WHO Calls For Action On Health Staff Migration

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A WHO report highlights the need for governments and leaders in the WHO European Region to better manage health personnel issues, including migration, by improving data collection, developing effective policies and reducing migration’s negative effects.

The report – a policy brief entitled "How can the migration of health service professionals be managed so as to reduce any negative effects on supply?" – was prepared for the WHO European Ministerial Conference on Health Systems, which takes place this week in Tallinn, Estonia. It outlines how the effective management of health worker migration is critical to ensuring solid and functioning health systems in both source countries – those that health workers leave – and destination countries – those recruiting and receiving increased numbers of migrant health workers.

“Like anyone, health workers have the right to travel and seek a better life. At the same time, people in countries hard-hit by emigration have the right to health. Technical solutions must be found to balance the right to migrate with the right for all to have access to a well-functioning health system, and there are ethical dimensions also to be considered,” said Dr Nata Menabde, Deputy Regional Director, WHO Regional Office for Europe. “Countries have to know what is needed ahead in terms of training, rather than relying on immediate needs and then ‘buying up’ personnel to fill the gaps. Training has to be robustly planned: countries need to train enough personnel, but not to train simply for export.”

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The international mobility of health professionals has been a growing feature of the global health agenda since the late 1990s. In the WHO European Region, the accession of more countries to the European Union (EU) since 2004 has increased health workers’ scope for migration. The WHO report underlines that some countries, particularly those in the eastern part of the European Region, are concerned about the emigration of health workers as a result of EU accession. In Croatia, for example, research found that 76% of final-year medical students would consider emigrating if they could not pursue their desired specialties in their home country. The preferred destination was the EU and the most frequent reason cited for emigration was a higher salary.

Health worker migration has both positive and negative effects on health systems. It can solve staff shortages in some countries, assist countries with an oversupply of staff and enable individual health workers to improve their opportunities and standard of living. On the other hand, migration can create additional shortages of health workers in countries that already lack staff and undermine the quality of and access to health care. It can also affect health workers’ morale and help to weaken health systems that may already be fragile.

The global shortage of health workers compounds the problem. WHO estimates a global shortage of over 4.3 million health workers, with 57 countries experiencing critical shortages. Migration from the countries with the worst shortages has increased substantially over the past 30 years. WHO research shows that foreign-born doctors currently average 18%, and foreign-born nurses, 11%, of the totals in countries belonging to the Organisation for Economic Co-operation and Development (OECD). Increases have been particularly large in the European Region, where the average annual growth in foreign-trained doctors and nurses can reach up to 30% in some countries.

"How can the migration of health service professionals be managed so as to reduce any negative effects on supply?" stresses the complex dynamics of international mobility, migration and recruitment, including individual motives and governments’ different approaches to managing, facilitating or attempting to limit the outflow or inflow of health workers. It underlines that migration is part of the broader dynamic of change and mobility in health care labour markets, and in policy terms should therefore not be addressed in isolation.

The issue of managing the health workforce will be very present at the Ministerial Conference. “With ageing populations and the increasing burden of disease, we know that demand for health workers will increase, meaning emigration trends are likely to persist. What is crucial now is for European countries to adopt an ethical approach to their health worker needs and thereby reduce the negative impacts of migration on health systems in developing countries,” said the Honourable Mary Robinson, former President of Ireland, President of Realizing Rights: the Ethical Globalization Initiative and Co-Chair of the Health Worker Migration Global Advisory Council, a group set up by the Global Health Workforce Alliance as part of its work to identify and implement solutions to the health workforce crisis.

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