How migration affects health workforce management

Filipino nurses are recruited abroad. Many thousands of qualified workers from African and Asian countries are working in the United Kingdom or elsewhere in Europe, without any compensation for the poverty-struck countries that trained them. Photo by: Juan Karlo Reyes / International Labor Organization / CC BY-NC-ND

2015 is the European Year for Development, and one of its key objectives is to raise awareness and foster a broader understanding of policy coherence for development.

EYD2015 therefore offers a timely and critical opportunity to imbue both European citizens and those of countries receiving development assistance with a sense of joint responsibility, solidarity and opportunity in a changing — and increasingly interdependent — world. This also includes an understanding of how unsustainable health workforce practices can have a negative global impact.

The Ebola crisis in West Africa vividly exposes the dramatic results of exceedingly weak health systems and health workforce shortages: More than 8,600 people have died so far, and it is likely that lives could have been saved had there been more qualified health workers available in the countries hardest hit by the virus.

Many thousands of qualified workers from African and Asian countries are working in the United Kingdom or elsewhere in Europe, without any compensation for the poverty-struck countries that trained them. The issue of how to strengthen health systems in developing countries has been taken up by the U.K. House of Common’s International Development Committee.

New and re-emerging infectious diseases affect us all: They do not respect the boundaries of nation states. It is a universal responsibility to address future outbreaks, given that we live in an increased interdependent world. This presupposes a prioritization of policy coherence for development, including the sustainable management of health workforce migration at a global level.

Shortages and poor working conditions do not only affect developing countries. Even Germany, dubbed as Europe’s “economic powerhouse,” is experiencing problems in retaining its health workers, with many nurses — and doctors — either leaving the country for better pay and working conditions elsewhere, while many nurses are even leaving the profession.

The Health Workers for All case study on the recruitment in Germany of nurses from the Philippines via a bilateral agreement illustrates that — in spite of the World Health Organization Global Code — there is a renewed trend to recruit candidates from outside of Europe. Unfortunately, this often occurs at the expense of improving conditions for the nurses already in the system, by fixing the problem at its roots.

The recruitment of Asian and African nurses is therefore the result of worsening working conditions and may act as another “push” for further cuts in wages and labor rights in the German nursing sector. In the specific German-Filipino case however — which could become a good example of ethical international recruitment — it was possible to avert detrimental consequences.

Such an outcome was achieved through a comprehensive agreement that considered the needs of both the country of origin and the destination country, as well as through including the social partners on both sides at the right time in terms of formulating and monitoring the agreement.

Health workforce migration intersects with policies in migration, health, development cooperation, economics and employment. It must therefore be addressed in a consistent manner.

As underlined by the Health Workers for All project’s “call to action” to European policymakers, action is urgently needed. Europe needs to support low- and middle-income countries — or LMICs — to strengthen (public) health systems and health workforces, primarily by reversing the harmful current trend to contain or reduce development aid for health.

The EU and its 28 member states should ensure that 50 percent of aid for health is directed toward strengthening health systems, with 25 percent impacting directly on health workforce training and retention — as recommended by WHO — by channeling funds through national health plans and related health workforce strategies.

Moreover, it is becoming increasingly important to “put our own house in order.” The WHO Global Code needs to be properly implemented within Europe too — and national health workforces need to be built up, nurtured and retained.

Strong leadership and commitment are required to ensure that these issues firmly remain on the EU and global agenda, but also to warrant that the objectives of EYD2015 — and ultimately policy coherence for development — can be achieved.

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About the authors

  • Linda m.  1

    Linda Mans

    Linda Mans is part of the Dutch civil society organization Wemos where she is a senior global health advocate on the Human Resources for Health project. She focuses on the role the Netherlands and Europe can play in contributing to solutions for solving the global health workforce crisis. Linda is the project coordinator of the European consortium project "Health workers for all and all for health workers," led by Wemos.
  • Sascha m.

    Sascha Marschang

    Sascha Marschang joined the European Public Health Alliance in 2009, where he is currently policy manager for health systems. Apart from issues related to the European health workforce, his policy portfolio includes e-health and medical devices, pharmaceutical policy, health threats, as well as other developments impacting health systems.