The Commission Communication
4.6 This present Communication sets out plans for
the coordinated response called for by the Council. It notes that
the problem of health worker migration, and the role played by
rich countries in creating the problem of health worker scarcity
in developing countries, especially Africa, has been on the international
development agenda for several years: poor terms and conditions
create incentives for workers to migrate to seek better opportunities;
but little evidence that substantial remittances sent home provide
adequate compensation for the impact on health systems, and by
implication, the health of the poor in those countries.
4.7 Developed countries are accused of contributing
to the problem by recruiting health workers from countries in
which health services are understaffed. The issue is difficult
to address because the interests of developing countries are not
aligned with the interests of health systems in rich countries,
who benefit from being able to access a pool of highly skilled
labour that they have not had to invest in. Although EU Member
States and the Commission already provide support to strengthen
human resources for health (HRH) in developing countries, more
could be done, and could be based on more systematic analysis
of the problem.
4.8 Specific steps for the Commission and EU Member
States operating bilaterally include:
— raising
the HRH problem in wider working groups in developing countries,
particularly those addressing barriers to achieving Millennium
Development Goals concerning child mortality, maternal health,
and HIV, TB, and malaria;
— increasing the predictability and longevity
of funding commitments and linking them more clearly to outcomes,
through use by the Commission of MDG contracts (long-term budget
support commitments intended to finance progress towards meeting
the MDGs), and by influencing international financial institutions;
— supporting national efforts to evaluate,
plan for and manage human resource capacity development and to
engage civil society and the private sector effectively in the
national response; drawing on expertise at the World Health Organisation,
particularly the Global Health Workforce Alliance and Health Metrics
Network (which aims to improve health by strengthening and aligning
health information systems around the world);
— providing more technical assistance and
research that helps developing countries to plan and retain health
workforces better;
— giving more support to develop health
worker training capacity, particularly linking developing country
institutions with counterparts in EU Member States, and particularly
at a regional level in Africa;
— supporting links between EU Member States'
professional associations and regulatory bodies, and those in
developing countries;
— based on solid evidence of what works,
supporting reform of HRH employment terms and conditions in public
sectors in developing countries, in the context of wider civil
service reform steps, in order better to attract, retain and motivate
staff;
— when forming policy, recognising that
HIV/AIDS is having an impact on the health workforce both through
increased workload, and also because it affects health workers
themselves;
— making sure that the Commission's Humanitarian
Office (ECHO) addresses HRH in its policies for fragile states.
4.9 Other steps include: paying attention to gender
issues in health workforce terms and conditions; supporting policies
that recognise the need to support communities; and providing
better coordination of technical assistance to developing countries.
4.10 The document also identifies the need for more
EU support to regional institutions. A regional platform on HRH
in Africa and an Asian Action Learning Network on HRH have been
established. The Programme for Action also proposes support for
regional actions by the New Partnership for Africa's Development
(NEPAD)[8] and the African
Union (AU; the successor to the Organisation of African States)[9]
to strengthen the African voice in the response to the crisis.
The EU will also try to help African countries to develop regional
policies and mechanisms to achieve "managed migration"
of HRH regionally, to reduce the negative impacts of migration;
and will support collection and use of information and policy
materials. The EU will support regional HR mapping and regional
meetings. The document proposes the use of innovative mechanisms
to address HR shortages, such as support for improved use of information
and communication technology to support training and provision
of health services. Finally, regional research capacity will be
supported.
4.11 The document also identifies specific steps
for the EU operating at European and global levels:
— noting
the rising shortages of health workers in Europe, it calls for
a concerted European strategy that addresses monitoring, training,
recruitment and working conditions of EU health professionals
in a way that does not worsen the HRH crisis in developing countries;
— it supports calls at the World Health
Assembly for a global code of practice on ethical recruitment
of HRH;
— it supports action to develop links between
diaspora communities and their home countries;
— it proposes that the EU should develop
mechanisms and guidelines on "circular migration" (non-permanent
migration between nations). This includes exploring such possibilities
as protection of migrant worker pension rights outside Member
States;
— it calls for support to EU Member States'
HRH training institutions that wish to develop partnerships with
counterparts in developing countries.
4.12 The Programme for Action sets out the following
next steps:
— in
the context of the costs of addressing the HRH, the Commission
and Member States to start measuring financial support to HRH
and benchmark against other donors;
— the Commission to commit €40 million
(£26.9 million) over 2007-13 to a range of catalytic and
strategic steps in support of the objectives described above,
including investing in leadership development in regional institutions
and supporting engagement of civil society and the private sector
in responses;
— using the Health Metrics Network frameworks
being developed, the Commission and Member States to improve monitoring
of HRH progress for reporting to the European Parliament and the
Council.
