have contact with the opposite sex, and they had very little regard for the job therefore they would rather not apply for nursing training (Aldossary, et al., 2008, p. 125; Alghemini & Denham, 2008, p. 89).

Conclusion

Over the past two decades the world has experienced economic recession coupled with reduced oil process and an increased unemployment rate. These factors have instigated the need to have workforce indigenized. Oman could face serious financial windfall if this continues as surging oil process continues. The Oman therefore needs to boost their domestic production of services (Alghemini & Denham, 2008, p. 89).

The country is faced with long-term challenges that need further reform especially that which can address the increase in participation of women, encourage enrolment I nursing courses and encourage returners to practice at home. In general, the entire gulf region in Middle east is attaining some progress in addressing the challenges but they ought to accelerate the rate of making these changes as the pressure from the increasing populations is very high (Alghemini & Denham, 2008, p. 89; Baldwin-Edwards, 2005, p. 89). This means that continued reliance on the foreign employees to supply the healthcare is still an option but exposes the country to risk of unsteadiness.

Failure to institute manageable and achievable reforms would mean that the country will still depend on foreigners to supply its healthcare service needs. This will be a major obstacle in its effort to attain self-sustainability in terms of service provision. The dependence on foreign workers has serious disadvantages. It is unpredictable, it is uneconomical, it can cause serious disrespect to cultural sensitivity for the local people, and it is unreliable (Alghemini & Denham, 2008, p. 89).

On the other hand, being able to attract more citizens to enrol in the healthcare professions and making use of the untapped women resource, Oman and other Gulf States will be able to meet the demands of their health systems (Zachariah et al, 2007, p. 62).

It is however very important to realize that there is a universal demand for healthcare practitioners. The migration of the existing works is determined by a complex interaction of social and economical push and pull factors, therefore addressing this would mean to take a multifaceted approach. The impact of migration of the healthcare profession from middle income nation to the high income nation already has far reaching implication. Despite this being an international problem, there is not yet a globally applicable solution to this issue (Connell, 2009, p. 51).

An obstacle that faces the implementation of healthcare policies to attain self-sufficiency is that it would be a contravention of basic human rights of free movement to try and put obstacles to employ migration (Witt, 2009, p. 57). In fact if all the Omani physician and nurse working abroad were compelled to return home, there are high chances that they would not find suitable jobs because the healthcare systems are still developing. This therefore means that they would not necessary solve the problem of shortage of healthcare workers and service to the poor communities in need of it.

The problem of international shortage of healthcare professionals calls for compromise in both the developed and the developing nations (Connell, 2009, p. 51). Therefore the professional form the low and middle income countries should still have that opportunity to accomplish the professional excellence they are seeking while still not jeopardizing the basic human right of access to medical care.

It is for this reason that this study will be seeking to understand the reason why doctors and nurses leave the country in the first place. The understanding of the factors affecting supply and demand is one of the main factors that will still allow development of policies that will retain and attract them back (Connell, 2009, p. 51). This knowledge will possibly allow Oman to change the current system and re-design the existing failing structure and then to maximize the return as well as encourage retention of the human resource for healthcare service provision (Buchan, 2010, p. 3).

Because of the problem of imbalance between supply and demand, nurses and doctors in Oman who took part in the study indicated that there was problems of overworking, family-life conflict, lack of a variety of career options, long working hours and inconvenient work shifts (Connell, 2009, p. 52). In some healthcare facilities, the nurses were not offer formal job descriptions and were therefore allocated any tasks coming up some which did not have anything to do with the nursing profession. For instance some nursing would be required to dispense drug in the pharmacy past midnight or even complete some statistical reports (Connell, 2009, p. 52).

The development factors of improving income, construction of new hospitals, population growth and conclusion and use of modern technology and new knowledge are an indication of progress. However, these factors are also some of the reasons for the shortage of nurses and doctors. When the foreign workers go back to their countries and the Omani professionals leave to work abroad, the outcome is severe shortage of workers. The MoH needs to step up its efforts of encouraging the highest number of enrolment of students in the medical profession, implementation of continued education programs and RN nurses course. As much as some of these are already running, they seem to be inadequate in addressing the looming shortage (Connell, 2009, p. 51).

As found out by this study, Oman is facing serious challenges in balancing supply and demand of healthcare workers. This means its recruitment and retention strategies are not working out well. The reason behind it is probably the lack of evidence-based HRH plan a national strategy for health professionals (Ghosh 2009, p. 4).

