Health professionals’ migration - CHES First meeting

25 March 2008

The shortage of health workers is a growing challenge for national health systems worldwide. Health workers make up an increasing share of the global migrant workforce, and with an ageing world population and the growing need to care for chronic and non-communicable diseases, this trend is expected to continue.

All EU Member States are suffering from labour shortages in the health sector and most have tried to answer these by engaging in active recruitment policies. Unfortunately such policies can have a domino effect, for example the brain drain of health workers from Western Europe to North America means that in some cases migrants from Central and Eastern Europe are filling shortages in Western Europe, as better working conditions and better pay (a nurse in Romania earns approximately €150 per month) are coaxing workers to move abroad.

Shortages in Europe have increased the trend for EU to ‘use’ health workers from developing countries to fill the gap in the growing shortages for health worker. However, this raises some important ethical issues, as, for instance, Africa suffers from 24% of the world’s disease burden but can only rely on 3% of the world’s health workers. In the worst-affected areas there is only one doctor for 50,000 people, yet, one in four doctors and one in 20 nurses trained in Africa are now working in OECD countries.

So not only are African patients missing out on care, but investment made in education and training is also being lost. It is estimated that between 1998 and 2002 Ghana lost £35 million of its training investment in health professionals - by contrast the UK saved £65 million in training costs.

How is South Africa tackling this challenge?

The South African government doubled its public healthcare sector budget between 2002 and 2008. In April 2007 its National Department of Health issued a ‘Policy on quality in healthcare for South Africa’, focusing on building capacity to improve quality and care delivery in the public sector. This opened the way for the development of public-private partnerships and exchange programmes in the health sector, as well as supporting South-South bilateral agreements and the uptake of new technologies to bridge the gap between rural and urban areas.

The policy also supports a moratorium on the recruitment of health workers from other African countries with human resources shortages in the health sector. But such policies also raise ethical issues as they impinge upon the free movement of workers.

If the migration of health workers cannot be stopped, what measures can be put in place to manage the need for health workers? And what can the EU do about it?

EU Member States need to take a closer look at their health sectors and assess the size of their health workforce and the scale of need for present and future generations, while the EU must assess whether it can train enough health professionals and how to finance this. At EU level it is crucial to boost information exchange and the standardisation of methodologies in order to get a clearer view of resources and needs in the health sector.

Europe and Africa should open up a more effective dialogue and the European Commission should become more actively involved in fora such as the Global Forum on Human Resources for Health which held it first meeting in Kampala in March 2008.

In line with the Africa Health Strategy for 2007-2011, OECD countries should agree to abide by an ethical code on the recruitment of health-workers. By January 2009, the World Health Organisation is expected to issue a global Code of Practice for ethical recruitment, which would rely on the goodwill of recruiters not to engage in aggressive recruitment of health workers in areas which are already suffering from severe labour shortages. But it remains to be seen whether such voluntary agreements will actually have an impact.

Finally the issue of funding education and training and compensating for the loss of trainees has to be addressed. If there is a global shortage of health workers, where will the funding come from to increase global supply? Within the EU, issues to be considered include whether the sustainability of heath sectors might be undermined by health professionals’ right to the free movement of workers.

Solutions to these problems should be discussed with all relevant stakeholders and particularly health professionals as well as policymakers and education specialists.