Local view for "http://purl.org/linkedpolitics/eu/plenary/2006-04-05-Speech-3-303"
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"en.20060405.22.3-303"2
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".
Mr President, the global shortage of doctors, nurses and other health professionals has reached a crisis point in many parts of the world. Ageing populations in Europe, the United States and most wealthy countries, combined with increasingly sophisticated medical treatments that require specialised staff, mean that demand for health workers in the developed world is outstripping supply. Indeed, the demand for health workers is not only outstripping our internal capacity to produce doctors and nurses: it is placing a huge strain on the international market for health workers.
The Commission has been leading and coordinating the development of a coherent European response. The communication on human resources for health has been debated and strong conclusions are due to be adopted by the Council. EU Member States have agreed a Statement of Commitment, which is being announced for World Health Day. That should demonstrate to the rest of the world that Europe takes this issue seriously and will support a significant response to the crisis.
However, the shortage of health workers in rich nations does not even begin to approach the severe shortages being experienced in many parts of Africa, where the lack of health workers can often mean the difference between life and death. With less than one health worker per 1000 people in Africa, compared to over 10 health workers per 1000 people in Europe, it is hardly surprising that the shocking and unacceptable death toll of children and their mothers continues. More than one in five children die before their fifth birthday and more than one in a hundred mothers die as a result of complications of pregnancy in many African countries. Progress towards the Millennium Development Goals in Africa is unacceptably slow, with progress reversal in some countries as a consequence of HIV/Aids. The burden of caring for the sick falls on families and communities who have few resources to cope with this significant burden.
The World Health Report for 2006 focuses international attention on the health worker shortage, and is very much welcomed. It puts a spotlight on a crisis that has been evolving over many years, but that now represents probably the most significant barrier to progressing towards the health-related Millennium Development Goals – reducing maternal and child mortality and controlling communicable diseases such as HIV/Aids, TB and malaria. Without doctors, nurses, pharmacists and other health workers, it will be impossible to improve healthcare, or to meet our commitments to increase access to essential services.
The causes of this crisis are complex. There has been chronic under-investment in health services in developing countries for many years, including under-investment in training of health workers. Many countries in Africa are still trying to run their health services on a budget of less than EUR 10 per capita – that is much less than the minimum of EUR 30 recognised as necessary for providing essential services.
But the problem is not just lack of investment in Africa. Many countries in Europe and elsewhere have underinvested and inadequately planned for health worker training to meet the needs of ageing populations. The rich world can attract health workers from other countries; the consequences for poor countries is that they train health workers who leave the country, effectively providing a perverse subsidy to health services in developed countries, by shouldering the burden of training costs.
Training more health workers worldwide is only part of the solution. Many health workers who are trained do not want to work in the poorest and most remote areas where needs are greatest. There is a pattern of internal migration from rural to urban areas, and from the public to the private sector, and from poor countries to richer neighbouring countries and then to the richer, developed world. However, it is difficult to blame the individual, once you have seen the conditions under which they have to work. We need to better understand the motivations of health workers, and to create incentive systems that encourage them to work where there is the greatest need.
The ‘push’ factors of poor working conditions, low salaries – which are paid irregularly, lack of drugs and equipment and lack of career prospects all contribute to the migration of health workers. Indeed, it is surprising that, given these poor conditions, you still get a hard core of dedicated health workers in many African countries who continue to do a remarkable job in very difficult circumstances. It is important not to lose sight of the achievement and the increasable contribution of many health workers who continue to serve their people, despite the challenges of their jobs and working environment.
The ‘pull’ factors for migration – better salaries in rich countries, better working conditions and greater security, which are sometimes coupled with aggressive recruitment practices by private recruitment agencies – also play a significant role in increasing health worker mobility.
These issues have all been described in the communication from the Commission to Parliament on the EU strategy of action to address the crisis in human resources for health in developing countries. If we are to overcome the crisis, developing solutions must begin in the countries most affected and must support strengthening of their planning and financing of health worker training, support and finance, and improved terms of conditions of services. It is essential that country action be supported by regional and global action, sharing knowledge and best practice, sharing training resources and changing international recruitment policies to make them more ethical. It is important that we look closely at our own health worker training programmes and increase our own production capacity, to make us more self-sufficient."@en1
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