Health Workforce: The Global Crisis and the European Perspective

Dr Galina PerfilievaWHO 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)

� The cornerstone of health systems in all countries

� Central to sustainable health systems

� Core component in the delivery of health servicesin all countries

� Access to health services = access to health workers

� Effectiveness of health systems and the quality ofhealth services rely on the performance of health workers� The largest single cost element in any health system (60-80% of total expenditure)

Why are the health workers important?

Health Workforce – A Global Profile

• Increased demand for health professionals at all le vels across the world → competition for personnel

• Globalisation of labour markets, removing barriers for labour flows

• Migration of health professionals is a global pheno menon

• Migration flows imply considerable brain drain up t o “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 healthexpenditure and burden of disease, by WHO region

The Global shortfall: 4.3 million health workers

� More than 1 million new health workersare 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 Africancountries have at least 80 percentof 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 migrationInternational 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 The EU is an important destination: the registered 39 million migrants represent migrants represent apprappr . 8 percent of the total population, the . 8 percent of the total population, the number of irregular migrants is difficult to estima te.number of irregular migrants is difficult to estima te.

Migration of Health personnel

•

Source: WHO Regional office for Africa

Share of foreignShare of foreign --trained or foreign physicians trained or foreign physicians in selected OECD Countries in 2008 in selected OECD Countries in 2008 (or latest (or latest

year available) year available)

Source: OECD Observer, February 2010

0

5

10

15

20

25

30

35

40

P oland

A us tri

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nce

D enma rk

N e the rla

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B e lgiu

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S w itze rla

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la n d

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ermany

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a y

Foreign-trained physicians Foreign physicians

Share of foreignShare of foreign --trained or foreign nurses in trained or foreign nurses in selected OECD Countries in 2008 selected OECD Countries in 2008

(or latest year available)(or latest year available)

Source: OECD Observer, February 2010

0

5

10

15

20

25

30

35

40

45

50

Fin

land

Neth

erlands

Sw

eden

Unite

d Sta

tes

Denm

ark

Canada

Unite

d Kin

gdom

A

us tralia

New

Zeala

nd

Irela

nd

Belg

ium

Fra

nce

G

ermany

Port

ugal

Italy

Foreign-trained nurses Foreign nurses

• 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 response of WHO to the CrisisThe response of WHO to the Crisis

The European Perspective

Health workforce in Europe

• Health workers represents about 10% of the European workforce.

• Serious disparity in the characteristics ofhealth 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

The European Commission DG Sanco estimates by 2020 a shortage of:

- 590.000 nurses- 230.000 physicians and- 150.000 allied health professionals

Estimated shortage of health workers in U

The changing context of European health workforce

Demographic and

epidemiological change

Technological and

organizational change

Political and

economic change

P

Geographical distribution of physicians in Europe

Source: WHO HFA database, June 2010

<= 700

<= 580

<= 460

<= 340

<= 220

No data

Min = 100

Physicians per 100000

Lastavailable

European Region339.21

P

MaldistributionMaldistribution of general practitionersof general practitioners

Source: WHO HFA database, June 2010

<= 200

<= 160

<= 120

<= 80

<= 40

No data

Min = 0

General practitioners (PP) per 100000

Lastavailable

European Region67.92

Geographical distribution of general practitioners in France

Diversities in the WHO European RegionDiversities in the WHO European RegionHealth professionals Health professionals / 100.000 population, 2007

72.46 *

(Sweden)

13.83

(Netherlands)

52.64

35.63 *

44.47

Midwives

114.8 *

(Belgium)

1.549.77

(Ireland)

163.95

(France)

534.59 *

(Greece)Highest in

EU

4.17 *

(Romania)

326.8 *

(Greece)

43.29 **

(Slovakia)

192.06

(Romania)Lowest in

EU

20.5794.7328.78376.78CIS

71.4*745.4796.68 *321.62EU

52.27 *725.967.92339.21European

Region

Pharmacists NursesGeneral

practitioners

Physicians

Source: WHO HFA database, data accessed in June 2010* 2006; ** 2005

0

1

2

3

4

5

6

AustriaBelgiumBulgariaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUnited KingdomEU European Region

Last available

Ratio of nurses to physicians in European countries

Source: WHO HFA 2010, June 2010

What is the compositionWhat is the composition of European of European health workforce?health workforce?

Doctors – 23.597Nurses - 16.425Midwives - 2.343Assistant nurses - 21.000 Health visitors - 407Allied health personnel – 9.768Administrative personnel – 8.448Technical personnel - 16.133 Others - 38

Greece: Composition of Hospital health workers, MoH, 2005

2 00

2 50

3 00

3 50

4 00

4 50

1 9 8 0 1 9 9 0 2 00 0 2 0 1 0

Euro p ea n R eg io nEU C ISC AR K

P h y s ic ia n s p e r 1 0 0 0 0 0

Source: WHO HFA database, 2010

Trends in physician's density over the Trends in physician's density over the last 25 years in the European regionlast 25 years in the European region

Trends in NursesTrends in Nurses’’ DensityDensity

500

600

700

800

900

1000

1985 1995 2005

European RegionEU CIS

Nurses (PP) per 100000

Source: WHO HFA database, 2010

1390284013.567.274.3631.6313.25Slovakia

586852068.7671.2547.95304.91Latvia

35943190963.4781.7700.69365.41Italy

4954524602.82.5181.191083.4357.85Sweden

4077227206.53.5381.48780.42336.13France

358421886.8 ** 6.864.5179.21745.47* 321.62EU

GDP / capita

Pub. Exp. on health / capita

Outpatient consultations

/ capita

IMRLife Expectancy

NursesPhysicians

Economic constraints(Estimates) (2007)

Demand (2007)

Health Indicators (2007)

HRH / 10,000 pop (2007)

Source: WHO HFA database, 2010* 2006; ** 2005, *** 2004

Health Workforce Performance: Health Workforce Performance: comparison of selected indicatorscomparison of selected indicators

Fifty-seventh session of the WHO

Regional Committee for Europe

Belgrade, Serbia

17–20 September 2007

Resolution EUR/RC57/R1Health workforce policies in the European Region

• to improve and expand the information andknowledge 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

Resolution EUR/RC57/R1

URGES Member States:

• to give high priority to monitoring health worker migration and policy interventions at national and international level

• to facilitate the development of an ethical guide/framework for international recruitment of health workers

• to continue building and strengthening networks and partnerships, to advocate for more effective investment in health workforce development

The Regional Director:

Fifty-ninth session of the WHO

Regional Committee for Europe

Copenhagen, Denmark

14–17 September 2009

Resolution EUR/RC59/R4

Health workforce policies in the European Region

SIXTY-THIRD

WORLD HEALTH ASSEMBLY

Geneva

21 May 2010

WHO Global Code of Practice on the International Recruitment of Health

Personnel

Thank you!