There is a lot that needs to be done to improve management and retention of workers. Based on the reports of country specific human resource strategies, Oman can explore the outlined recommendations to react to its specific challenges. Being able to develop a timely and proper healthcare workforce strategy is needed urgently since the quality of care delivered high depends on the availability of better qualified healthcare workers. These finding in this study require immediate response. Healthcare profession in Oman has only four decades experience and still has a long way to go.

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Appendices

Appendix A Pilot Questionnaire

The students will be asked the following questions.

1. To what degree do you want to move to your foreign nation to live and work for a long period more than two years?
2. How likely or unlikely are to move to a foreign country to live and work for a long period of over 2 years?
3. How much consideration have you dedicated to shifting to another country to live and to work?
4. How likely or unlikely is it that you would move from Oman to Europe or US within five years after graduation?
5. Give Reasons why you believe that the Omani Hospitals are truly great workplaces to work

Appendix B Actual Questionnaire

The physicians and nurse will be asked the following questions;

1. Give some Barriers that are stopping the Omani health facilities from becoming the best places to work;

   1. Pay
   2. Improvement
   3. The People
2. Name the 3 most important things you would like to be improved in Omani hospitals

   1. Salary
   2. Allowances and Benefits
   3. Fairness
   4. Education
   5. Support
3. Give the reason why you were initially attracted to study and work in Omani healthcare system

   1. Money – The sakary
   2. Experience
4. Name some of the thing that may affect your decision making for future choice of staying or leaving Omani Healthcare system

   1. Money
   2. experience
   3. Family and Friends
   4. Benefits
   5. colleagues
5. Identify some of the policies or issues that have improved (if any) over the past year in Omani healthcare service provision

   1. Facilities and technology
   2. Training and Education
   3. Salaries and wages
   4. Quality of Service provision
   5. Process and Systems
6. Working in Oman as a healthcare service provider is a satisfying job

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree
7. Career opportunities are not available in Oman

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree
8. The healthcare policies and practices do not favor working in home country as they are bad and inefficient

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree dads
9. Career advancement opportunities are readily accessible abroad than in Oman

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree
10. There are ready jobs abroad and the working conditions are better than those in the Omani healthcare system

    1. Strongly Agree
    2. Agree Disagree
    3. Neither Agree Nor Disagree
    4. Disagree
    5. Strongly Disagree

Appendix C

The expartriates working in oman will be asked the following questions

1. When did you leave to OMAN?
2. What was the reason for you to OMAN?
3. Why do you think physicians and nurses from developing nations come to work in OMAN?
4. Which nationalities of other health professional work in OMAN?
5. What can you say is the intensity of migration of healthcare workers to OMAN?
6. Do the health care facilities in OMAN actively recruit professionals from outside the country?
7. Do you think OMAN has bilateral agreements with other nations in the region?
8. Were you recruited in Omani health care by recruitment agencies?
9. Do you work in a private or public healthcare center?
10. generally is your emigration to the OMAN temporary or permanent?
11. Are there major differences in the working conditions, salaries and contracts between the private and public sector?
12. professionals face problems of integrating with the OMAN culture

    1. Strongly Agree
    2. Agree Disagree
    3. Neither Agree Nor Disagree
    4. Disagree
    5. Strongly Disagree
13. foreign professionals always get further training

    1. Strongly Agree
    2. Agree Disagree
    3. Neither Agree Nor Disagree
    4. Disagree
    5. Strongly Disagree
14. there no or less efficient institutional healthcare professional retention strategies in Oman

    1. Strongly Agree
    2. Agree Disagree
    3. Neither Agree Nor Disagree
    4. Disagree
    5. Strongly Disagree

Appendix D

The following question were asked to the professionals from Oman working outsides the country (those who emigrated to the US and UK, etc)

1. There are better working conditions in my current station and abroad in general

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree
2. What is the estimate of foreigners in your organization?
3. From which countries does the majority of foreign health professional come from?
4. How do you related with the other workers of the country you emigrated to? Is there a difference in education, communication, skills and experience?
5. Do you have a wider diversity of career options? Which ones are they?
6. Is there a specific area in UK and US that attract Omani professionals more than others?
7. there is a great difference in salaries between employees with similar job titles back in Oman

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree
8. foreigners treated better than residents

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree
9. I got what you expected when you shifted to this destination country

   1. Strongly Agree
   2. Agree Disagree
   3. Neither Agree Nor Disagree
   4. Disagree
   5. Strongly Disagree
10. I get the job satisfaction, better pay, opportunities to advance my career and other benefits

    1. Strongly Agree.
    2. Agree Disagree.
    3. Neither Agree Nor Disagree.
    4. Disagree.
    5. Strongly Disagree.