###LANG###

A health worker for everyone, everywhere! European Call to Action

Call to Action for European decision-makers, towards strong health workforces and sustainable health systems around the world

 

The European Call to Action "A health worker for everyone, everywhere!" was launched in 2014 by the partners of the project "Health workers for all and all for health workers" (HW4All). In an event in Brussels on 9 December 2015, the Call to Action and a list of 175 institutional signatures were handed over to the European Commission. The collection of signatures was closed afterwards. 

"The world is 7.2 million health workers short. The health worker crisis is one of the biggest threats to global health today, and it is having a particularly detrimental impact on people’s fundamental right to health in a number of medium and low-income countries. Europe is part of the problem, because various European countries recruit trained health personnel from abroad, a practice that is unsustainable, increases inequality and further weakens health systems in and outside Europe.

Europe could be part of the solution, however, by implementing globally agreed practices for the recruitment of health workers. In 2010, the international community and the World Health Organisation (WHO) framed a roadmap for developing the global health workforce. Called the ‘WHO Global Code of Practice on the International Recruitment of Health Personnel’ (the Code), it addresses the root causes of migration and brain drain, including health worker training, retention, working conditions and remuneration, financing and rights. Despite this Code, political consensus on the sustainable management of health workforces and of health worker migration at the regional and global level is still a long way off. There are powerful – albeit sometimes short-sighted – conflicting interests, and in many countries austerity measures have put a damper on health expenditures and limited the implementation of policy options.

The European Union and its member states must take a firm stance in this debate. As a fundamental element in the social and welfare model that underpins European identity, the existence of a health workforce is a public good that must also be upheld at the global level. The Code should therefore be used as a framework to regulate the pan-regional approach to human resources for health and to strengthen health systems not only in Europe but also globally.

We hereby call on European and national decision-makers to show leadership in this issue and to apply a coherent approach to the sector policies currently in place in order to develop and maintain sustainable health workforces both in and outside Europe. This Call to Action provides recommendations to EU institutions and member states in achieving this aim."

One call - five recommendations

(1) Plan long term and train self-sustainable health workforces

Planning, forecasting and providing for domestic health workforces without resorting to international recruitment are key to the development of sustainable health workforces globally, and a fundamental step towards reducing brain drain.

We call on the EU and its member states to:

  • Develop and implement health workforce planning and forecasting processes. This should involve multiple sectors, institutions and stakeholders – such as professional associations and training institutions, and patient and civil society representatives – and connect with decision-making in the health and education systems;
  • Develop and implement comprehensive national health sector and health workforce strategies. This should link planning to a long-term goal of non-reliance on internationally-trained health personnel, through high-quality training programmes focussed on goal-oriented rather than disease-oriented care.
  • Strengthen research and data collection on stock and flows of human resources for health at a national level. To improve collaboration and data exchange at the bilateral, regional and global level, the ‘EU Joint Action on Health Workforce Planning and Forecasting’ can serve as a reference for collaboration platforms, which should receive adequate follow-up.

(2) Invest in the health workforce

Public expenditure in the health sector is a necessary investment. It can support health workforce development and has a positive impact on the health of populations, which are to be considered a global public good. It also tends to strengthen countries’ capacity to deal with the impact of the current economic crisis; in fact, investments in health – and in social protection – can accelerate economic recovery.

We call on the EU and its member states to:

  • Protect cost-effective public health services – particularly preventive services and primary care – from budget cuts. European countries striving to recover from economic downturns and recession must increase investments in their public health systems and health workforces.
  • Implement mechanisms for health impact assessments of fiscal policies. Health ministers should be co-accountable for decisions related to public expenditure, both in national and EU-level negotiations.
  • Take funding for public investments – and for health and social expenditure in particular – out of the national basis for calculating the deficit. This will ensure that the implementation of recent European fiscal policies, including Six Pack and Fiscal Compact, will not reduce productive social expenditure beyond a sensible level.
  • Include investment in the health workforce in the ‘Reflection process on modern, responsive and sustainable health systems’, as based on the ‘investing in health’ approach put forward by the European Commission.

