Opening remarks at the Subregional Policy Dialogue on Health Professional Mobility in Central and Eastern Europe

5 April 2011, Budapest, Hungary

Delivered by Hans Kluge, Director, Division of Health Systems and Public Health, on behalf of Zsuzsanna Jakab, WHO Regional Director for Europe.

Honourable Minister Szócska, distinguished colleagues, ladies and gentlemen, I am delighted to be here today at this important event – the launch of the publication Health professional mobility and health systems: evidence from 17 European countries and opening of the Subregional Policy Dialogue on Health Professional Mobility in Central and Eastern Europe.

The international recruitment and migration of health professionals has been a growing feature of the global health agenda since the late 1990s. Physicians, nurses and other health workers have always taken the opportunity to migrate in pursuit of new opportunities and better career prospects. However, the level of migration has increased significantly in recent decades, and the patterns of migration have also become more complicated and involve more countries.

The world is currently experiencing a global health workforce crisis, with a global deficit of about 4.5 million health workers. Many low- and medium-income countries no longer have enough health workers to provide the most essential health care. This critical shortage undermines our collective ability to meet the health-related Millennium Development Goals.

The global shortage has the potential to deepen in the coming years. The need for health workers will escalate markedly in all countries, rich and poor. Shortages in higher-income countries send strong market signals to poorer countries, with an inevitable response through increased flows of migrant workers. The exodus of health professionals from poorer countries that invested in their education is jeopardizing the right to health in these countries and represents a major policy challenge to their governments.

The consequences of health professional mobility have become a prominent public policy concern in the past few years.

In order to provide a global response to this concern and address the global health workforce shortage, the 2004 World Health Assembly requested WHO to develop a code of practice on the international recruitment of health personnel.

The WHO Regional Office for Europe and the European Member States strongly supported the development and adoption of the code, building on their experience with national and regional codes, ethical workforce policies and other instruments for managing health professional mobility as well as broader aspects of health workforce policy and planning.

Following discussions in numerous international and national forums and consultations with all stakeholders, the Sixty-third World Health Assembly adopted the WHO Global Code of Practice on the International Recruitment of Health Personnel on 21 May 2010.

The Code is the only global framework for international cooperation on health workforce recruitment; it provides key guidance to Member States on internationally accepted ethical norms and principles related to health worker migration, discourages recruitment from countries with workforce shortages and provides guidance to strengthen the workforce and health systems across the globe, including an emphasis on improving staff retention, workforce sustainability and effective workforce planning. It should make a strong and ongoing contribution to addressing the global health workforce crisis.

The Code is relevant for the European Union and the broader European Region and provides a framework for developing the health workforce and ensuring the sustainability of health systems. It stresses strengthening and further developing education and training and monitoring and coordinating labour market activities; it addresses the skewed distribution of health professionals through educational measures, financial incentives, regulatory measures and social and professional support.

Although voluntary by nature, the Code includes provisions for monitoring efforts by governments to align their policies with its provisions.

Effective policies to address the drivers, trends and effects of health workforce migration need to be grounded in a sound evidence base. Although information on health workforce migration is becoming more available, knowledge about international migration flows is far from complete.

The Code encourages Member States to strengthen or establish health workforce information systems, including information on migration, in order to collect, analyse and translate data into effective health workforce policies and plans.

Crucial to making the Code work is agreement on data sets and information exchange. It needs to gain strength by building a body of knowledge and evidence that can help inform how to ensure flows that enable shared, sustainable solutions and mutual gain.

The publication, with findings from the PROMeTHEUS Project, presents evidence from 17 countries on health professional mobility in Europe. This work is an excellent example of scientific intercountry collaboration on health professional mobility. The book presented today comprehensively analyses mobility patterns and the effects of migration on health systems and the relevance of this for policy-making and policy responses across Europe.

I therefore welcome this volume, with its emphasis on the need to put health professional mobility into the wider context of country efforts and health systems.

I wish you a most productive meeting and interesting discussions on health professional mobility: surely one of the greatest challenges facing public health.