5 The EU and health workers in developing
countries
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17118/06
COM(06) 870
| Commission Communication: A European Programme for Action to tackle the critical shortage of health workers in developing countries (2007-2013)
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| Legal base | — |
| Department | International Development
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| Basis of consideration | Minister's letter of 20 March 2007
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| Previous Committee Report | HC 41-vii (2006-07) para 4 (24 January 2007)
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| To be discussed in Council | May 2007 General Affairs and External Relations Council
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| Committee's assessment | Legally and politically important
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| Committee's decision | Not cleared; further information requested
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Background
5.1 In response to a Commission Communication on HIV/AIDS, malaria
and tuberculosis), the Council requested that the Commission consider
the more general problem of lack of human resources in health
care in developing countries; which it did in its Communication
15774/05 of 12 December 2005. The focus was primarily on Africa,
in line with the EU Africa Strategy — where a global crisis
(75 countries with less than 2.5 health workers/1000 population)
has been exacerbated by the HIV/Aids pandemic — and the
primacy of the UN Millennium Development Goals (MDGs),[12]
where addressing the crisis in human resources in health is a
prerequisite to making progress.
5.2 "Push" factors identified in the developing
world include the lack of decent work opportunities and limited
incentives, particularly to work in under-served areas and with
poor people, and high health worker mobility. "Pull"
factors in the developed world include high global demand for
health workers, fuelled by ageing populations. Common to both
is inadequate long-term resource planning and domestic production
of health workers. The Communication proposed EU action at three
levels:
- country level (the main focus):
ensuring that human resource issues are adequately reflected in
health policy and within the wider development agenda in poverty
reduction strategies. Better country-specific problem analysis
and support to strengthen human resource planning and management
systems, to increase training of appropriate cadres, to improve
terms and conditions of service and to provide opportunities for
career progression. A major focus on efforts to increase retention
and distribution of staff to underserved areas;
- regional level: strengthened EU support where
such an approach adds value in relation to advocacy, information,
technical support, sharing best practice, and where appropriate,
in developing regional approaches to training and strengthening
research capacity; and
- EU action: development of an EU Statement of
Commitment to Global Action (to tie in with the WHA/WHO decade
of action on human resources) and a Code of Conduct on Ethical
Recruitment (an area where UK leads), better EU workforce planning,
strengthening networks of excellence linking EU and developing
country training institutions to offer post-graduate training
opportunities and work with the health worker diaspora (those
from the developing world working in the EU).
5.3 The 10-11 April General Affairs and External
Relations Council adopted Conclusions on the Strategy and called
on the EC and Member States to develop a coordinated response
in support of country level efforts to address the crisis in human
resources in health (HRH). The Council also adopted a Consensus
Statement on the Crisis in Human Resources for Health, stating
that:
"Europe is committed to supporting international
action to address the global shortage of health workers and the
crisis in human resources for health in developing countries".[13]
The Commission Communication
5.4 This present Communication sets out plans for
the coordinated response called for by the Council. When we considered
it on 24 January, we noted that, in his accompanying Explanatory
Memorandum, the Parliamentary Under-Secretary of State at the
Department for International Development (Mr Gareth Thomas) again
welcomed the recognition that rich countries must not only address
the domestic factors that attract health workers from developing
countries, but also support such countries to improve their health
systems and workforce planning processes. But while broadly supporting
what he described as a complex and ambitious Programme for Action
set out in the new Communication, he said it needed 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. He said he would be pursuing
this between now and the May "development" GAERC, which
will adopt Conclusions on the Communication.
5.5 In paragraph 4.1.(1) of the Communication the
Commission also proposes a "pull side" counterpart —
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.
We were surprised that the Minister said that the Government supported
this proposal without qualification. Neither the Communication
nor the Minister explained 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".
5.6 So we asked for the Minister's comments on whether
the envisaged strategy may lawfully be adopted under Article 152
EC, and for him to tell us, before the May GAERC —by which
time the draft Conclusions should be clear — how his concerns
about the Programme of Action had been met; and in the meantime
retained the Communication under scrutiny.
