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Global mobility of health workers and triple win migration

Bratislava, 28-30 January 2014. Mobility and migration of health personnel both in Europe and at global level was a well addressed issue during a conference of the Joint Action on Health Workforce Planning and Forecasting. Wemos, a member of the European HW4All project, organized a break out session on "Global mobility and triple win migration" on the second day and participated with an input in the Expert meeting on the applicability of the WHO Global Code of Practice on the International Recruitment of Health Personnel on the third day.

By Linda Mans, Wemos

During the first day, Irene Glinos, policy analysis at the European Observatory on Health Systems and Policies, noted that the impact of the financial crisis on the health workforce in Europe has been enormous. Mobility of health workers has become increasingly volatile and unpredictable – also due to austerity measures taken by different countries. According to Glinos (besides ethical considerations) it is not sustainable for countries relying too heavily on foreign health workers - as they might easily come and go based on changes in policies and preferences.

In his key note speech, Martin Seychel, Deputy Director General of Directorate General for Health and Consumers, European Commission, referred to the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel. Cross border recruitment must be sustainable and should not put health systems of source countries at risk. It shouldn’t be a race to the bottom as health systems have become interdependent and rely on fewer health professionals within the European region. EU countries need to plan their health workforce needs, better forecast skills needs and collaborate in recruitment and retention strategies. These are means to create a sustainable health workforce and avoid an excessive reliance on foreign health professionals.

Triple win migration?

A break out session on the second day organized by Wemos focussed on global mobility of health workers and triple win migration as a means for ethical international recruitment. (session overview)

Yoswa Dambisya, Regional Network for Equity in Health in East and Southern Africa (EQUINET), kicked off with a presentation on austerity and mobility of health workers in Eastern & Southern Africa. He pointed out that the lack of financial support for health care systems, and for health care work force in particular, has been dramatic for an already big burden of disease in the African region (e.g. HIV/aids). It increased the migration of already scarce health professionals to other parts of the world. (presentation)

As head of the Institute for European healthcare research and social economy (IEGUS), Grit Braeseke discussed the Triple Win Migration as a way of responsible international recruitment. In Germany the need for health workers will increase due to demographic evolution. Especially the long term care sector will expand and the national health workforce will not be able to cover the patients’ needs for health workers. Triple Win Migration implies that source and destination countries and migrant health workers need to benefit from this managed health workforce mobility. Braeseke emphasised that Triple Win Migration would be just one instrument among many to create a sustainable health workforce in Germany. (presentation)

Heino Güllemann from terre des hommes Germany argued that the concept of Triple Win needs improvement for migrant health workers to actually ‘win’ from migration. The lack of recognition of certain skills and diplomas can lead to unequal workers rights and the workload for nurses in Germany has increased a lot. Domestic resolutions are therefore preferred above international recruitment, also because mobility may have adverse impact on the sustainability of the health workforce due to its short term nature. (presentation)

The deputy-secretary for labour management and education for health, Fernando Antonio Menezes da Silva from the Ministry of Health in Brazil, showed that Brazil has taken a series of actions on health workforce policies in the past. Still, not all patients have access to a qualified health professional, and new policies have been introduced. Most of these policies are aimed at training and education of medical doctors and retention strategies to have them work in a primary care setting in underserved areas. The ‘Maís Medicos’ Programme includes the international recruitment of Cuban doctors as one of the means taken. (presentation)

A discussion during the interactive part of the break out session highlighted that there is a need for sustainable migration. Greater coherence – between ministries within a country and between countries – among migration policies, development co-operation policies, as well as employment, trade and security policies is required for all parties to gain more from migration. The position of migrant health workers remains vulnerable in both destination and upon returning to their source countries. In destination countries labour rights and social protection of migrant health workers need to be ensured. Therefore the voices of migrant health workers and labour unions should be present and represented in the social dialogue. Source countries need to take action to better guide health workers back into the health care sector when they return to their home country. In some countries health workers that re-migrate are perceived as traitors. Also, their experiences and skills acquired abroad may not be taken into account. Globally sustainable and fair personnel policies need to be strived for. And we shouldn’t forget the human factor in this discussion.

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