Presentation on theme: "Addressing the global health workforce crisis"— Presentation transcript:
1 Addressing the global health workforce crisis Five European Countries towards the WHO Code ofPracticeADVANCING IN THE ETHICAL RECRUITMENT OF HEALTH PROFESSIONALSSara Paterlini - Cestas/AfGHMadrid, 17 June 2011
2 THE FOCUS Cooperation policies Domestic policies regarding health workers in the five EU countrieshome to the Action for Global Health (AfGH)Network: FRANCE, GERMANY, ITALY, SPAINAND THE UNITED KINGDOM
3 THE CRISIS AT A GLANCE 57 countries - 36 in Africa – are facing a severe shortage of adequately trained andsupported health personnel (2006 WorldHealth Report)Density of HRH AFRICA per 1,000EUROPE - 10 per 1,000
4 THE CRISIS AT A GLANCE Europe trains 173,800 doctors a year, Africa only 5,100.Situation exacerbated by the hiring ofhealth personnel from Africa and otherdeveloping nations to address staffingshortages in EU Member States
5 THE CRISIS AT A GLANCE 3.5 million more health workers (including managers and administrators)across 49 low-income countries wererequired to accelerate progress towardsthe health related MDGs (WHO)
6 THE CRISIS AT A GLANCE Countries with a density of fewer than 2.28 HRH per 1,000 people generally fail toachieve a targeted 80 % coverage forSkilled birth attendance and childimmunization (2006 World Health Report )
7 THE CRISIS IN DEVELOPING COUNTRIES CAUSES Governments cannot afford to pay staff, increase wages or improve depressing working conditions.Short term programmes and or vertical approaches, especially in response to emergencies such as HIV/AIDS.Health budget ceilings and restraints on public sector salariesInsufficient numbers of health care workers are being trainedJobs in the public health sector are regarded as too demanding and poorly paidHuge discrepancies between rural and urban areasLack of responsiveness to the needs of communities (i.e. vulnerable groups)Brain drain from the public to the private sector (including charities and international NGOs)Lack of coordination between public and private health initiatives.
8 THE ANSWERS IN COOPERATION POLICIES FRANCE Renewal of commitment and leadership on health systems strengthening (Strategies for HSS and HRH)ESTHER Twinning Programme – links hospitals in France with health facilities in Africa to provide comprehensive care for PLWAs
9 THE ANSWERS IN COOPERATION POLICIES FRANCE Strong policy commitments are not always translating into funding for health systemsFailure of HRH training initiatives due to the decrease of direct technical assistance
10 THE ANSWERS IN COOPERATION POLICIES GERMANY HRH strengthening is strategic in HSSPolicies (25-50% funds to capacity building)Support for health sector reform in 16developing countries
11 THE ANSWERS IN COOPERATION POLICIES GERMANY Strong policy commitments are notalways translating into funding for HSSLack of clarity on who will leadimplementation of the WHO Code
12 THE ANSWERS IN COOPERATION POLICIES ITALY Renewal of commitment and leadershipon HSS at G8 Summit in 2009.Cooperation guidelines call for support,training, better working conditions andadequate pay for HRH
13 THE ANSWERS IN COOPERATION POLICIES ITALY The bulk of Italian ODA goes to verticalFundsLagging behind other major donors on the0.7 ODA and 0.1 health targets
14 THE ANSWERS IN COOPERATION POLICIES SPAIN Strong policy commitment to strengthenPublic health systems (60 % of bilateral aid to HSSvia IHP+ by 2012)The new AECID health plan includes several HRHindicators: 80 % of NGO projects funded byAECID in 2012 must include HRH training
15 THE ANSWERS IN COOPERATION POLICIES SPAIN Diversity of actors without adequateSpace for suitable coordination – RegionalAuthorities vs. Central Government
16 THE ANSWERS IN COOPERATION POLICIES UNITED KINGDOM Strong pre- and in-service trainingInitiatives including the new Health SystemsPartnership FundRelative transparency on progresstowards HRH and HSS goals (IHPscorecard)
17 THE ANSWERS IN COOPERATION POLICIES UNITED KINGDOM The UK is a major destination formigrant health workers: action needs to betaken to address the role of privaterecruitment agencies.
