Transcript Folie 1 - Action for Global Health

Ethical recruitment of health professionals – Madrid, 17th June 2011
Coordinating spaces - The
Netherlands example
Dr. Remco van de Pas
Wemos foundation, The Netherlands
On behalf of the Medicus Mundi International
network
Current trends in Dutch health
sector
• Demographic changes (23.7 % pop. > 65 year in 2035)
• Health-adjusted life expectancy inceased to 73y.
• Increase health care expenditure (25% of income 2020)
• Health care reform since 2006
• Government role changed from steering to safeguarding
• 1.1 Billion € budget cuts public health care (2011)
• Social protection changes (retirement increases to 67y.)
Trends in the health workforce
• Due to retirement amount of HCW will not increase
• Care will become more complex due to chronic illnesses
• Expected need of 470.000 extra HCWs in 2025
• Investments in education, self-sufficiency, carreeropportunities and working conditions
• Immigration of HCW from outside EU: 200 temporary
labour permits in 2008, of which 50% from LICs
• Shift from restrictive towards selective immigration
(So called circular - or knowledge transfer migration)
Foreign policy and international
development cooperation
• Change of government early 2011
• Migration important topic for current government
• ODA reduced from 0.8 % to 0.7 %
• Int. cooperation focus on economic development, less on
poverty reduction
• Thematic focus on water & food security and SRHR
• Bilateral assistance on health reduced considerably,
multilateral investments for health-related MDGs remain
(WB, GAVI,UNFPA, UNICEF, EC, IHP+, GFATM, WHO)
The Dutch HRH Alliance
• Created on initation by Wemos in 2009
• Recognizing the challenges on workforce development
and international shortages, maldistribution and migration
• Intersectoral initiative with aim to advocate and facilitate
dialogue with government departments and health sector
players on HRH related policies
• Composed of professional associations, labour unions,
INGO’s and CSOs, academia and independent experts
• Shared strategic plan, policy papers and media
statements, roundtable discussions, advocacy via MP
Implementation of the CoP and
the role of civil society
1. Contributing to implementation and monitoring framework
developed by WHO
2. Translation CoP, awareness raising at national level
3. Creation multisectoral HRH network and observatory
4. Stakeholder analysis and dialogue facilitation
5. Data-collection, research and monitoring
6. Development of bilateral or multilateral agreements
7. Address health governance, SDH and macro- economic
conditions that are root causes for health worker migration
Principles for intersectoral approach
on HCW development and migration
• Right to health in Netherlands and in global context
• Freedom of movement of health personnel
• Joint responsibility for health as a global public good
• ‘Health in all policies’ and ‘coherence for development’
• CoP on the international recruitment of health personnel
• Self-regulation via national healthcare governance code
• Sustainability and (e)quality within Dutch health system
Recruitment of Foreign Health Personnel
National Government
Ministry of Health,
Welfare and Sports
International
Affairs (IZ)
Ministry of Social
Affairs and
Employment
MEVA
Ministry of the Interior
and Kingdom
Relations
Agency SzW
CIBG
UWV
Werkbedrijf
Ministry of Foreign
Affairs
Minister of
Immigration and
Asylum policy
Ministry of
Education,
Culture and
Welfare
Ministry of
Economic Affairs,
Agriculture and
Innovation
DGIS
NZa
Executive Governmental
Organizations
Inspectorate
Agencies
Immigration
and
Naturalisation
Service (IND)
Labor Inspectorate
(Arbeidsinspectie)
Health Care Institutions (Employers)
Health Workers (Employees)
Social Partners
StAZ
BoZ
Abvakabo
V&VN
Employer Organizations
Health Care
Governance
Commission
Dutch labor unions and health professional
organizations
KNMG O&R
HRH – alliance
RVZ
Health Council
Dutch Civil Society
Organizations
National
CEG
Advisory
Councils
Recruitment Offices
WHO
SER
ZIP
Capacity Body
Works Council
WRR
EPSCO
International
International
Organizations
EU
IOM
Current situation
PROBLEM A
PROBLEM B (‘SLUITPOST’)
Shortage HRH Netherlands
- Financing of education (preservice&post-graduate) Solutions
- Attraction, retention / actions
Foreign recruitment
PRIMARY ACTIONS
SECONDARY ACTIONS –
STIMULATING
SECONDARY ACTIONS COUNTERING
- Education Fund (specialized)
- Knowledge Migration
(specialized)
- Working permit (non-highly
skilled)
GOALS (WHO CODE)
- Self-sufficiency
-Ethical
- Compensation
-Collection and exchange of data
-Guaranteeing rights
Information: technical and
responsibilities on HCW migration
Technical: Lack of qualitative data
•
Responsibilities:
MoH is responsible for bilateral agreements
MoSE is responsible for work permits
MoH is responsible for ‘Opleidingsfonds’
MoE is responsible for numerus fixus
MoFA is concerned with migration and development,
but development efforts are targeted at countries
with low HDI (not where migrants come from)
SER advice on migration, brain drain and health care is
not addressed to MoH
Conceptual model of policy implementation
(Adapted from Bressers, 2004, Spratt, 2009)
Motivation and power
Stakeholder
Objectives/ responsibilities
Motivation
Power
Employers
- HRM – recruitment at low costs
- HRM – quality
- Post-graduate education
- Good governance, ethical recruitment
- Implementation Code
+
+
??
