Health Workforce: The Global Crisis and the European Perspective
Dr Galina Perfilieva WHO Regional Office for Europe Riga, Latvia, 17 June 2010
Who are the health workers?
“The stock of all individuals engaged in the promotion, protection or improvement of health of the populations� ( World Health Report 2000)
Why are the health workers important? The cornerstone of health systems in all countries Central to sustainable health systems Core component in the delivery of health services in all countries Access to health services = access to health workers Effectiveness of health systems and the quality of health services rely on the performance of health workers The largest single cost element in any health system (60-80% of total expenditure)
Health Workforce – A Global Profile • Increased demand for health professionals at all levels across the world → competition for personnel • Globalisation of labour markets, removing barriers for labour flows • Migration of health professionals is a global phenomenon • Migration flows imply considerable brain drain up to “fatal flows” in international health systems
• Global shortage: 4,3 million health workers are needed to achieve the health related MDGs • Imbalances within countries (e.g. rural areas vs. cities)
Picture of the global health workforce
Countries with a critical shortage of doctors, nurses and midwives
Distribution of health workers by level of health expenditure and burden of disease, by WHO region
The Global shortfall: 4.3 million health workers More than 1 million new health workers are needed in next 6 years for the countries in sub-Saharan Africa to deliver the basic services. 13 African nations have fewer than 5 physicians per 100,000 people. A serious impediment to achieving the health-related MDGs.
More information on http://www.globalhealthtrust.org
Magnitude of health problem in African countries • Only 19 percent of African countries have at least 80 percent of their populations immunized for measles. • 12,000 children die every day in sub-Saharan Africa • Every minute 8 children die from easily preventable or treatable conditions, 2 of them are newborns • On average, 910 women die for every 100.000 live births.
Sourse: “Child Survival: A Strategy for the African Region, WHO AFRO,2007
International migration Patterns of migration becoming more complicated and involving more countries. Skilled health professionals represent an increasingly large component of migration flows.
In OECD: 11% of employed nurses and 18% of employed physicians are foreign-born.
The EU is an important destination: the registered 39 million migrants represent appr. 8 percent of the total population, the number of irregular migrants is difficult to estimate.
Migration of Health personnel •
Source: WHO Regional office for Africa
s tr
la n d
F r ia an D e ce N e nm a th e rk rla n B e ds lg i u F in m la C a nd na S w da S w ed e n i tz er l A u a nd U n s tr al i U n te d S i a i te t d K a te s in g do m I r Ne e la w Z e nd a la nd Sl ov ak Re J a p. pa Gr n ee ce It G e a ly rm a P o ny r tu No ga l rw ay
Au
Po
Share of foreign-trained or foreign physicians in selected OECD Countries in 2008 (or latest year available) 40
35
30
25
20
15
10
5
0
Foreign-trained physicians
ource: OECD Observer, February 2010
Foreign physicians
Share of foreign-trained or foreign nurses in selected OECD Countries in 2008 (or latest year available)
Source: OECD Observer, February 2010
Foreign nurses
ly Ita
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ga
y Po
G
er m
an
ce Fr an
iu m Be
lg
d la n I re
d an al
N
ew
Ze
st ra
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m do ng Ki
d i te
Foreign-trained nurses
Au
a ad an
nm
ar k C
Un
d i te
De
St at es
en ed Un
Sw
nd rl a th e
Ne
Fi nl
an
s
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50 45 40 35 30 25 20 15 10 5 0
The response of WHO to the Crisis • Joint Learning Initiative (JLI) report, 2004 • Resolutions WHA57.19 (2004), WHA58.17(2005) – alarming issues of health worker Migration • World Health Report 2006 • Resolution WHA 59.23 (2006) on the rapid scaling up of health workforce production • Resolution WHA 59.27 (2006) on strengthening nursing and midwifery • First Global Forum on HRH, Kampala, Uganda, March 2008
The European Perspective
