European perspectives on global health: a policy glossary

5. Europe must act now for global health
Europe must support global
policies for human resources
for health
The World Health Organization defines health
workers as all people engaged in actions whose
primary intent is to enhance health. Europe must
support and be at the centre of the efforts to
address the human resources crisis.
Globalisation has increased the movement of people
across national borders in search of better labour
markets and improved quality of life. The push
and pull forces underlying international migration
also apply to the health sector. The root causes for
migration of health workers are related to inadequate
remuneration and promotion, limited opportunities
for continued education and training, poor working
environment, heavy work load, lack of conducive
environment for the development and education of
their children. Among the pull factors are prospects
for better remuneration, better opportunities for
continued education and improved living conditions.
The unmet demand for well-trained health workers in
developed countries is an important pull factor.
The WHO defines health workers as all people engaged
in actions whose primary intent is to enhance health.
This includes mothers and carers, community health
workers and traditional birth attendants. Formal health
workers can be classified into two major groups : the
health service providers ( two-thirds of the formal health
workers ) and health management and support workers
( one-third of formal health workers ). WHO estimates
the number of full paid health workers worldwide
at 59.2 million – a conservative estimate. There is a
significant gender imbalance in the health workers’
distribution : 70 % of doctors are male and over 70 % of
nurses are female. The global shortage of formal heath
workers is estimated to be 4.3 million workers.
It is acknowledged that there is a global, chronic
shortage of trained health workers, most critical
in developing countries. Demographic and
epidemiological transition and high disease burden,
compounded with migration and poor human resource
management are some of the major causes of the
current human resources crisis. There is no global
consensus on the best strategies to address the
problem. Data on real numbers, profile, distribution
and migration is scanty and difficult to compare in a
systematic manner. Migration of health workers from
rural areas to urban centres, as well as their regional
and international migration, is on the increase, with a
major impact on the health system and the quality of
services provided.
Although detailed and accurate data is not available
for most countries and difficult to compare, it
is estimated that emigration of skilled health
personnel from developing to developed countries
has significantly increased over the past years, with
some <strong>European</strong> countries recruiting foreign trained
personnel on a large scale. It is estimated that
more than 25 % of physicians and nurses in the UK,
US, Australia and Canada are foreign trained. It is
estimated that 15,000 foreign nurses were recruited
into the UK in 2001 and 35,000 more are needed by
2008. With increasing needs for highly skilled health
personnel in developed countries – due in large
part to the ageing population and epidemiological
transition – it is anticipated that this trend will
continue over the coming years.
There have been concerns raised over ethics of
recruitment of health workers by developed countries
and in some cases official policy has stopped direct
recruitment for national health systems. But migration
continues through professional agencies specialised in
outsourcing skilled workers from developing countries.
In Europe, it is estimated that there are 1,890 health
workers per 100,000 population.
In Sub-Saharan Africa ( SSA ), the average ratio of
physicians and nurses per 100,000 people is 15.5 and
73.4 respectively. In selected developed countries,
this ratio is 311 and 737.5. The emigration of trained
health personnel and other causes ( such as HIV / AIDS
and macroeconomic policies ) can only worsen this
already serious situation. The depletion in human
capital further reduces the potential for economic
growth. Mode 4 of service supply under the General
Agreement on Trade in Services ( GATS ) presents the
opportunity for economic gains from the remittances
of migrated health workers. However, such remittances
at present do not assist the health economies of
developing countries which are put at great risk by
64 <strong>European</strong> Foundation Centre – <strong>European</strong> Partnership for Global Health