European Health Management Association Transitional Countries Network launch - PowerPoint PPT Presentation

Loading...

PPT – European Health Management Association Transitional Countries Network launch PowerPoint presentation | free to download - id: 4ee239-NDNmO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

European Health Management Association Transitional Countries Network launch

Description:

Transitional Countries Network launch Mobility of health workforce: The challenges for Europe Albena Arnaudova, Dr Galina Perfilieva Budapest, Hungary, 19 May 2009 – PowerPoint PPT presentation

Number of Views:68
Avg rating:3.0/5.0
Slides: 49
Provided by: NTI80
Learn more at: http://www.ehma.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: European Health Management Association Transitional Countries Network launch


1
European Health Management Association
Transitional Countries Network launch
  • Mobility of health workforce
  • The challenges for Europe
  • Albena Arnaudova, Dr Galina Perfilieva
  • Budapest, Hungary, 19 May 2009

2
Outline
  • Health Workforce Global Profile
  • Increase in mobility/migration of health
    professionals
  • The European perspective
  • The EU perspective
  • The Response of WHO to HRH Crisis
  • Process to develop a WHO code of practice
  • guiding principles of the draft WHO code

3
The health workforce crisis
  • Which exactly crisis? They all around
  • Flu A(H1N1) Europe is not spared
  • Financial / economic Europe is in recession
  • Demographic Europe is aging
  • EUs institutional deadlock and the EU
    Enlargement Europe has changed but does change
    yet
  • Health workforce relates to them all.

4
The health workforce crisis
  • Relative As compared to
  • the 57 countries with critical shortages
  • the other crises Europe has to deal with
  • Uneven Across the WHO European Region, between
    countries and groups of countries
  • Universal No European country is spared
  • Difficult to deal with The urgency - not so
    visible, the solutions - long-term, the need to
    act and invest - immediate

5
Health Workforce - Global Profile
  • Increased demand for health professionals at all
    levels across the world ? competition for health
    personnel migration of health professionals is
    an inevitable characteristic of globalisation
  • Globalisation of labour markets, removing
    barriers for labour flows
  • Global shortage 4,3 million health workers are
    needed to achieve the health related MDGs
  • Maldistribution Health worker density Africa
    with 2.3 health worker per 1,000 population,
    Europe 18.9 and Americas 24.8 per 1,000
    population
  • Imbalances within countries (rural areas vs.
    cities, composition of the health workforce, etc.)

6
Driving forces and challenges
7
The Global shortfall 4.3 million health workers
  • A serious impediment to achieving the
    health-related MDGs.
  • 13 African nations have fewer than 5 physicians
    per 100,000 people.
  • More than 1 million new health workers are needed
    in next 6 years for the countries in sub-Saharan
    Africa to deliver the basic services.

More information on http//www.globalhealthtrust.o
rg
8
Health workers move (brain drain) towards
  • higher (absolute relative) pay
  • better working conditions
  • better resourced health systems
  • improved career opportunities
  • increased opportunities for education
  • safety and stability
  • The ethical questions rights and needs of
    health personnel, of source and destination
    countries

9
The response of WHO
  • AT GLOBAL LEVEL
  • Joint Learning Initiative (JLI) report, 2004
    need for urgent
    concerted actions to address the HRH crisis
  • WHA57.19, WHA58.17 alarming issues of HRH
    Migration
  • World Health Day and World Health Report 2006
  • Launch of Global Health Workforce Alliance
    (GHWA), partnership to identify
    coherent solutions to the health
    workforce crisis at global level, 2006
  • First Global Forum on HRH, Kampala, Uganda, March
    2008 The Kampala declaration and
    Agenda for Global Action
  • Call from G8 Summit, Toyako, July 2008

10
Resolution WHA57.19
  • World Health Assembly Resolution 2004
    International migration of health personnel a
    challenge for health systems in developing
    countries
  • 193 WHO Member States requested the Director
    General "to develop, in consultation with Member
    States and all relevant partners, a code of
    practice on the international recruitment of
    health personnel. ".
  • Main orientations
  • - conduct research (international migration of
    health personnel)
  • - explore measures (to assist in fair practices
    of international recruitment of health personnel)
  • - support countries efforts (facilitate dialogue
    and raising awareness at the highest national and
    international levels).