++++
Recruiters
- Attract and recruit health personnel
-Acquire Hallmark?
??
++++
Minister of
Immigration
and Asylum
and IND
- Making NL attractive for highly skilled
migrants and foreign students needed in the NL
- prevent permanent migration of loweducated migrants
- More power to the referent (e.g. employer)
-Concerned with negative impact of knowledge
migration to NL (drain)
MoH and
CIBG
- Quality of care
- Accessibility of care
- Affordability of care
- Power with the market, self regulation
++++
-
+/+
+
- / ??
-
+++
Motivation and power – continued
Stakeholder
Objectives / responsibilities
Ministry of
Foreign Affairs
- Creation of global conditions that serve NL
interests
- Development cooperation policies
- Migration in general (not health in
particular) and pro-poor
- Coherence between policies regarding
developing countries
- Piloting managed migration through
temporary/ circular migration
Ministry of
Social and
Labour Affairs
and UWV
- Functioning national labour market
- Good working conditions
- Professional development
- Participation in labour market
- Guaranteeing labour migrants’ rights
- Recruitment from EEA first
Ministry of
Education
- Pre-service education of HRH based on
planning with VWS and capacity organ
Motivation Power
++
??
-
+
??
??
??
??
??
+
+
+++
+++
- / ??
Motivation and power – continued
Stakeholder
Motivation
Power
Min. Economic - Time efficient procedures for attracting
Affairs
highly skilled migrants
-
++
Insurance
companies
- Quality of services
- Costs of services
+
-
+++
Professional
organizations
- HRH quality
- HRH motivation (workload, …)
- HRH status (nurses, medical specialists)
- HRH protection
- HRH freedom to move
- HRH international solidarity
+
+
+/+
+
+
++(+)
Ministry of
Finance
- Budget allocation for health and
education sector
Advisory and
inspectorate
bodies
-SER and WRR: Labour migration does not
solve problems
- NZa: expand numerus fixus and aio places
- Arbeidsinspectie: supervision knowledge
migrants
+
- Health system strengthening in LICs
+
CSOs
Objectives / responsibilities
++++
-
++
+
+
++
First conclusion of mapping
stakeholders and powerrelations
Information: Responsibilities are with different actors
•
Motivation:
Non-matching interests between actors
Stakeholders responsible for implementation code are
not highly concerned with the effect of foreign
recruitment on health systems in developing countries
Interaction: Seemingly difficult to convince actors of value
of making links and intersectoral agreements
What other ‘Powers’ can be targets or strategic alliant?
Eg Ministry of Finance
Next steps for research and advocacy
• In-depth qualitative information of motivation and
• interaction between stakeholders:
- Agree general principles in the CoP?
- Does the CoP match your goals?
- Principles CoP reflected in existing Dutch Code?
- Possibilities and limitations implementing CoP in NL?
- Ideas stakeholders, roles, powers and responsibilities?
- Ideas about incentives, monitoring and enforcement?
• Writing of a publication and media involvement
• Round table dialogue with ‘champions’ of health sector
• Support data-collection and reporting national focal point
• Exchange with other alliances and governance platforms
International mobility of health
workers - an ethical approach
For more information, find HRH dossiers at:
www.wemos.nl
www.medicusmundi.org
[email protected]