human resources for health - a bottleneck for primary health care? dr. remco van de pas wemos, the...

Human Resources for Health - A bottleneck for Primary

Health Care?

Dr. Remco van de Pas

Wemos, The Netherlands

Medicus Mundi International network

People’s Health Movement

Conference 50 years Medicus Mundi: Atención Primaria de Salud y Cooperación: ¿una utopía? 7-6-2013

Interrogating scarcity – a valuable alternative

approach?“[S]carcity is not the result of

any absolute lack of a resource but rather of the decision by society that it is not prepared to forgo other goods and benefits in a number sufficient to remove the scarcity” (Calabresi & Bobbitt, 1978)

WHO: 6 building blocks of a health system

(Bozorgmehr, 2010)

International recruitment of HRH: An ethical approach -

Task shifting?

(Javanparast et. al, 2011)

Macro-economic frameworks and fiscal space

(Wibulpolprasert, 2003)

(Wibulpolprasert, 2003)

International actors influencing workforce

development • IMF: Wage bill ceilings (17 African countries

2003-2005)

• WB: Grants & Loans: incentives for rural delivery, training, infrastructure, health sector reforms

• WTO: Foreign direct investments in health

• G8, Bilateral dev. cooperation, Gates foundation, BRICS..

• WHO: WHR 2006, guidelines on retention and distribution, workforce observatories and national planning, integrating CHW & taskshifting, HSS, Code of Practice Int. recruitment

• Global Health Workforce Alliance: advocacy, enabling funding, Country coordination & facilitation, “leadership”, migration

• GFATM & GAVI: HSS? Eg HRH emergency plan Malawi

• NGOs: Capacity building but also creating parallel systems

“Key advances have occurred but challenges requiring increased attention”

(2nd global forum on HRH, 2011)

“The G8 members will work towards increasing health workforce coverage(2008):

Overall, outcomes achieved are assessed as ‘below expectations’ ”

(G8 accountability report, June 2013)

“Understanding the impact of global trade liberalization on health systems pursuing

UHC”

o WTO – GATS, regional and bilateral Free Trade Agreements(FTA)

o 4 modes (cross-border supply, consumption abroad, commercial presence, mobility of personnel)

o Principles also in EU “Maastricht treaty” (1992) – single market

o Health workers moving from public to private sector

o Medical tourism o International recruitment of health personnel o Remittances, knowledge exchange, exacerbating

imbalanceso Global governance for health in relation to FTA?

(Missoni, 2013)

(Kondilis et. al., 2013)

“Investment in intensive programmes to help people return to work; Active Labour Market Programmes reduce depression and suicides”

“ The fiscal multiplier – the economic bang- for spending on health care, education, and social protection is many times greater then for money ploughed into, e.g. bank bailouts or defense spending”

(Stuckler, 2013)

Alternatives?

• Iceland investing in social protection after 2008 crises

• Netherlands investing social protection oil crises ’70s

• Brazil national health policy based on integrated primary health care & social protection

• Ethiopia: integration 30.000 extension health workers

• Ghana: HSR (2008), fiscal flexibility for higher wages

• Thailand: fiscal flexibility UHC & public staff

• Cuba: health workers at the core of society

“While critics have been correct to blame the International Monetary Fund for its policies curtailing public health spending in developing countries, their analysis generally neglects the underlying issue of why developing countries are seemingly unable to build their domestic tax base on which health budgets depend. International health advocates should engage with such macroeconomic questions and challenge the failures of the dominant neoliberal economic model that blocks countries from industrializing and building their own productive capacities with which to generate their own resources for financing their health budgets over time.”

(Rowden, 2010)

Remco van de PasRemco.van.de.pas@wemos.nl

www.wemos.nlwww.medicusmundi.orgwww.phmovement.org