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Health Workforce: The Global Crisis and the European Perspective
Dr Galina PerfilievaWHO Regional Office for Europe
Riga, Latvia, 17 June 2010
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Who are the health workers?
“The stock of all individuals engaged in the promotion, protection or improvement of health
of the populations”
( World Health Report 2000)
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� The cornerstone of health systems in all countries
� Central to sustainable health systems
� Core component in the delivery of health servicesin all countries
� Access to health services = access to health workers
� Effectiveness of health systems and the quality ofhealth services rely on the performance of health workers� The largest single cost element in any health system (60-80% of total expenditure)
Why are the health workers important?
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Health Workforce – A Global Profile
• Increased demand for health professionals at all le vels across the world → competition for personnel
• Globalisation of labour markets, removing barriers for labour flows
• Migration of health professionals is a global pheno menon
• Migration flows imply considerable brain drain up t o “fatal flows” in international health systems
• Global shortage: 4,3 million health workers are needed to achieve the health related MDGs
• Imbalances within countries (e.g. rural areas vs. cities)
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Picture of the global health workforce
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Countries with a critical shortage of doctors, nurses and midwives
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Distribution of health workers by level of healthexpenditure and burden of disease, by WHO region
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The Global shortfall: 4.3 million health workers
� More than 1 million new health workersare needed in next 6 years for the countries in sub-Saharan Africa to deliver the basic services.
� 13 African nations have fewer than 5 physicians per 100,000 people .
� A serious impediment to achieving the health-related MDGs.
More information on http://www.globalhealthtrust.org
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Magnitude of health problem in African countries
• Only 19 percent of Africancountries have at least 80 percentof their populations immunized for measles.
• 12,000 children die every day in sub-Saharan Africa
• Every minute 8 children die from easily preventable or treatable conditions, 2 of them are newborns
• On average, 910 women die for every 100.000 live births.
Sourse: “Child Survival: A Strategy for the African Region, WHO AFRO,2007
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International migrationInternational migration�Patterns of migration becoming more complicated and involving more countries.
�Skilled health professionals represent an increasingly large component of migration flows.
�In OECD: 11% of employed nurses and 18% of employed physicians are foreign-born.
The EU is an important destination: the registered 39 million The EU is an important destination: the registered 39 million migrants represent migrants represent apprappr . 8 percent of the total population, the . 8 percent of the total population, the number of irregular migrants is difficult to estima te.number of irregular migrants is difficult to estima te.
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Migration of Health personnel
•
Source: WHO Regional office for Africa
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Share of foreignShare of foreign --trained or foreign physicians trained or foreign physicians in selected OECD Countries in 2008 in selected OECD Countries in 2008 (or latest (or latest
year available) year available)
Source: OECD Observer, February 2010
0
5
10
15
20
25
30
35
40
P oland
A us tri
aF ra
nce
D enma rk
N e the rla
nds
B e lgiu
mF inla
ndC anada
S wed en
S w itze rla
ndAus tra
lia
U nited S
tate
s
U nited K
ingdomIre
la n d
N ew Zea la
ndS lo
va k Rep.
J a pa n
Gre
e ceIta
lyG
ermany
P ortug a l
N orw
a y
Foreign-trained physicians Foreign physicians
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Share of foreignShare of foreign --trained or foreign nurses in trained or foreign nurses in selected OECD Countries in 2008 selected OECD Countries in 2008
(or latest year available)(or latest year available)
Source: OECD Observer, February 2010
0
5
10
15
20
25
30
35
40
45
50
Fin
land
Neth
erlands
Sw
eden
Unite
d Sta
tes
Denm
ark
Canada
Unite
d Kin
gdom
A
us tralia
New
Zeala
nd
Irela
nd
Belg
ium
Fra
nce
G
ermany
Port
ugal
Italy
Foreign-trained nurses Foreign nurses
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• Joint Learning Initiative (JLI) report, 2004
• Resolutions WHA57.19 (2004), WHA58.17(2005)
– alarming issues of health worker Migration
• World Health Report 2006
• Resolution WHA 59.23 (2006) on the rapid
scaling up of health workforce production
• Resolution WHA 59.27 (2006) on strengthening
nursing and midwifery
• First Global Forum on HRH, Kampala, Uganda, March 2008
The response of WHO to the CrisisThe response of WHO to the Crisis
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The European Perspective
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Health workforce in Europe
• Health workers represents about 10% of the European workforce.
• Serious disparity in the characteristics ofhealth professions (numbers, job descriptions, roles and responsibilities, training paths, regulatory structures).
• Imbalances and maldistribution in almost all European Member States jeopardizing the right to health and solidarity, equity and participation .
