The healthcare skills drain - a call to action
May 2005
On 14 April 2005, the British Medical Association organised an international conference on the global health workforce in association with the Commonwealth, and with participants from the American Medical Association, the American Nurses Association, the Canadian Medical Association, the Canadian Nurses Association, the Commonwealth Medical Association, the Commonwealth Nurses Federation, Health Canada, the Medical Council of Canada, the Royal College of Nursing and the South African Medical Association. The conference agreed the following principles and recommendations.
The lack of healthcare workers in developing countries, particularly those in sub-Saharan Africa, is an emergency that demands urgent action. The impact of healthcare worker migration from developing to developed countries is a significant component in this crisis.
All citizens have a right to enjoy the highest attainable standard of health, and this, along with the prevention and treatment of ill health, is central to sustaining poor people’s ability to escape poverty. Measures to realise these aims are essential to the Millennium Development Goal of poverty reduction.
Therefore, recognising that:
- all countries need an adequate healthcare workforce strategy and the means to manage this, and that the workforce represents the most important investment in healthcare systems;
- many countries have actual and projected shortages of health workers. Examples include a projected deficit by 2020 in the USA of 200 000 doctors and 800 000 nurses, and one million health workers needed in Sub-Saharan Africa to meet the Millennium Development Goals (MDGs) by 2015;
- in countries which already have severe shortages of healthcare workers (fewer than one health worker per 1000 population) further loss of such workers through premature death or migration is very likely to result in loss of health services and loss of life in the countries’ populations;
- billion dollar funds amassed to address overwhelming global health problems (such as HIV/AIDS) are constrained primarily by the lack of healthcare professionals;
- All countries must strive to attain self-sufficiency in their healthcare workforce without generating adverse consequences for other countries;
- Developed countries must assist developing countries to expand their capacity to train and retain physicians and nurses, to enable them to become self-sufficient;
- All countries must ensure that their healthcare workers are educated, funded and supported to meet the healthcare needs of their populations;
- Action to combat the skills drain in this area must balance the right to health - go to note 1 - of populations and other individual human rights.
1) All developed countries must strive to attain self-sufficiency in their healthcare workforce without generating adverse consequences for other countries
- All nations should work towards self-sufficiency in the supply of health professionals with a view to meeting the future needs of their populations.
- All countries must commit to a clear and explicit human resources strategy to meet their healthcare needs for the next twenty years
- Developed countries must sign up to ethical recruitment policies (such as the Commonwealth Code of Practice for the International Recruitment of Health Workers)
- Developed countries must end reliance on health staff from developing countries (except in the case of countries with government to government agreements)
- Health professionals in developing nations cannot be effective without guaranteed programmes to produce universal access to clean water, public transport systems and local health facilities.
- Governments, NGOs and international organisations must work in partnership with developing nations to achieve this.
- Developed nations must create and implement schemes that encourage health professionals to undertake work placements for limited periods in developing countries.
- Developed nations must create twinning/exchange schemes between health training bodies, hospitals and clinics in the developed world and those in developing countries.
- The IMF and World Bank must relax the financial restrictions on Government spending in developing countries to allow for increased investment in health and health professionals
- All countries should do their utmost to develop incentives to encourage both the retention of the existing healthcare workforce and the return of workers who have left. Such incentives will include good human resources policies such as improved working conditions, flexible working arrangements, lifelong education, support for the achievement of personal and professional goals, the provision of security, and childcare facilities
- Countries should explore improving productivity by changing the skill-mix of the healthcare workforce through national reviews of its appropriateness
- In order to improve the efficiency of the healthcare workforce there should be an increase in the number of mid-level/paraprofessional workers world-wide
- Support is needed for the expansion of training facilities to increase the supply of health workers.
- Developing nations should consider working together with developed nations to address their educational infrastructure needs
- Programmes should be developed to encourage the recruitment and retention of healthcare workers in developed countries through returner support schemes, to reduce reliance on healthcare workers from other countries;
- Developed countries should create opportunities for their healthcare staff to undertake attachments/sabbaticals in developing countries.
- Governments must act upon their responsibilities to ensure that the right to health of their populations is upheld.
- Health workers should not be prevented from leaving their home or adopted country to pursue career opportunities or skills development in other countries.