The Minister's letter
5.7 In his 20 March letter, the Minister recalls
his concern over "the lack of an implementation plan that
describes the concrete steps that would be taken in support of
the Communication's expressions of intent". He says that
the UK is not alone in its concerns and that:
"together with others, we have called upon
the Commission to develop an appropriate plan, and to report back
on progress at both collective and national EU level by December
2007. This has been made explicit in the draft Council Conclusions".
5.8 He then says that there is shared concern related
to the ambiguity of the language about the role of the African
Union (AU) and New Economic Partnership for Africa (NEPAD), and
that:
"the draft Council Conclusions have now
clarified that this involves a strengthening of the African Union
(AU) and the New Partnership for Africa's Development (NEPAD),
with a view to share (sic) lessons and hold (sic) their member
states to account on steps to address the human resources crisis
in the context of regional markets and economic migration. We
are happy with this".
5.9 The Minister then comments on whether the proposals
for a concerted European strategy on health professionals within
the Community may lawfully be adopted under Article 152 EC as
follows:
"DFID has sought clarification on the phrase
'concerted European strategy'. The phrase refers to an existing
process being led by the High Level Working Group on Health Services,
which is hosted by the Commission's Health and Consumer Protection
Directorate General. As the UK Department of Health is an active
participant in this process it will need to be fully consistent
with Article 152. Informal communication with the Commission clarifies
that the reason for referencing the 'concerted European strategy'
in the Communication is to seek to influence the strategy. The
strategy is likely to propose the monitoring of health worker
density patterns and movements within the Union, and to improve
information about where shortages and surpluses arise. DG Development
will seek to ensure that the strategy takes into account the impact
that Member States' training and recruitment policies have on
developing countries in a way that is consistent with Article
152. This is an essential component of solutions to address the
workforce crisis in developing countries.
"DFID has also consulted the Department
of Health and FCO on this topic, specifically requesting advice
from their solicitors and policy leads on workforce planning.
They advise that the phrase 'concerted European strategy' is a
loose term, implying a range of possibilities from more binding
measures to non-binding Council Conclusions (see below). In principle,
Community action to deal with a shortage of health care professionals
could fall within the type of matters that could be considered
under Article 152(1), and until such proposed Community action
is defined, there is no reason to assume that it will be contrary
to this article. This assumption is bolstered by the fact that
the strategy will be developed 'fully respecting the subsidiarity
principle' (4.1(1) in the Communication). Monitoring in principle
should not fall foul of article 152 and is to a degree already
the subject of Community action.
"In view of this advice, I believe that
there is no reason to expect that the Commission's proposals for
a 'concerted European strategy' will be unlawful under Article
152 EC. The Department of Health will, nevertheless, be heavily
involved in preparation of the proposal".
5.10 In light of these responses, he hopes that we
will now be able to lift the Communication from scrutiny.
Conclusion
5.11 We have set out in full the Minister's response
to our question about whether Article 152 EC provides a legal
base for the proposed strategy because we do not understand parts
of his explanation and are surprised that he has not given an
explicit assurance that the Government will carefully scrutinise
the proposal when it is made to ensure that it is lawful, proportionate
and consistent with the principle of subsidiarity. We shall certainly
wish to satisfy ourselves on each of those points when the proposal
is deposited in Parliament and we ask the Minister to ensure that
the Explanatory Memorandum he sends us fully sets out the Government's
view of all three issues.
5.12 We are also not reassured by his other comments.
We do not understand any more clearly than hitherto, beyond generalities,
what the roles of the AU and NEPAD are to be — particularly,
what the phrase "hold their member states to account on steps
to address the human resources crisis in the context of regional
markets and economic migration" means.
5.13 As for an implementation plan, all we have
so far is that the Commission will be asked to report progress
on the devising of one before the year's end. What will the Minister
do if, come December, the progress report shows that a convincing
implementation plan is not in prospect?
5.14 We understand that the Presidency is aiming
for the adoption of Council Conclusions based on this Communication.
We have no wish to hold up further detailed work towards this
end. But we do not yet feel sufficiently assured about these issues,
both legal and political, to feel able to clear the Communication,
and shall therefore continue to retain it under scrutiny.
12 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
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COM (06) 870, page 2. Back
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