Select Committee on European Scrutiny Sixteenth Report

5 The EU and health workers in developing countries



COM(06) 870

Commission Communication: A European Programme for Action to tackle the critical shortage of health workers in developing countries (2007-2013)

Legal base
DepartmentInternational Development
Basis of considerationMinister's letter of 20 March 2007
Previous Committee ReportHC 41-vii (2006-07) para 4 (24 January 2007)
To be discussed in CouncilMay 2007 General Affairs and External Relations Council
Committee's assessmentLegally and politically important
Committee's decisionNot cleared; further information requested


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.


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

13   COM (06) 870, page 2. Back

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