18 THE ANSWERS IN DOMESTIC POLICIES FRANCE The Country has 227,683 doctors and 494,895 nursesSevere shortage of midwives (mainly rural and disadvantaged areas)20,000 midwives per 800,000 births in France against 35,000 midwives per 650,000 births in the UKThe number of doctors in France will decline by nearly 10 % over the next decade and the density of doctors will decrease from 37 per 10,000 to 27 per 10,000 by 2020
19 THE ANSWERS IN DOMESTIC POLICIES FRANCE In 2007 France employed 7,966 doctors not French citizens (3.5 % of all physicians). Of these, 53 % were EuropeansInternational recruitment of doctors and nurses without EU qualifications to both public and private practice was prohibited in 1999
20 THE ANSWERS IN DOMESTIC POLICIES FRANCE StrengthsInter-ministerial platform enables coordination between Ministries and bodies for the implementation of the WHO CodeSteps are being taken to prevent a future crisis, including the raising of quotas on medical school entrancesWeaknessesLegislation designed to reduce the possibility of health workers being recruited from developing country is being circumvented by private agenciesWorking conditions especially for midwives and general practitioners need to be dramatically improved as a matter of urgency
21 THE ANSWERS IN DOMESTIC POLICIES GERMANY 17,000 full-time physicians were lacking in 2010This shortage will rise to 56,000 in 2020 and 166,000 in2030.For health workers other than doctors there was aslight ‘oversupply’However, a shortage of about 14,000 fulltime staff is predicted by 2020, rising to 786,000 in2030
22 THE ANSWERS IN DOMESTIC POLICIES GERMANY 11 % of all physicians and 10 % of nursesworking in Germany have been trainedoverseasIn 2006, 4.5 % of all HRH were foreignnationals and 4.6 % naturalized citizens
23 THE ANSWERS IN DOMESTIC POLICIES GERMANY StrengthsGermany already has strong legislation in place to ensureinternational recruitment is managed jointly with the sourcecountryWeaknessesCurrently, coordination between government agencies isweakRetention measures need to be taken to prevent Germandoctors migrations, and to incentivise them to take uprural posts
24 THE ANSWERS IN DOMESTIC POLICIES ITALY 215,000 doctors are working in Italy, giving a ratio of 37per 10,000 peopleItaly will face a shortage of highly specialised doctorsIn the near future (today shortage of qualified specialists inanaesthesia and radiology)Shortage of nurses is above 50,000Strong limitations on access to medical/nursing schools
25 THE ANSWERS IN DOMESTIC POLICIES ITALY About 4.4 % of all physicians in Italy were bornabroad28.4 % of nurses registered with the ItalianNursing Federation are from outside Italy
26 THE ANSWERS IN DOMESTIC POLICIES ITALY StrengthsThe system for training, recruiting and retaining physiciansin Italy appears to be functioning well.Measures taken, albeit slowly, to increase the numbers of nursesentering the profession.WeaknessesItaly is unlikely to resolve its impending HRH crisis unless itincreases investment in the health system overall.Domestic and foreign policy on human resources for health are inconflict. The implementation of the WHO Code presents a timelyopportunity to bring them into alignment.
27 THE ANSWERS IN DOMESTIC POLICIES SPAIN The Country has 21 doctors and 74 nurses/ midwives per10,000 people (below the EU average for density of doctorsand nurses)Deficit of 9,000 doctors (family doctors in rural areas,anaesthetists, paediatricians, radiologists, psychiatrists andGynaecologists).If current trends continue, the shortfall will be 25,000doctors by 2025
28 THE ANSWERS IN DOMESTIC POLICIES SPAIN 8,000 Spanish health professionals work abroadEfforts put in place to promote volunteer returnhave so far been unsuccessfulIt is estimated that the number of foreignProfessional doubled between 2002 and 2006
29 THE ANSWERS IN DOMESTIC POLICIES SPAIN StrengthsSpain enacted excellent legislation on the management of healthprofessionals in 2003 that would greatly improve the situation if it wasimplemented.Awareness of the scale of the HRH shortage in Spain is increasing andrestrictions on the number of students entering medical training aregradually being lifted.WeaknessesThe Government has no centralised register of health personnelworking in the country and thus no way of managing the situation.Spain is currently implementing drastic cuts in public services that are likelyto exacerbate shortages in health personnel.
30 THE ANSWERS IN DOMESTIC POLICIES UNITED KINGDOM The ratio of doctors to population is just 21 per 10,000.Over 200,000 registered doctors working in the UKIn the year 2000, the UK embarked on intensiveinternational recruitment of health professionals followinga directive from Department of Health to address personnelshortages
31 THE ANSWERS IN DOMESTIC POLICIES UNITED KINGDOM At end of 2005 around 30 % of UK doctors and 10% of its nurses had received their initial trainingoverseas645,000 foreign nurses are registered in the UK, ofwhich 300,000 are working in the NHS, while200,000 are working in private sector and the145,000 are not practicing
32 THE ANSWERS IN DOMESTIC POLICIES UNITED KINGDOM StrengthsThe existence of the UK Code of Practice and a decade ofexperience in its implementation gives the UK a head startin terms of delivering on the WHO Code of Practice.The Government has pledged to preserve the NHS budget even asother public services are subject to major cuts.WeaknessesDue in part to colonial ties and NHS history, the UK is unlikely tochange its status as a popular destination for migrant healthworkers.Until there is better regulation of private recruitment agencies, theyWill continue to stimulate migration in the developing world.
33 RECOMMENDATIONS Development Cooperation Policy Ensure that 50 % of all new funding for health is directed towards health system strengthening, with 25 % impacting directly on the retention and training of HRHIn line with the Kampala Declaration and Agenda for Action, support the development and implementation of comprehensive, evidence- and needs-based, fully costed and funded national health plans and related health workforce strategies.Commit financially and politically to the global target for the training, deployment and management of at least 3.5 million new health workers by 2015 in countries with an acute shortage (including community-based health workers.Promote the integration of a gender approach into health workforce policies and measures to increase recruitment and retention of female health care workers by addressing gender segregation, gender based violence and other discriminatory factors within the health system.Incentivise international NGOs and multilateral initiatives to reduce pull factors in health migration by requesting adherence to voluntary codes of conduct, such as the NGO Code of Conduct for Health Systems Strengthening.
34 RECOMMENDATIONS Domestic Health Policy Develop clear time bound national action plans with measurable goals and SMART and gendersensitive indicatorsDevelop coherent, sustainable and gender-sensitive national health workforce policies to enableself sufficiency and remove the need for international recruitment. This includes:Training sufficient numbers of health workers according to meet the health needs of the population.Ensuring a well balanced distribution of the health workforce nationally.Increasing efforts to retain existing health workers through the improvement of working conditions and career opportunities.Where they are lacking, institute national health workforce information systems that allow the monitoring of migration trends and evidence based policy making.Act to regulate the international recruitment of health workers by private agencies, not currently covered by the WHO Code of Practice.Maintain levels of investment in the national health systems and adequate salaries for public sector workers, even in the face of budget deficits.
35 www.actionforglobalhealth.eu www.healthheroes.eu THANK YOU MERCI DANKE GRACIASGRAZIE