The human resource crisis in the health sector
The human resource crisis in the health sector is a global one relating to a lack of training, poor working conditions and lack of incentives. All of these factors combine to deter health professionals from the areas where the need is most urgent. They provide incentives for professionals to turn towards better opportunities in urban areas, in wealthier neighbouring countries or in resource rich countries which act as pull factors for migration. The present Communication outlines the European Union's response in the context of the decade of action on human resources proposed by the 57th World Health Assembly, which began in 2006.
Communication from the Commission to the Council and the European Parliament - EU Strategy for Action on the Crisis in Human Resources for Health in Developing Countries [COM(2005) 642 final - not published in the Official Journal].
Africa is the continent facing the greatest shortage of health workers. However, this Communication recognises the problem in other regions such as Asia, which is facing significant internal health worker distribution problems, and the Caribbean, which is threatened by the migration of health workers to the USA.
In 2005, the Programme for Action to Confront HIV/AIDS, TB and Malaria through external actions identified the lack of health workers in poor countries as a major barrier to progress in tackling the three diseases and to progress towards Millennium Development Goals (MDGs). Moreover, two Commission Communications on migration assess the impact of skilled worker migration and identify concrete orientations to minimise the negative impact of skilled worker migration and enhance its potential to build human resource capacity. This Communication will serve to outline the European Union's coherent and coordinated response to this crisis.
According to its report on the Challenge of Human Resources for Health in Africa, the Joint Learning Initiative (JLI), Africa has the highest disease burden per capita of any continent as it has the fewest health professionals and 80% of the population has no access to social protection coverage.
The deficit situation in the health care delivery process among the poor is accentuated by high health worker mobility, lack of decent work opportunities, lack of social protection coverage, limited incentives, particularly to work in under-served areas and with poor people, combined with high global demand for health workers.
Even if countries such as India, the Philippines, Cuba, Indonesia and China have increased health worker training, the majority of them go abroad to respond to the global demand for health workers despite domestic shortages. National, regional, and global efforts are required to respond to this crisis which is due to under-training, poor retention and migration of health workers from poor countries towards rich ones to satisfy their high resource requirements. National, regional, and global efforts are required .
The migration of health workers is due to various factors: not only the high salary differential between rich and poor countries, but also the effectiveness of the health system and working conditions, the failure to recognise family needs and to provide adequate security for women who are working in remote and potentially insecure environments. Effective incentive measures to encourage health professionals to work where demands are most urgent will therefore be required. These measures should include improved housing, support for their children's education and allowances for working in remote or under-served areas.
The health worker mobility issue needs to incorporate international level action strategies, as the migration from rural towards urban areas, from poor towards rich countries, and from the public towards the private sector, creates a vicious circle: these migrations enable rich countries to accumulate large quantities of wealth while causing poor countries considerable losses in terms of training costs and the opportunity cost of understaffed health facilities. The Health Strategy of the New Partnership for Africa's Development (NEPAD) highlights the need for countries to ensure effective management of human resources for health by updating their employment and deployment policies, developing flexible career paths, providing supportive supervision and continuing education and fostering motivation and retention strategies.
Another element contributing to this crisis relates to HIV/AIDS, as many health workers will themselves be either infected or affected personally by HIV/AIDS in some way. Furthermore, there is a risk of distorting healthcare delivery in favour of HIV/AIDS interventions at the expense of the delivery of other equally essential services. Care must be taken that the additional resources mobilised for HIV/AIDS prevention and care complement rather than compete for existing limited human resources.
European Union action to address this crisis will be based on principles of solidarity, on the recognition that tackling this issue is a shared responsibility and on a coherent and comprehensive package of interventions at national, regional and global level. Programming decisions and budget allocations with respect to actions proposed in annex to this Communication will be made in accordance with the structure of instruments determined for the 2007-2013 financial perspectives.
European commitment to move more rapidly towards achieving the target of 0.7% of GNI as ODA by 2015 and G8 commitments to support greater debt relief will make more resources available for development. As increased financing is indispensable, assurances are needed that international assistance will be long-term and predictable and that recipient countries will not be abandoned with unaffordable liabilities. Budget support, which is particularly effective for meeting recurrent costs such as human resource development, will be maintained by the European Commission in order to provide increasingly long-term and predictable aid.