Sharing knowhow and joining forces towards Health for All

MMI Network News, March 2014

Photo: (c) P. Virot
Photo: (c) P. Virot

Editorial: Health workers for all - a global problem

Dear reader,

No one doubts that having sufficient health workers both in quantity and quality is vital to a health system that responds to the health needs of its population. However, the global situation is far from acceptable: More than 50 countries, mainly in Africa and South Asia, face a critical shortage of health workers which explains much of the mortality and morbidity in these countries. In Spain, the situation can become dramatic as well.

Aging societies of the so-called developed countries in Europe and North America need more and more chronic care. This trend, together with the increased use of health care and the aging of the health workforce itself - with many retirements to be expected in the years to come - cause staff needs that are not covered by the respective national health systems. In fact, the European Commission estimates in its working document Action Plan for the EU Health Workforce that if the current training skills are kept, there will be a shortage of one million health workers in Europe by 2020. In Spain, it is estimated that by 2025 there will be a 14% deficit of health workers, including family physicians and specialists. These estimates were obtained before knowing the current situation, where, because of the economic crisis, many Spanish professionals are seeking job opportunities outside our borders.

The WHO identifies four key strategic areas for Member States to achieve a volume of sustainable health workforce and to strengthen health systems: defend, communicate and mobilize existing resources; build information systems for human resources for health; strategically invest in human resources for health development; and align human resources with other public health policies and interventions.

What solutions exist for staff shortages? The first and most rational solution we find when we think about this subject is that each country would appropriately plan its needs of health workers and in this way put the basis for ensuring the training of the needed staff, both in quantity and quality. However, this plan is not easy. On one hand, changes in epidemiological and demographic patterns and future demands of the population are difficult to estimate, and even more in countries with a fragile health system that do not have sufficient resources to successfully carry out this planning. Furthermore, many countries - if not all of them - do not know the exact number of their health workers, especially in the private sector. For example, Spain is trying to introduce the first record of health workers, which is expected to be operational in 2014, because we do not know how many health workers are currently in our country and so we rely on estimations. Even designating who should be included in "medical staff" is sometimes confusing, especially in countries where traditional medicine or health promoters play an important role in health care.

The second and "easier" solution implemented by many countries over the recent years is the import of health personnel. As the labour market becomes more globalized, the increasing international demand is boosting the migration and mobility among health workers. Until not long ago, the most developed countries were the largest recipients of health workers, but in recent years this transfer of staff also occurs from developed countries to emerging countries. A current example of this is the Brazil program "Mais médicos para o Brazil" (More doctors for Brazil) where 28% of the 358 physicians enrolled in its third edition are Spanish. Therefore, it is a global problem that affects or could affect every country.

The recruitment of foreign health workers can be a way to satisfy domestic demand for a certain time. However, it can worsen the shortage of skilled workers elsewhere, especially in low and middle income countries and even in developed countries like some European ones. And there is another element to add to this debate: The cost incurred by the countries in training health personnel. For example in Spain it is estimated that it costs about 120,000€ to train a graduate. The CESM (Spanish Confederation of Medical Trade Unions) estimates that the cost of training a MRI specialist is approximately 200,000€. Worldwide, figures are worrying. Estimates show that the national health systems of nine African countries have lost 2,170 million dollars, the investment in the training of their doctors, due to emigration after graduation. The same influx of immigrants has come to provide a profit of 4,550 million dollars to the recipients of these professionals. So we have the contradiction that the flow of health workers is going from countries where there is a larger shortage to countries that have more resources.

Those who work in development know this story very well. Many of the training programs that are developed in the health cooperation have little success because the staff migrates once the training is over, leaving the populations with most needs without staff to assist them. The proportion of health workers in many African countries is ridiculous compared to Europe: 2 doctors/1000 inhabitants in Africa to 33 doctors/1000 inhabitants in Europe - and Europe keeps attracting African staff! Although this capture is worldwide, some countries absorb most of the foreign staff. The United States, Canada, United Kingdom and Australia use 69% of the overall foreign doctors working in OECD (Organization for Economic Co-operation and Development Countries).

Carlos Mediano, federacion2@medicusmundi.es
Federation of Medicus Mundi Spain

 

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Related Network report: HW4All
Health workforce shortages and international mobility in the EU

A report published by the European civil society project «Health workers for all and all for health workers» (HW4All) warns of an impending crisis in Europe which will have a global impact. The report analyses trends in the international recruitment of health workers in the European region and highlights three cross-cutting issues: Human Resources for Health planning capacity across the European Union; fiscal space for health workforces in the context of the economic crisis; and health workforce mobility and trade in services. (The HW4all project includes various MMI Network members and the MMI secretariat)

> https://interact.healthworkers4all.eu/pages/viewpage.action?pageId=3735989 

 

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Related Network paper: Wemos
Caring for carers - a relevant concern?