11

Process to develop a WHO code of practice on the
international recruitment of health personnel

Jan08 Mar08 April08 May08
June08 July08 August08
Sept08 Oct08 January09
Tallinn Euro Ministerial
EB122 Migration Progress Report
Public Hearings
Kampala Forum
PAC TWG meeting
G8 Summit
Drafting of the Code
Launch of Global Dialogue on Migration
Draft revised
Progress Report for EB124, incl. Draft
Resolution Draft Code
Draft Code
Draft Outline for a Code
12
First Global Forum on Human Resources for
Health, Kampala, Uganda, March 2008)
Draft code was outlined by the WHO Secretariat
  • Global Forum adopted the Kampala Declaration and
    Agenda for Action
  • The Kampala Declaration called on WHO to
    accelerate negotiations for a global code of
    practice
  • WHO/Europe - commitment to managing migration and
    collaboration with all relevant partners

WHO Regional Office for Europe initiates policy
dialogue between source and destination
countries, EURO roundtable, Kampala.
13
The Kampala Declaration called to accelerate
negotiations for a Code
  • Fundamental and interconnected strategies
  • Building coherent national and global leadership
    for health workforce solutions
  • Ensuring capacity for an informed response based
    on evidence and joint learning
  • Scaling up health worker education and training
  • Retaining an effective, responsive and equitably
    distributed health workforce
  • Managing the pressures of the international
    health workforce market and its impact on
    migration
  • Securing additional and more productive
    investment in the health workforce

14
Web-based public hearings September 2008
15
Conclusions of the EB 124 and key issues on the
draft code, Geneva, January 2009
  • Member States welcomed and supported the draft,
    but agreed that more consultations and effective
    participation by Member States was essential to
    finalize and adopt the code
  • Issues raised
  • Mutuality of benefits (art.5) should be precise
    and strengthen for the profit of developing
    countries
  • Debate on "voluntary status"
  • Debate on inclusion of "Compensation mechanisms"
  • Retention mechanisms
  • Self sufficiency - health workforce
    sustainability
  • Needs to generate more evidence and data on
    migration
  • Financial issues to implement the code

16
Global Code of Practice on the International
Recruitment of Health Personnel
  • Objectives
  • To establish and promote voluntary principles,
    standards and practices for international
    recruitment
  • To serve as an instrument of reference for Member
    States in establishing or to improving the legal
    and institutional framework and in formulating
    and implementing measures
  • To provide guidance that may be used where
    appropriate in the formulation and implementation
    of bilateral agreements and other international
    legal instruments, both binding and voluntary
  • To facilitate and promote international
    discussion and advance cooperation on matters
    related to the international recruitment of
    health personnel.

17
Guiding principles of the draft WHO code (1/2)
  • The code is voluntary
  • Health workers have the right to migrate
  • Right of everyone to the enjoyment of the highest
    attainable standard of health the source
    countries perspective
  • International recruitment may contribute to the
    development and strengthening of a national
    health workforce
  • Voluntary international standards and
    coordination of national policies maximize the
    benefits and mitigate the negative impacts.
  • Transparency, fairness and mutuality of benefits
  • Developing and transition countries particularly
    vulnerable to health workforce shortages and/or
    with limited capacity to implement the code
  • Effective national and international data
    gathering, research and information sharing are
    essential.

18

Next steps in the Process to develop a WHO code

March09 May09
Sept-October 09 January 10
March10 May10
National Consultations
WHO RCs
Progress Report for EB
Technical Briefing during WHA09
Global Consultation?
Issue Paper
Draft Code for the WHA?
Draft Code
19
The European dimension migration
  • The WHO European Region is an important
    destination
    - EU 39 mln registered migrants 8 of the
    total population
  • - number of irregular migrants - difficult
    to estimate
  • Skilled health professionals represent an
    increasingly large component of migration flows
  • In OECD 11 of employed nurses
  • and 18 of employed doctors are
  • foreign-born
  • Many variations across countries
    (source, destination and transit
  • countries)


20
Challenges in assessment HRH stocks and flows
  • In Europe we observe
  • Limitations and gaps in data,
  • Lack of international recording system
  • Lack of a single or complete data source
  • Different sources give different information -
    e.g foreign born OR foreign trained OR
    foreign registered
  • Main sources include census, registration data,
    migration/work permit data

21
Distribution of physicians in the European Region
P
Source WHO HFA database, 2008
22
(No Transcript)
23
(No Transcript)
24
Diversity in the European regionHealth
professionals / 100.000 population
Physicians General practitioners Nurses Pharmacists
European Region 339.71 68.05 727.45 52.28
EU 322.38 96.71 745.64 71.43
CIS 376.78 28.78 794.73 20.55

