Initiatives addressing health workers migration concerns

1
Initiatives addressing health workers migration
concerns

• Dr Mubashar Sheikh
• Executive Director, Global Health Workforce
  Alliance, Geneva
• 12thWFPHA Congress on Public Health
• Istanbul, Turkey, 27 April - 1 May 2009

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The heart of the matter

• Health workers are the cornerstone and drivers of
  health systems

Health system performance
Adequate Health workforce
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Global health workforce crisis

• Shortfall of 4.3 million globally
• 2.4 million health service providers and 1.9
  million management support workers
• One billion people without access to health
  workers
• Rates of training and education too low
• Ethiopia 200 doctors trained per year for
  population of 75 million
• UK 6000 doctors trained per year for 60 million
  
• Sub-Saharan Africa 25 of global burden of
  disease but only 3 of world's health workers
• (Source World Health Report 2006)

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The health workforce crisis has no single cause

• Public health care systems are not training and
  recruiting enough people.
• The pool of skilled workers is unevenly
  distributed, with high concentrations in urban
  areas and many working in the private sector
  rather than in public health care.
• Many health workers leave the profession due to
  the pressure of poor working conditions and low
  pay.
• Others migrate abroad or move to the private
  sector and nongovernmental organizations.
• Health workers are affected by illness and
  disease (e.g. HIV/AIDS) and emergencies.

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Migration - figures tell the story

• Estimates suggest 20 of Malawian nurses and 60
  of Malawian doctors work abroad. One of the
  countrys central hospitals has just 30 nurses,
  26 of whom have plans to leave the country.
• In Swaziland, 90 nurses graduate from Swazi
  schools each year an estimated 60 to 80 of
  these then migrate to the United Kingdom.

• Nearly 30 of Ghanas physicians are working
  abroad roughly half of all doctors and a third
  of nurses leave the country after training.
  Conversely, Save the Children UK estimates that
  the United Kingdom saved 65 million in training
  costs between 1998 and 2005 by recruiting
  Ghanaian health workers.

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Effects of migration

• Negative features
• Financial loss to source countries on investment
  of education of health workers
• Remittance-receiving households consume the
  remittances they receive and this are not
  available for investment in the health sector
• Risk of collapse of a fragile health system if
  expatriates leave due to any reason
• Positive features
• Billions of US in remittances (the money sent
  back to home countries by migrants)
• When health workers return, significant skills
  and expertise back to their home countries
• Cross cultural exchange and interaction

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Addressing migration

• Underpinning values
• Making global ethics explicit
• Internationally accepted human rights serve as
  the frame for our shared vision of ethical
  behavior
• Responsibility as opposed to charity
• Required actions
• Joint investment by all partners on research and
  information systems.
• Consensus on ethical recruitments and working
  conditions for migrant health workers.
• Commitment from the donor countries to assist the
  crisis countries in their efforts to improve and
  support for addressing health workforce
  challenges including migration.

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Global architecture for ethical management of
health worker migration
W.H.O Draft Global COP, 2009-10 (193 member
states)
N.G.O C.O.P., 2008 (38 NGOs)
Voluntary Code for F.E.N 2008
Common- wealth C.O.P. 2003 (53 member states)
E.U. Green Paper, 2008 (27 member states)
Pacific C.O.P. 2007 (22 member states)
EPSU-HOSPEEM Agreement, 2008
Scotland C.O.P. 2006
Norway PCS
UK C.O.P. 2001, revised 2004
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Addressing migration as an integral part of
global HRH crisis

• World health report 2006 highlighted the critical
  global scenario of health workforce that required
  urgent action and initiatives
• Non traditional and innovative approaches are
  required to address the multi-dimensional issues
  related to health workforce including the
  migration challenge

GLOBAL HEALTH WORKFORCE ALLIANCE (GHWA) created
in 2006
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• What is it?
• A partnership dedicated
• to identifying and implementing
• solutions to the health workforce
• Vision
• All people everywhere
• will have access to a skilled, motivated and
  supported health
• worker, within a robust health system.
• Mission
• To advocate and catalyze global and country
  actions to resolve the human resources for health
  crisis, to support the achievement of the
  health-related millennium development goals and
  health for all.

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GHWA initiatives for addressing migration issue

• Objectives
• Advocacy to build support and understanding
• Capacity and commitment in both source and
  destination countries to collect essential data
• Facilitating countries to adequately address the
  issue to provide essential health care as
  required for their populations.
• Ongoing initiatives
• Series of meetings to raise awareness and demand
• Health Workers Migration Policy Initiative (HWMI)
• First Global Forum on HRH
• Positive Practice Environments campaign

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Health Worker Migration Policy Initiative (HWMI)

• HWMI is a partnership of GHWA, WHO and Realizing
  Rights
• Established in 2007 - the HWMI focus is on
• developing a Framework for the Code of Practice
  for the international recruitment of health
  personnel in response to WHA Resolution 57.19
• conducting assessments of bilaterals, codes and
  agreements underway and
• supporting countries in the development of policy
  to address health worker migration as needed.
• HWMI also supports WHO in development,
  negotiation and implementation of the draft code
  of practice.

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First Global Forum on HRH, 2 7 March 2008,
Kampala, Uganda
Six fundamental and interconnected strategies

• Building coherent national and global leadership
• Ensuring capacity for an informed response based
  on evidence and joint learning
• Scaling up education and training
• Managing pressures of the international health
  workforce market and its impact on migration
• Retaining an effective, responsive and equitably
  distributed health workforce
• Securing additional and more productive
  investment in the health workforce

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Kampala Declaration andAgenda for Global Action

• Priority points on migration
• Monitoring health workforce flows in and out of
  countries, making such data transparently
  available and using this information to inform
  policy and management decisions.
• WHO will accelerate negotiations for a code of
  practice on the international recruitment of
  health workers.
• Address current and anticipated global health
  workforce shortages.
• Develop coherent policies and build capacity to
  analyze the implications of trade agreements on
  the mobility of the health workforce.
• Stakeholders will test and evaluate innovative
  interventions in the international health
  workforce market to assist retention.

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Positive Practice Environment Campaign

• Positive practice environments are settings that
  ensure the health, safety and personal well-being
  of staff, support the provision of quality
  patient care and improve the motivation,
  productivity and performance of individuals and
  organisations.
• Guidelines on incentives for health professionals

• Multi-stakeholder collaboration
• World's leading health and hospital professional
  associations (including the International Council
  of Nurses (ICN), International Hospital
  Federation (IHF), International Pharmaceutical
  Federation (FIP), World Confederation for
  Physical Therapy (WCPT), World Dental Federation
  (FDI), and World Medical Association (WMA)

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Migration of health workforceway forward

• Supporting the developing countries to gather
  information on their losses of professionals for
  incorporating in national migration policies.
• North-south consensus on an International Code of
  Practice with a common approach and agenda on
  migration issues facilitating interaction between
  source and recipient countries.
• Engaging all partners including private sector
  and civil society for the actions supporting the
  use of the international code of practice.

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Last words

• President Obamas Inauguration speech
• (January 20th, 2009)
• And to those nations like ours that enjoy
  relative plenty, we say we can no longer afford
  indifference to suffering outside our borders
  nor can we consume the world's resources without
  regard to effect. For the world has changed, and
  we must change with it.