Here is a subject dear to my heart and critical for achieving global health equity.
“Health Workers for All and All for Health Workers’ was the slogan of First Global Forum on Human Resources for Health, March 2008, Kampala, Uganda.
The COVID -19 pandemic has once again exposed the global health workforce (HWF) crisis that is characterized by wide spread shortages, mal-distribution and poor working conditions. This HWF crisis was documented by the report of the Joint Learning Initiative on Human Resources for Health in 2004. The HWF shortages have today resulted in a silent scramble to recruit health workers from poor countries by the richer countries. This scramble is inspired by the urgent needed to fill gaps in the scaled up COVID -19 responses and to address long standing HWF shortages.
Visa requirements for health workers have been eased and I have seen recruitment agencies openly advertising for health workers from Africa, Asia and the Caribbean in web posts of some government agencies and in social media. These agencies are convening meetings in poor countries to pirate away health workers who are needed more in their home countries. Significantly, some African and Caribbean countries have formally protested against these clandestine recruitment but have been ignored. These countries have been left to appeal to the patriotism of their HWF to mitigate the dreaded exodus that would cripple health systems during these times of crisis.
This piracy of health workers, left uncontrolled, carries a public health threat to all countries of the world and is untenable. The pivotal role played by the HWF in public health and health emergencies as exposed by the COVID -19 pandemic is sufficient to classify health workers as a Global Public Health Good at par with or ahead of vaccines and drugs. The G20 leaders met recently with the WHO and agreed to collaborate in urgently in developing and equitably sharing new technologies including vaccines and therapies for COVID -19. They should also have included HWF in these discussions and it is regrettable that global support for the HWF agenda has declined. So what is the problem?
Evidence from the UN High Level Commission on Health Employment and Economic Growth (www.who.int/hrh/com-keeg/en) shows that between 2000 and 2010 there was 60% increase in migrant doctors and nurses working in OECD countries and the increase was 84% for those who migrated to OECD from countries previously identified by WHO with critical HWF shortages. Even worse, there are disturbing unethical stories of these migrant health workers being treated differently from local colleagues in destination countries and are impoverished and dying disproportionately from COVID -19.
These global HWF labour market dynamics are driven by demographic realities of ageing populations in the rich countries who require increasing health services and social care which cannot be met by the local labour market. The WB Global Monitoring Report 2015/16 and the UN Population Prospects 2019 Data booklet show declining working age populations in rich countries and the fact that half of worldwide population growth between2019-2050 will come from Sub-Saharan Africa. The Global HWF strategy 2030 estimates a global shortage of 18 million health workers. It points out that in the face of these demographic realities, rich countries will afford to import the health workers that they need while the poorer countries will not have resources to employ their needed HWF. This imbalance leaves global health security in a perilous state that is not acceptable. Fortunately, we have a solution.
The WHO Code on the International Recruitment of Health Personnel (www.who.int/hrh/migration) was adopted by the World Health Assembly in 2010 following acrimonious debates between Health Ministers from rich and poor countries over unregulated recruitment practices. The Code took six years to negotiate and is comprehensive. The objective is to scale up training and share a global HWF pool guided by the Code using voluntary ethical practices; taking into account the rights, obligations and expectations of source and destination countries and above all of the migrant health personnel. The goal is that countries will use the Code, led by Ministries of Health, to negotiate mutually supportive binding agreements for sharing and upholding the rights of all health personnel.
This is an appeal and a call to action for global solidarity and to all countries to take advantage of the COVID -19 pandemic to refocus attention and effort on the global HWF crisis and the WHO Code. This provides the only solution to move from current conflict to collaboration in our quest to provide a skilled, motivated and supported health worker for every person in every village everywhere.
How do we create a global movement that will make this happen?