Nobody doubts these days that having enough health personnel, in terms of quantity and quality, is a crucial element in order to have a sanitary system responsive to the healthcare needs of the population. However, the global situation is far from being acceptable. More than 50 countries, mostly in Africa and in Southern Asia, suffer from a critical healthcare personnel shortage, responsible for the mortality and mobility found in those countries. But the situation in the so-called developed countries in Europe and North-America is far from being optimal. The healthcare needs of the ageing societies in those countries, who need chronic care, together with the intensive use of healthcare and the ageing of the healthcare workforce itself, cause that the needs in personnel are not adequately covered by their own health systems. In fact, in Europe the European Commission, in its working document “Action Plan for the EU Health Workforce”, estimates that if the training capacities remain as they are now, a million healthcare workers will be lacking by 2020. In Spain, the situation may also be distressing. It is estimated that in 2025 there will be a shortfall of 14% in healthcare personnel in Spain, including family doctors and specialists. And these estimations were established before the current situation, where a great number of Spanish health professionals are seeking job opportunities across national borders.
What Solutions for the Healthcare Personnel Shortage? Planning and Migration
The most rational solution is that every country plans conveniently its need in healthcare personnel and sets the basis to ensure the training of such personnel, in terms of quantity as well as in terms of quality. But such a planning isn’t an easy task. On the one hand, because the changes in epidemiologic and demographic patterns, as well as envisaging the future demands of a population are difficult to estimate, especially in many countries whose healthcare system is extremely fragile and doesn’t have the resources needed to adequately engage in such a planning process. On the other hand, incredibly enough, many countries, if not all, including the developed ones, do not know exactly the number of healthcare workers who are working in their countries, especially in the private sector. For example, Spain is endeavouring to establish the first register of healthcare staff, expected to be operative in 2014, because to date the number of healthcare workers working in Spain is unknown, which forces people involved in planning to base on estimates. Even the definition of who and how the healthcare personnel has to be included is often rather confused, especially in those countries where traditional medicine or health promoters play a relevant role in health care.
The second solution –the easiest– the one that countries have been in general promoting is the importation of health personnel. As the labour market becomes increasingly globalised, the rise in the demand for health workers is encouraging their migration and mobility. Until recently, the most developed countries were the major hosts of health workers, but in the last years their transfer is also taking place from developed countries to those emerging ones. An example of this trend is the Brazilian programme “Mais médicos para o Brasil”, where 28% of the 358 doctor inscribed in their third call are Spanish. It is thus a global problem which affects or may affect all countries in the future
The problems Associated with Healthcare Personnel Migration
The recruitment of foreign health workers may be a way to satisfy the domestic demand on a one-time basis, but this can cause a worsening of the shortage of qualified personnel in another country, especially in those countries with low and medium incomes, and even in developed countries, like some European ones. Unless there is an adequate planning, it may cause a chronic shortage in the training of human health resources, because once the immediate needs in personnel are covered, the training of health personnel ceases to be a priority.
There is one more element that mustn’t be forgot: the cost of the training of health personnel funded by states. On the global level, this translates into worrisome figures. Estimates show that the national health systems of nine African countries have lost 2,170 million dollars, the cost of the investment in training of their doctors, due to their migration after graduation. The same affluence of immigrants has implied a gain of 4.550 million dollars for the countries hosting those professionals. Thus, we are confronted to the contradiction according which the health personnel flow is going from those countries where there is a major shortage to the ones where the resources are greater. The rate of health personnel in most African countries is ridiculous compared to the European rate: 2 doctors/1000 inhabitants in Africa against 33/1000 inhabitants in Europe. And we continue draining their human resources away! Even though this recruitment is common all over the world, certain countries absorb the majority of this foreign health personnel. The Unites States, Canada, The United Kingdom and Australia together employ 69% of the total amount of doctors working in the Organisation for Economic Co-operation and Development.
But the problem doesn’t only involve donor countries, but also health workers themselves. In addition to the difficulties inherent to the adaptation to a new environment, mot of them don’t have the same working conditions as the local professionals, and are even underemployed, and some even end up giving up their professional activity.
The Recruitment of Foreign Health Personnel: The International Code of Practice
During the 2010 World Health Assembly, Member States, including Spain, adopted a “Global Code of Practice on the International Recruitment of Health Personnel“, where the guidelines for the international recruitment of health personnel are established.
This Code is basically intended as a guide for Member States, working together with stakeholders on the international recruitment of health personnel. It sets clearly that nothing in this Code should be interpreted as limiting the freedom of health personnel to migrate to countries that wish to admit and employ them. Member States are encouraged to establish effective health workforce planning, education and training, and retention strategies that will reduce their need to recruit migrant health personnel, to facilitate circular migration of health personnel, so that skills and knowledge can be achieved to the benefit of both source and destination countries. However, this Code implies a real engagement on the part of Member States to implement its objectives.
That’s why, through a programme called Health Workers For All different civil society organizations, funded by the European Union, intend making this Code known among the health professionals and society in general, monitoring and reporting on its implementation in order for the European society to consider this issue seriously. As we to date see, migration and its impact is a problem which can affect any of us, and to global problems global solutions should be found. Since it’s my problem, it’s ours, it involves all of us.
medicusmundi Member and co-ordinator of the Health Workers For All’s campaign in Spain
Translated from Spanish by Sílvia Aymerich