The Government's view
4.13 In his 17 January 2007 Explanatory Memorandum,
the Parliamentary Under-Secretary at the Department for International
Development (Mr Gareth Thomas) welcomes the recognition that rich
countries must address the domestic factors that attract health
workers from developing countries, but must also support such
countries to improve their health systems and workforce planning
processes and broadly supports the Programme for Action as set
out in the Communication. He continues as follows:
"Many of the policies are already in line with
DFID policies on HRH, aid effectiveness or strengthening health
systems. We are particularly supportive of points about EU support
for action in developing countries to improve staff retention;
and EU steps to improve sustainability and longevity of support
for health systems. However, we think that the Programme for Action
is complex and ambitious, and therefore are concerned about the
lack of a more detailed implementation plan. We will be advocating
for better planning going forward.
"Paragraph 4.1 (1) of the Communication proposes
that 'While fully respecting the subsidiarity principle, a concerted
European strategy covering issues such as monitoring, training,
recruitment, and working conditions of a sufficient number of
health professionals will be developed to help ensure that the
Union as a whole will be able to meet its objective of providing
high quality health care, without exacerbating the human resource
crisis in developing countries.' We (including the Department
of Health) support this proposal.
"We support the plan to develop a set of principles
to guide recruitment. These principles will be modelled on those
already in place in the UK. In 2001 the UK, uniquely, instituted
a code of practice governing the international recruitment of
health workers. It proscribes active recruitment of health workers
by National Health Service employers and tries to discourage the
private sector from doing so. It promotes the labour rights of
international staff working in the UK health sector.
"We do not see the AU and NEPAD as implementing
agencies in this context but more as providers of political advocacy,
accountability and facilitating lesson-learning across member
states. Also, actions at regional level should not cut across
AU/NEPAD member state responsibilities. The Programme for Action
text proposes 'strengthened AU/NEPAD leadership of regional action'
and calls for 'a regional platform for action.' We will propose
that the Council Conclusions recognise that this slightly ambiguous
statement should not lead to the development of additional AU/NEPAD
secretariats seeking to direct the actions of AU/NEPAD member
states".
4.14 Looking ahead, he says that the Programme for
Action will be considered at the May General and External Relations
Council.
Conclusions
4.15 The Minister notes the need for what he describes
as a complex and ambitious Programme of Action to acquire the
necessary focus of a detailed implementation plan, and to avoid
the creation of an unnecessary layer of bureaucracy between the
EU and Member States and the African partner countries whose endeavours
they are trying to support, and will be pursuing this between
now and the May "development" GAERC, which will adopt
Conclusions on the Communication.
4.16 We are surprised that the Minister says that
the Government supports, without qualification, the proposal in
paragraph 4.1.(1) of the Communication, for a concerted European
strategy on health professionals within the Community. Neither
the Communication nor the Minister explains how this may properly
be done under Article 152 EC, which provides only for Community
action to complement that of Member States and requires, in Article
152(5) EC, any such action to, "fully respect the responsibilities
of the Member States for the organisation and delivery of health
services and medical care". We should be grateful for the
Minister's comments on whether the envisaged strategy may lawfully
be adopted under Article 152 EC.
4.17 We should also be grateful if he would write
to us before the May GAERC, by which time the draft Conclusions
should be clear, to show how his concerns about the Programme
of Action have been met.
4.18 In the meantime, we shall keep the Communication
under scrutiny.
6 The eight Millennium Development Goals that, in 2000,
the UN set itself to achieve, most by 2015: eradicate extreme
poverty and hunger; achieve universal primary education; promote
gender equality; reduce child mortality; improve maternal health;
combat HIV/Aids, malaria and other diseases; ensure environmental
sustainability; develop a partnership for development - each with
associated targets and benchmarks to measure progress. Back
7
COM (06) 870, page 2. Back
8
The NEPAD strategic framework document, which was formally adopted
in 2001, arises from a mandate given to the five initiating Heads
of State (Algeria, Egypt, Nigeria, Senegal, South Africa) by the
Organisation of African Unity (OAU) to develop an integrated socio-economic
development framework for Africa. See http://www.nepad.org/2005/files/home.php
for more information. Back
9
See http://www.africa-union.org/root/au/AboutAu/au_in_a_nutshell_en.htm
for further information. Back