Globally sustainable and fair personnel policies for the Dutch health care sector: What does it mean in practice? Wemos published a booklet intended for anyone directly or indirectly involved with the problem of impending staff shortages in the Dutch health care sector and similar sector shortages in other countries’ health care sectors.

> https://interact.healthworkers4all.eu/pages/viewpage.action?pageId=3735964

 

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Related Network paper: Health Poverty Action
The Health Worker Crisis - an analysis of the issues and main international responses

The report produced by Health Poverty Action gives an overview of the impact of the brain drain on health care provisions in source countries and current international strategies to mitigate its effects. It will argue that these strategies are faced with severe challenges and present some alternative approaches to address the health worker shortage, based on an acknowledgement of the Global North's contribution to the current crisis.

> https://interact.healthworkers4all.eu/pages/viewpage.action?pageId=3735872


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Related Network resource: HW4All
HW4All online collaboration platform launched

The European civil society project «Health workers for all and all for health workers» (HW4All) launched an online collaboration platform where all relevant actors and stakeholders are invited to share experiences, opinions, suggestions, best practices and proposals on health workforce issues. Platform users will also find occasions to activate themselves as advocates of increased coherence between development cooperation policies and domestic health policies and practices of European Member States. Join in! (The online platform is administered by the MMI secretariat)

> http://bit.ly/hw4all-news       

     

MMI Network: Events 2014 (what we know so far...)

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Network event: Medicus Mundi Switzerland
Is "Value for Money" the best approach for improving weak health systems?

Basel, 9 April 2014. The aid community now systematically refers to the “Value for Money” (VfM) concept in relation to health programmes. Still, the concept has varying meaning among individuals and agencies. It spans benchmarking the costs of certain products, to focusing exclusively on high level impact indicators. Applying universal standards in very different contexts can be counterproductive, force missed opportunities, and devalue the need for “patient capital” and long-term capacity development. Consider the situation of countries with weak health systems - where health conditions are dire, and resources are limited. Is VfM the mantra that leads to the most prudent allocation of investments? Spring Symposium of the Swiss TPH, a member of the Network Medicus Mundi Switzerland.

> http://www.swisstph.ch/spring_symposium_2014.html

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Network event: Medicus Mundi Switzerland
How to address sexual violence and HIV

Bern, 10 April 2014, aidsfocus.ch conference. Sexual violence is a fundamental violation of human rights and has a direct impact on the health and wellbeing of people, especially women. Research shows that violence is a major cause of HIV transmission, but also a consequence of HIV infection. The conference explores how sexual and gender based violence increases vulnerability to HIV, AIDS and other STIs. It highlights current interventions to address the consequences of sexual violence on the health of women, children and men. Based on experiences and best practice, the conference will explore programming and key actions addressing the consequences of sexual violence on HIV in protection of the survivors of sexual violence. The focus is on sharing of experiences and information and learning from each other. The conference is co-organized by aidsfocus.ch, a platform coordinated by Medicus Mundi Switzerland, and its member terre des hommes schweiz.

> http://www.aidsfocus.ch/platform/Event.2013-09-11.4135

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Network event: Medicus Mundi Switzerland
Global Health: Interconnected Challenges, Integrated Solutions

Geneva, 15-17 April 2014. "During recent decades significant progress has been made to focus policy attention and channel new financial resources towards global health issues. Despite this, the challenges facing our global community are becoming increasingly complex and inter-connected." The Geneva Health Forum is organized by the Division of International and Humanitarian Medicine at the Hospitals of the University of Geneva, a member of Medicus Mundi Switzerland

> http://ghf.globalhealthforum.net/2013/03/19/announcing-geneva-health-forum-2014/#.UcgUcZzheBx

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Network event: Ecumenical Pharmaceutical Network
Maternal and Child Health Care Access to Safe Pharmaceuticals

Nairobi, 28-30 April 2014. This year's EPN Forum is expected to bring together senior executives from Christian Health Associations, Church Based Pharmaceutical Supply Agencies and International Organizations working on or interested in health and pharmaceutical supply issues as well as other stakeholders. The biennial EPN Forum is an opportunity for members of the Ecumenical Pharmaceutical Network to meet physically, learn, share and exchange experience and knowledge, discuss, develop ideas and make critical decisions in relation to the activities of the Network with experts, friends and partners. Visit the EPN websites for updates.

