No tug of war: Health workforces, policy coherence and the HiAP approach

DISCLAIMER: All opinions in this column reflect the views of the author(s), not of EURACTIV Media network.

Healthcare performance

The Commission says healthcare is at the heart of the European social model. [Shutterstock]

Whether in Europe or the developing world, people are deprived of quality healthcare, and national health systems are pitched against each other in competition for qualified health workers, write Sascha Marschang and Linda Mans. 

Sascha Marschang is policy manager for Health Systems at the European Public Health Alliance (EPHA) and Linda Mans is coordinator of Health Workers for All at the Wemos Foundation.

‘Health in All Policies’ (HiAP) was the theme of the 2015 EPHA conference that took place on 2-3 September in Brussels, which took stock of the concept first introduced by the Finnish Presidency in 2006. Vitally, the HiAP approach ‘systematically takes into account the health and health systems implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity’.

In spite of insufficient exposure and implementation problems, not least due to its broadness and value-based underpinnings, the conference explored how HiAP remains a valuable guiding principle for a future European ‘Union for Health’. The concept also shows a parallel with policy coherence for development (and even contributes to sustainable development) and offers interesting elements for the human resources for health (HRH) policy shortcomings underlined by HW4All.

As the collection of case studies published by HW4All demonstrates, the ‘solution’ to the global HRH crisis relies to a great deal on promoting and achieving better policy coherence between health and migration/mobility, development, employment and other policies that – underwritten by the aim of improving population health – need to be properly aligned in order to plan, train, recruit and retain adequate numbers of health professionals in both ‘sending’ and ‘receiving’ countries.

The WHO Global Code of Practice on the International Recruitment of Health Personnel is the main international tool available to achieve this, but as a voluntary instrument it requires reinforcement at national and regional levels to really make a long-term impact. Moreover, it relies on effective, orchestrated collaboration between actors at different levels and representing diverse political, civil society and business interests. 

Two examples illustrate what can be achieved in different settings. To begin with, the HW4All case study recounted by Belgian NGO Memisa illustrates how a partnership approach focusing on policy coherence and driven by concerns about universal access to health resulted in a Charter that not only comprises ethical recruitment but crucially also emphasises supporting institutional development in countries of origin to shape sustainable health workforces. 

The Charter was elaborated by the members of the Be-cause Health Platform which brings together Belgian academic and development cooperation actors. Their common goal is to work towards achieving universal health coverage through health systems strengthening and advocating sustainability in HRH policies. 

The commitments of the Charter buttress the WHO Global Code’s training and recruitment principles, but they go further by offering concrete HRH policies and development plans to be implemented by institutions both in Belgium and in partner countries, tied in with follow-up and evaluation. The strong focus on global responsibility and partnership has resulted in efforts by the Congolese government to draw up a Charter based on the Belgian template, linking up development cooperation with health institutional actors. 

Secondly, in Italy the work of NGOs and universities in cooperating at cultural and educational level with the FNOMCeO (Federazione Nazionale degli Ordini dei Medici e degli odontoiatri) has made a huge contribution to connect health professionals working at national level with global realities experienced in developing country settings.

Several recent manifestos – on multiculturalism in healthcare, global health and health workforce strengthening – have sensitised Italian health professionals to the benefits of adopting a development cooperation approach within the health sector. This has also stimulated the creation of an internal Committee on Global Health and Development Cooperation, which includes the participation of civil society representatives.

In this way, multi-stakeholder cooperation has produced public health gains through the promotion of quality healthcare both in Italy and abroad. By putting health professionals at the core of the process, involving them in shaping globally responsible ethics, and setting up bilateral framework agreements and regional laws to allow the transfer of skills between Italy and countries in the South, the FNOMCeO committee has demonstrated that ‘health in all policies’ is indeed possible and can produce benefits at global, national and local level. 

Both case studies have also helped national policy makers recognise the importance of ‘pulling in the same direction’ when it comes to HRH policies which crucially relies on establishing links with key areas beyond the health sector, including development actors, fiscal policies, social services and protection.

That this ‘comprehensive’ approach is also increasingly underlined on the international stage is confirmed by the fact that the 2016 World Health Assembly will focus on adopting a new Global Strategy on HRH: Workforce 2030. Because ultimately, what is at stake is solidarity and access. Whether in Europe or the developing world, people are being deprived of quality healthcare, and national health systems are pitched against each other in the disgraceful competition for qualified health workers.

We need to reverse this trend – collectively.

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