Health workforce in Europe • Health workers represents about 10% of the European workforce. • Serious disparity in the characteristics of health professions (numbers, job descriptions, roles and responsibilities, training paths, regulatory structures). • Imbalances and maldistribution in almost all European Member States jeopardizing the right to health and solidarity, equity and participation. • Lack of reliable data and information
Estimated shortage of health workers in U The European Commission DG Sanco estimates by 2020 a shortage of: - 590.000 nurses - 230.000 physicians and - 150.000 allied health professionals
The changing context of European health workforce Demographic and epidemiological change
Technological and organizational change Political and economic change
Geographical distribution of physicians in Europe Physicians per 100000 P
<= 700 <= 580 <= 460 <= 340
Last available
European Region 339.21
Source: WHO HFA database, June 2010
<= 220 No data Min = 100
Maldistribution of general practitioners General practitioners (PP) per 100000
P
Geographical distribution of general practitioners in France
<= 200 <= 160 <= 120 <= 80
Last available
European Region 67.92
Source: WHO HFA database, June 2010
<= 40 No data Min = 0
Diversities in the WHO European Region Health professionals / 100.000 population, 2007 Physicians
General practitioners
Midwives
Nurses
Pharmacists
European Region
339.21
67.92
44.47
725.9
52.27 *
EU
321.62
96.68 *
35.63 *
745.47
71.4*
CIS
376.78
28.78
52.64
794.73
20.5
Lowest in EU
192.06 (Romania)
43.29 ** (Slovakia)
13.83 (Netherlands)
326.8 * (Greece)
4.17 * (Romania)
Highest in EU
534.59 * (Greece)
163.95 (France)
72.46 * (Sweden)
1.549.77 (Ireland)
114.8 * (Belgium)
Source: WHO HFA database, data accessed in June 2010 * 2006; ** 2005
What is the composition of European health workforce? Ratio of nurses to physicians in European countries 6 Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom EU European Region
5
4
3
2
1
0 Last available
Source: WHO HFA 2010, June 2010
Greece: Composition of Hospital health workers, MoH, 2005 Doctors – 23.597 Nurses 16.425 Midwives 2.343 Assistant nurses 21.000 Health visitors 407 Allied health personnel – 9.768 Administrative personnel – 8.448 Technical personnel 16.133 Others 38
Trends in physician's density over the last 25 years in the European region P h y s i c ia n s p e r 1 0 0 0 0 0 450
400
350
E u ro p e a n R e g io n EU C IS C AR K 300
250
200 1980
Source: WHO HFA database, 2010
1990
2000
2010
Trends in Nursesâ&#x20AC;&#x2122; Density Nurses (PP) per 100000 1000
900
800 European Region EU CIS 700
600
500 1985
Source: WHO HFA database, 2010
1995
2005
Health Workforce Performance: comparison of selected indicators HRH / 10,000 pop (2007)
Health Indicators (2007)
Demand (2007)
Economic constraints (Estimates) (2007)
Physicians
Nurses
Life Expectancy
IMR
Outpatient consultations / capita
Pub. Exp. on health / capita
GDP / capita
Italy
365.41
700.69
81.7
3.47
6
1909
35943
Latvia
304.91
547.95
71.2
8.76
6
520
5868
336.13
780.42
81.48
3.53
6.5
2720
40772
313.25
631.6
74.3
7.2
13.56
840
13902
357.85
1083.4
81.19
2.51
2.8
2460
49545
321.62
745.47*
79.21
4.51
6.86
1886.8 **
35842
France Slovakia Sweden EU
Source: WHO HFA database, 2010 * 2006; ** 2005, *** 2004
Resolution EUR/RC57/R1 Health workforce policies in the European Region
Fifty-seventh session of the WHO Regional Committee for Europe Belgrade, Serbia 17â&#x20AC;&#x201C;20 September 2007
Resolution EUR/RC57/R1
URGES Member States: •
to improve and expand the information and knowledge base on the health workforce at country level, encourage research and build capacities
•
to develop, embed and mainstream policies on health workforce, relevant to the needs of the country
•
to assess the trends in and impact of health workforce migration in order to identify and act on effective migration-related policy options
The Regional Director: â&#x20AC;˘
to give high priority to monitoring health worker migration and policy interventions at national and international level
â&#x20AC;˘
to facilitate the development of an ethical guide/framework for international recruitment of health workers
â&#x20AC;˘
to continue building and strengthening networks and partnerships, to advocate for more effective investment in health workforce development
Resolution EUR/RC59/R4 Health workforce policies in the European Region
Fifty-ninth session of the WHO Regional Committee for Europe Copenhagen, Denmark 14â&#x20AC;&#x201C;17 September 2009
WHO Global Code of Practice on the International Recruitment of Health Personnel
SIXTY-THIRD WORLD HEALTH ASSEMBLY Geneva 21 May 2010
Thank you!