Lowest 115.02 (Albania) 17.56 (Azerbaijan) 310.8 (Turkey) 3.35 (Uzbekistan)
Highest 534.59 (Greece) 177.3 (Belgium) 1549.78 (Ireland) 154.0 (Finland)
Source WHO HFA database, January 2009
25
Contribution of the foreign-trained doctors to
the net increase in the number of practicing
doctors in selected OECD countries, percentage
1970-2005
Growing reliance on foreign trained doctors
Source OECD Health Data 2007 and OECD International Migration Outlook 2007
Note data for Germany, Belgium and Norway refer to foreign doctors instead of foreign-trained doctors. Note data for Germany, Belgium and Norway refer to foreign doctors instead of foreign-trained doctors. Note data for Germany, Belgium and Norway refer to foreign doctors instead of foreign-trained doctors.
26
  • Over the last decade and in response to domestic
    supply shortages, developed (EU OECD) countries
    have come to rely on foreign trained doctors
  • For OECD European countries, less than one third
    of foreign born doctors come from other OECD
    countries.
  • The ethical questions take from the poor
    neighbours to take care of the rich us

27
Since 2000, reliance on foreign trained
professionals has increased in Europe
This decade has seen a growing reliance on
foreign trained health professionals, in Europe
and elsewhere
28
Other key challenges in HRH in Europe
Unfinished agenda
Maldistribution Skill imbalances Low
productivity Low salaries Poor work
environments Weak knowledge base
Labour flexibility Lack of social
protection Uncontrolled migration Growing
shortages Increasing role of private sector
New challenges
29
Health workforce policies in the WHO European
Region Resolution EUR/RC57/R1
57th session of the WHO Regional Committee for
Europe Belgrade, Serbia 17-20 September 2007
30
Health workforce policies in the WHO European
Region Resolution EUR/RC57/R1
  • Member States are urged
  • to improve and expand the information and
  • knowledge base on the health workforce, encourage
  • research and build capacities
  • to develop, embed and mainstream policies on
  • health workforce as a part of health system
    development
  • to assess the trends in and impact of health
    worker migration in order to identify and act on
    effective migration-related policy options

31
Health workforce policies in the WHO European
Region Resolution EUR/RC57/R1
  • WHO/Europe is urged
  • to give high priority to monitoring health worker
    migration and policy interventions at national
    and international level
  • to facilitate the development of an ethical
    guide/framework for international recruitment of
    health workers
  • to continue building and strengthening networks
    and partnerships, to advocate for more effective
    investment in health workforce development

32
Existing Codes of Practice in Europe
  • "UK" Department of Health Code of Practice for
    International Recruitment of Health Care
    Professionals, 2001/2004
  • Commonwealth Code of Practice for the
    International Recruitment of Health Workers, 2003
  • NHS Scotland Code of Practice, 2006
  • Common features they provide guidelines for an
    ethical approach to the international recruitment
    of health workers
  • Share three broad objectives
  • Ensuring that flows of migrant health workers do
    not unduly disrupt the health services of source
    countries
  • Protecting individual migrant workers from
    unscrupulous recruiters and employers
  • Ensuring that individuals are properly prepared
    for and supported for the job

33
Why are health workers so important?
  • Health workers are central to managing and
    delivering health services in all countries
  • Health system performance depends on the
    availability, efforts and skills of the workforce
  • The health workforce comprises around 8 of the
    total workforce in the European Region, and
    absorbs around two thirds of the total health
    spending

34
Why do we need to reform health workforce
policies?
  • Rising demand for health services - health
    professionals at all levels
  • Evidence of shortages and imbalances in
    distribution of health workers
  • Globalization of labour markets, removing
    barriers for labour flows increased proportion
    of health professionals in migration flows
  • The need to shift the focus of health service
    delivery towards prevention, early interventions
    and self-management
  • Workforce diversity, serious disparity in the
    characteristics of health professions (numbers,
    job descriptions, roles and responsibilities,
    training paths, regulatory structures).

35
Shaping the European health workforce policies
tothe future challenges is a priority
Demographic and epidemiological change
Technological and organizational change
Political and economic change
36
Health workforce from issues to policy questions
  • Issue Imbalances in the health workforce
  • Policy question
  • What is the most efficient mix of skills to
    achieve the desired coverage of health
    interventions in a country?
  • Issue Skills shortages
  • Policy question
  • Should governments invest more in training and
    building capacity to ensure and maintain skills?
  • What are the costeffective strategies for
    scaling up HRH?
  • Issue Health worker migration and mobility
  • Policy question
  • How can mobility be managed and regulated?

37
Health workforce from issues to policy questions
  • Issue Working conditions and health workers
  • Policy question
  • How can incentives be linked to produce better
    health services and better health outcomes?
  • Issue Education and training
  • Policy question
  • How can professional qualifications be
    standardized throughout Europe? What are the
    policy implications of Bologna process?
  • Issue External support to HRH development
  • Policy question
  • How can external support facilitate the HRH
    development in compliance with the region?