(3) Respect the rights of migrant health workers

Health workers have every right to develop professionally and build long-term careers no matter where they live – and that also applies to migrant health workers trained outside Europe. Their presence benefits European health systems and their rights and professional competencies must be valued.

We call on the EU and its member states to:

  • Grant equal treatment and equal rights to migrant health workers – including to workers with Intra-Corporate Transfers Permits – in both recruitment and employment, and ensure the full portability of social security and pension rights.
  • Make recruiters the legal duty-bearers for fully informing migrants about their rights.
  • Integrate the voices of health care workers in policymaking at EU and national levels. This must include migrant health care workers, their representative bodies and labour unions.
  • Make the EU Global Approach to Migration and Mobility (GAMM) – and, more broadly, the entire New Agenda for Home Affairs currently under discussion – development-sensitive. In its provisions for both highly skilled and low-skilled workers, the EU should ensure that existing and future mobility partnerships, Common Agendas on Migration and Mobility, circular migration schemes, the Blue Card scheme and other relevant directives and tools are all coherent with the Code. They should allow facilitated re-entry rights to the EU and contain tangible incentives whereby health workers can resettle in their countries of origin after a period of work in the EU under good conditions, with portability of social security and pension rights acquired in the EU.

(4) Think and act coherently at national, regional and global level

Policy coherence with development objectives is a legal obligation enshrined in the Lisbon Treaty. The intersections between migration, health, development cooperation, fiscal and employment policies discussed here must be addressed in a consistent manner, while the impact of policy incoherencies must be redressed.

We call on the EU and its member states to:

  • Design and adopt a policy coherence framework for developing sustainable health workforces in and outside Europe. This must align EU public health policies with development objectives, include the migration dimension and contain clear political goals and concrete actions.
  • Develop implementation mechanisms for this framework. These should be inter-institutional and cross-sector and be framed within larger implementation mechanisms for Policy Coherence for Development as pursued at EU level, including: ex-ante health impact assessments of policies, an arbitration system operated by the president of the Commission, policy monitoring and ex-post assessments, multi-stakeholder dialogues extending to include EU delegations, a complaints mechanism open to non-EU actors and a clear policy review process.
  • Reverse the current trend to contain or reduce development aid for health. The EU and its member states should ensure that 50% of aid for health is directed towards strengthening health systems, with 25% impacting directly on health workforce training and retention – as recommended by the WHO – by channelling funds through national health plans and related health workforce strategies.
  • Develop a political dialogue with source countries of migration. This should explore the loss of investment and skills versus the benefit to destination countries, and aim to redress this loss.
  • Foster research and policy elaboration on viable compensation mechanisms. This should clarify the actors to be compensated, the nature of the loss, the rationale and methods for calculating how much is due and channels for administrating compensation funds.
  • Fully exploit the potential of European Structural Funds to re-orient health and social systems towards equity and to improve the distribution of health workers within the EU. This can be achieved through targeted measures to support health workforce retention measures in European sending countries and through the exchange of good practices between professionals in sending and host countries. At the national level, a long-term strategic approach and intensive capacity building are needed to exploit this potential.
  • Promote adherence to codes of conduct with a view to protecting public health systems. This should include all development actors, including NGOs and multilateral initiatives, with a view to the protection of public health systems.

(5) Play your part in Code implementation

European actors must take a firm stand in the global health workforce debate, putting the quest for equity in health in all countries front and centre.

We call on the EU and its member states to:

  • Endorse statements at the highest political level (where these do not yet exist) orienting public sector leadership and stewardship towards equity in health.
  • Widely disseminate and discuss the Code and translate key elements of it into enforceable national and regional legislation, including to discourage active recruitment from countries with a critical shortage of health personnel or where this might become an issue in the near future.
  • Develop and implement sound accountability mechanisms. These should include stakeholder consultations at national and regional level and transparent reporting on Code implementation by the World Health Assembly, the European Parliament and national parliaments.

Signatories and promoters

Download the Call
Institutional signatories

Members of the European Parliament signing the Call to Action

  • Biljana Borzan, Croatia
  • Soledad Cabezón, Spain
  • Nessa Childers, Ireland
  • Dennis de Jong, The Netherlands
  • Ismail Ertug, Germany
  • Filiz Hyusmenova, Bulgaria

Co-promoters