Europe concerned about the mobility of health personnel

How can European countries, the Netherlands included, contribute to the creation of a sustainable health workforce worldwide? What can we do within our own borders, and how can we help ensure countries beyond Europe have the qualified health providers they need to build up their public health systems? But beyond that, how should we address the growing inequality in access to health providers in Europe? These are thought-provoking questions, and the first two are my particular focus at Wemos – but the third one is emerging.

By Linda Mans*

Access to a health provider is an essential criterion of Universal Health Coverage (UHC), a concept (and term) formulated by the World Health Organization (WHO) and defined as access to health care (prevention, health promotion, treatment, rehabilitation and palliative care) for all people without financial risk to themselves. It will also be the theme of the third Global Forum on Human Resources for Health (HRH), held in November 2013. Organized by the WHO and the Global Health Workforce Alliance (GHWA) to highlight the urgency of UHC, the Forum will concentrate particularly on what national and regional parties can do to build a sustainable and fair global health workforce.

The Oslo Consultation on Human Resources for Health for high income countries

A first step in this direction was taken on 4 and 5 September 2013, when representatives of 14 European countries convened in Oslo. Among those attending were WHO, GHWA, WHO/Europe, policy makers, researchers, professional organizations and civil society organizations such as Wemos. As the coordinator responsible for the European Health workers for all and all for health workers (HW4ALL) project, I had been invited to shed light on the role of civil society organizations. In the HW4ALL project, Wemos and organizations from eight other European countries have partnered to raise awareness about the WHO Code of Practice for the International Recruitment of Health Personnel. Efforts include translation of the WHO Code for practitioners and the facilitation of dialogue between the actors involved in training, recruiting, retaining and deploying health care workers. By working together to identify opportunities and avenues for promoting a sustainable and fair national health personnel policy, this multi-stakeholder approach has enabled us to join forces and pool our professional expertise to stimulate policy and activities keyed to this objective.

During the Oslo conference, the central question was how the migration and mobility of health personnel in Europe – which exploded on the back of the economic recession – is impacting the availability of qualified health providers for European citizens. Notably, participants steered clear of any discussion of European funding distribution policy, apparently feeling that financial debates about how public funds should be spent and how much money is needed to support a sound and adequately staffed public health system ought to be left a national affair. However, I doubt whether a discussion limited to purely practical aspects, with no consideration of budgetary responsibilities, will get us very far.

The Finnish delegation explained that a future-proof national health plan will only come within reach if different ministries (health, employment, finance and foreign affairs) can all be brought to the same table. This would enable countries to stake out health personnel policies that are only minimally dependent on international influx, that are geared towards the welfare of an ageing population and that will not crack under austerity measures.

WHO Code of Practice for the International Recruitment of Health Personnel

Representatives from Norway and Ireland demonstrated that the WHO Code of Practice for the International Recruitment of Health Personnel can provide an anchor for a coherent health workforce policy. Both countries have implemented national measures to ascertain how many doctors and nurses need to be trained and in which specializations. In making these countries less dependent on foreign health personnel, these measures also ensure they won’t be exacerbating the global and regional brain drain. Alongside this focus on education and training, these countries are also looking at how to retain their own health personnel, for example through education programmes and salary provisions. And if an injection of foreign health personnel is needed, they make agreements with the countries of origin regarding the duration of stay, employment conditions, training options and workers’ return. Additionally, Norway and Ireland have both adopted foreign policies that aim to help low-income countries strengthen their own health systems, including measures and investments keyed to health personnel. These two member states have played an active role in promoting this topic at the WHO. At home, regular meetings on global public health issues between officials from the respective ministries of health and foreign affairs enable them to coordinate with each other and thus ensure the coherence of their policy interventions.

These examples dovetail with the next step of the HW4ALL project, which will shortly be presenting an online platform where policy-makers at different ministries and health professionals will be able to share examples and experiences of good practices with each other. For example, the retention of health personnel and achieving an equal workforce distribution are a key priority for various European countries. In particular, they are concerned that people living outside urban areas will no longer be able to find doctors as these have all moved to the cities or abroad. Denmark has introduced a system in which during their internship medical specialists are deployed to a particular region for a certain period, giving them a look behind the scenes at different institutions and assuring Danish citizens access to good care. The online platform will offer a space for sharing and discussing measures and interventions like these and for different disciplines and countries to learn from each other.

Fundamental debates on the future of welfare and health care are essential

At Wemos, one of the main questions we are looking at is how we can ensure that everyone in the Netherlands and, indeed, all of Europe, continues to have access to a qualified health provider even in these times of government cutbacks. Already, some European researchers have been sounding the alarm. At the European Public Health Alliance (EPHA) conference that also took place during the first week of September in Brussels, the Romanian State Secretary of Health related how the conditions dictated by the International Monetary Fund (IMF) and the European Commission in 2009 have led to the disappearance of many clinics in rural Romania. What’s more, following salary cuts in 2011, more than 2,000 doctors registered for international recognition of their credentials in order to be able to immigrate and work in Western Europe.

Besides learning from one another’s health personnel policies, Wemos believes financial choices have to be made that reinforce governments’ obligation to provide good health care, both at national level and throughout Europe. This calls for fundamental debates about the future of welfare and health care, centring on the need for solidarity and equal access to care. Crucially, it will also require a coherent approach by the European Commission and EU, and the national ministries of Health, Welfare and Sport, Economic Affairs, and Foreign Affairs. And this is precisely what Wemos is working to achieve.

*Linda Mans, Wemos, project coordinator of ‘Health workers for all and all for health workers’
linda.mans@wemos.nl, www.wemos.nl, www.healthworkers4all.eu/