38
Evidence required to answer policy question
  • Policy briefs

39
(some) Strategies
  1. Building realistic strategies
  2. Strengthening strategic intelligence (information
    and evidence)
  3. Building institutional capacity
  4. Improving education for better performance
  5. Planning for the future
  6. Regulating HRH framework
  7. Addressing the challenges of health worker
    migration

A health system wide approach
40
The Tallinn Conference and Charter
  • In a rapidly globalizing world, generation of
    knowledge, infrastructure, technologies, and
    above all, human resources with the appropriate
    skills and competence mix requires long-range
    planning and investment to respond to changing
    health care needs and service delivery models.
  • The Tallinn Charter, June 2008

41
Some WHO work in south-east Europe
  • National policy dialogues on human resources for
    health - Albania, June 2008 Serbia, April 2009
  • Joint EC/WHO workshop on human resources for EU
    candidate/accession countries - July 2008,
    Brussels
  • Annual Conference of European Medical
    Associations, March 2009 workshop
  • Scaling up international partnerships Russian
    federation-Finland, March 2009
  • Negotiating with Member States the 2010-2011
    framework bilateral agreements

42
South-eastern Europe Health Network the health
workforce
  • SEE and the EU how they compare
  • Commonalities
  • - Free mobility is a basic human right, as are
    health and health care.
  • - The need for a strong health workforce is a key
    issue across the WHO European Region.
  • All countries need to develop workforce policies,
    and improve information infrastructure and
    management mechanisms.
  • Many countries have undergone a transition
    process, making thorough reforms at great speed.
  • Certain differences should not be neglected,
    however.
  • The relevance of health professionals mobility
    varies between large and small countries, with a
    proven impact on quality, as some countries are
    hardly, while others heavily affected.
  • The challenges in ensuring proper and strategic
    workforce planning vary across the Region.
  • The political context still varies dramatically
    and the influence of economic development is not
    uniform.

43
South-eastern Europe Health Network the health
workforce
  • SEE and the EU how they compare
  • Differences
  • The relevance of health professionals mobility
    varies between large and small countries, with a
    proven impact on quality, as some countries are
    hardly, while others heavily affected.
  • The challenges in ensuring proper and strategic
    workforce planning vary across the Region.
  • The political context still varies dramatically
    and the influence of economic development is not
    uniform.
  • Involvement of non-health sectors still a
    concern

44
The European Union context
  • 70 of EUs health care budgets for staff and
    employment related expenses
  • The cross-border care saga
  • DG SANCO taking the lead
  • The Bologna process
  • Green Paper of the European Commission Dec09
  • Czech Presidency of the Council of the EU
    statement at the WHO EB, January 2009
  • How to work with the EC on human resources for
    health in the accession/potential candidate
    countries (the acqui communautaire)

45
The financial and economic crisis
  • Undoubtedly impact on the health sector and on
    the health workforce in particular
  • We do not know yet demand will raise because
    supply shortages and inability of people to pay
  • Impact on countries with already fragile health
    systems
  • Mixed picture in Western Europe, employment is
    raising, the health sector is among the few that
    continue recruiting
  • In the long run, the trend will reverse cost
    containment pressure
  • New mobility patterns are expected to countries
    less impacted by the crisis, leaving those with
    deteriorated job markets

46
The financial and economic crisis
  • Different measures are being taken with regard to
    health workers levels of pay
  • Bulgaria and Hungary have frozen salary levels in
    state-owned hospitals.
  • Hungary eliminated payment of a 13th month of
    salary per year.
  • Ireland and Lithuania are also considering pay
    reductions.
  • Finland and Greece have increased pay levels,
    Romania is considering a raise of 7
  • Germany since November 2008, 33.000 new
    employees, rise in recruitment

47
The financial and economic crisis
  • Fewer health workers are retiring early
  • Older nurses delay retirement and part-time
    nursing is rising, with more nurses and doctors
    taking more shifts
  • Hospitals renovations, expansions and procurement
    ar ebeing delayed
  • More patients are postponing elective surgery or
    that for which they have to contribute our of
    pocket
  • New graduates fewer entry level jobs, as health
    facilities scale down hiring of new staff
  • No incentives to hire less experienced health
    personnel, as health administrations are required
    to scrutinize costs

48
Conclusions
  • International migration is an important factor
  • Continuous growth in the demand for health
    professionals in higher income countries
  • Impact on countries with already fragile health
    systems
  • Global approaches to address migration concerns,
    including monitoring and research
  • Global Code of Practice on the International
    Recruitment of Health Personnel
  • No European country is spared
  • The economic crisis provides opportunities as
    well for long-needed health reforms
  • Role of professional associations
  • The EU cooperation a huge potential
  • The south-east European Health Network of WHO
About PowerShow.com