• Lack of reliable data and information
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The European Commission DG Sanco estimates by 2020 a shortage of:
- 590.000 nurses- 230.000 physicians and- 150.000 allied health professionals
Estimated shortage of health workers in U
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The changing context of European health workforce
Demographic and
epidemiological change
Technological and
organizational change
Political and
economic change
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P
Geographical distribution of physicians in Europe
Source: WHO HFA database, June 2010
<= 700
<= 580
<= 460
<= 340
<= 220
No data
Min = 100
Physicians per 100000
Lastavailable
European Region339.21
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P
MaldistributionMaldistribution of general practitionersof general practitioners
Source: WHO HFA database, June 2010
<= 200
<= 160
<= 120
<= 80
<= 40
No data
Min = 0
General practitioners (PP) per 100000
Lastavailable
European Region67.92
Geographical distribution of general practitioners in France
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Diversities in the WHO European RegionDiversities in the WHO European RegionHealth professionals Health professionals / 100.000 population, 2007
72.46 *
(Sweden)
13.83
(Netherlands)
52.64
35.63 *
44.47
Midwives
114.8 *
(Belgium)
1.549.77
(Ireland)
163.95
(France)
534.59 *
(Greece)Highest in
EU
4.17 *
(Romania)
326.8 *
(Greece)
43.29 **
(Slovakia)
192.06
(Romania)Lowest in
EU
20.5794.7328.78376.78CIS
71.4*745.4796.68 *321.62EU
52.27 *725.967.92339.21European
Region
Pharmacists NursesGeneral
practitioners
Physicians
Source: WHO HFA database, data accessed in June 2010* 2006; ** 2005
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0
1
2
3
4
5
6
AustriaBelgiumBulgariaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUnited KingdomEU European Region
Last available
Ratio of nurses to physicians in European countries
Source: WHO HFA 2010, June 2010
What is the compositionWhat is the composition of European of European health workforce?health workforce?
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Doctors – 23.597Nurses - 16.425Midwives - 2.343Assistant nurses - 21.000 Health visitors - 407Allied health personnel – 9.768Administrative personnel – 8.448Technical personnel - 16.133 Others - 38
Greece: Composition of Hospital health workers, MoH, 2005
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2 00
2 50
3 00
3 50
4 00
4 50
1 9 8 0 1 9 9 0 2 00 0 2 0 1 0
Euro p ea n R eg io nEU C ISC AR K
P h y s ic ia n s p e r 1 0 0 0 0 0
Source: WHO HFA database, 2010
Trends in physician's density over the Trends in physician's density over the last 25 years in the European regionlast 25 years in the European region
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Trends in NursesTrends in Nurses’’ DensityDensity
500
600
700
800
900
1000
1985 1995 2005
European RegionEU CIS
Nurses (PP) per 100000
Source: WHO HFA database, 2010
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1390284013.567.274.3631.6313.25Slovakia
586852068.7671.2547.95304.91Latvia
35943190963.4781.7700.69365.41Italy
4954524602.82.5181.191083.4357.85Sweden
4077227206.53.5381.48780.42336.13France
358421886.8 ** 6.864.5179.21745.47* 321.62EU
GDP / capita
Pub. Exp. on health / capita
Outpatient consultations
/ capita
IMRLife Expectancy
NursesPhysicians
Economic constraints(Estimates) (2007)
Demand (2007)
Health Indicators (2007)
HRH / 10,000 pop (2007)
Source: WHO HFA database, 2010* 2006; ** 2005, *** 2004
Health Workforce Performance: Health Workforce Performance: comparison of selected indicatorscomparison of selected indicators
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Fifty-seventh session of the WHO
Regional Committee for Europe
Belgrade, Serbia
17–20 September 2007
Resolution EUR/RC57/R1Health workforce policies in the European Region
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• to improve and expand the information andknowledge base on the health workforce at country level, encourage research and build capacities
• to develop, embed and mainstream policies on health workforce, relevant to the needs of the country
• to assess the trends in and impact of health workforce migration in order to identify and act on effective migration-related policy options
Resolution EUR/RC57/R1
URGES Member States:
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• to give high priority to monitoring health worker migration and policy interventions at national and international level
• to facilitate the development of an ethical guide/framework for international recruitment of health workers
• to continue building and strengthening networks and partnerships, to advocate for more effective investment in health workforce development
The Regional Director:
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Fifty-ninth session of the WHO
Regional Committee for Europe
Copenhagen, Denmark
14–17 September 2009
Resolution EUR/RC59/R4
Health workforce policies in the European Region
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SIXTY-THIRD
WORLD HEALTH ASSEMBLY
Geneva
21 May 2010
WHO Global Code of Practice on the International Recruitment of Health
Personnel
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Thank you!