> www.epnetwork.org/

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Network event: Medicus Mundi International
Global health: What's ahead?

Geneva, 24 May 2014. Annual General Assembly of the Medicus Mundi International Network with a public mini-symposium on global health challenges in the next five years - in view of the development of a MMI Network strategy 2015-20. Mark the date! Details to follow in April.

> office@medicusmundi.org 

 

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Network event: action medeor
innovativ und kompetent helfen

Tönisvorst, 27 June 2014. The German MMI Network member action medeor celebrates its 50th Anniversary with a symposium and exhibition at their headquarters.

> http://www.medicusmundi.org/en/contributions/events/2014/innovativ-und-kompetent-helfen 


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Network event: MMI / Cordaid / Memisa
An ideal match! Successfully connecting NGO practice and Health Systems Research

Cape Town, October 2014. The MMI Network participates in the Third Global Symposium on Health Systems Research which will be held in Cape Town, South Africa, from 30 September to 3 October 2014, with a session on "An ideal match! Successfully connecting NGO practice and Health Systems Research." The session targets NGOs, researchers, policy makers and funders to learn how international NGOs working in the field of health development cooperation have successfully started integrating an evidence based approach into their institutional culture and operational practice. Experiences of successful collaboration of NGOs and research institutions will be discussed. The focus will be less on the content of the research collaboration but on processes allowing innovative interaction between critical actors in a people-centered health system.

> http://hsr2014.healthsystemsresearch.org/

 

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Network event: MMI / Medicus Mundi Switzerland
Sexual and Reproductive Health and Rights

Basel, 5-6 November 2014. Annual MMI Network meeting with a symposium hosted by Medicus Mundi Switzerland. Mark the dates! And get in touch with the MMI secretariat if you are interested to contribute to the planning of the symposium on sexual and reproductive health and rights!

> office@medicusmundi.org 


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Network event: MMI / Medicus Mundi Switzerland
The best science for global health challenges

Basel, Basel, September 6-10, 2015. The next European Congress on Tropical Medicine and international Health (ECMTIH) will be organized by the Swiss TPH, a member of Medicus Mundi Switzerland, on behalf of the Federation of European Societies for Tropical Medicine and International Health (FESTMIH) and the Swiss Society for Tropical Medicine and Parasitology. As the conference topic "The best science for global health challenges" is highly relevant for NGOs working in the field of international health cooperation and global health, Medicus Mundi International and Medicus Mundi Switzerland participate as NGO partners in the Local Organizing Committee. A first congress website will be available in April 2014.

> office@medicusmundi.org 


To be included in the MMI Network news and in the events calendar on the MMI ePlatform, Network members are invited to send their announcements to the MMI Secretariat.

International health and global health policy: MMI updates

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Universal health coverage, Health systems strengthening
Health financing (national and global level)

MMI thematic guides:

www.bit.ly/mmi-hss
www.bit.ly/mmi-uhc

See also below:
Health beyond 2015
Global health policy

Twitter: #UHC

 

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Health policy and systems research

MMI thematic guide:
www.bit.ly/mmi-research
  

 

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Human resources for health
Migration of health professionals

MMI thematic guides:
www.bit.ly/mmi_hrh
www.bit.ly/mmimigrationguide

Twitter: #HRH, #healthworkers #healthworkerscount, #3GFHRH

 

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Access to medicines and vaccination
Medical research and development
Communicable diseases

 

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Women’s and children’s health
Sexual and reproductive rights and health

MMI thematic guide:
www.bit.ly/mmi-mch

 

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Prevention and control of NCDs
Disabilities, Mental Health, Care

 

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Equity and human right to health
Social determinants of health
Poverty and social protection

MMI thematic guide:
www.bit.ly/mmi_sdh

Twitter: #SDH, #HIAP

 

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Global health governance and policy

MMI thematic guide:
www.bit.ly/ghgovernance

Twitter: #globalhealth #healthgovernance


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Health beyond 2015 (MDGs and SDGs)

MMI thematic guide:
www.bit.ly/mmi-beyond2015guide

Twitter: #post2015

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World Health Organization
WHO reform and financing

MMI thematic guide
www.bit.ly/whoreformguide

 

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Development, aid and international institutions

MMI thematic guide:
www.bit.ly/mmi-ngoguide

 

Follow the MMI Updates on Twitter:
https://twitter.com/mmi_updates

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