Healthcare recruitment "harms poorest nations"

Hospitals rely increasingly on workers from abroad Keystone

The high proportion of foreign healthcare workers in Switzerland could have catastrophic consequences for developing countries, says an international health expert.

This content was published on February 8, 2010 minutes

The Federal Health Office has offered qualified support to a World Health Organization (WHO) proposal to improve the recruitment of staff from abroad.

Without foreign workers Switzerland’s public health system would grind to a halt. In many hospitals more than half the health professionals come from abroad.

Every year 13,000-16,000 non-graduate healthcare jobs need to be filled – a third more than the number of people actually completing training. In the care sector as a whole the deficit is 50 per cent.

As a result hospitals, clinics and other institutions have for years cast their nets abroad – those in German-speaking Switzerland mostly in Germany and those in French-speaking Switzerland mostly in France.

This plugs the worst staffing shortages in the Swiss healthcare sector, but it triggers a knock-on effect that spreads around the world.

“Germany is then forced to recruit in Poland, which has to look in Ukraine, which turns to Russia, which in turn has to go to developing countries,” said Martin Leschhorn from Medicus Mundi Switzerland (MMI), the network of Swiss organisations working in the field of international health.

He adds that the losers in this spiral are, as is often the case, the poorest and the weakest.

“In countries with only one doctor or midwife per 1,000 people, when [these health workers] emigrate, it is catastrophic for the local population,” he said.

This is particularly so in countries with high rates of HIV/Aids, where anti-retroviral therapies need well-trained staff.

WHO proposal

For this reason MMI is backing regulations proposed by the WHO concerning the international recruitment of healthcare workers.

Most importantly, recruitment should benefit everyone involved, i.e. the countries of origin, host countries as well as the emigrating workers themselves.

In addition, employers should only recruit in countries with which they have bilateral or multilateral accords concerning education or regional development.

“You can’t simply recruit in countries where there aren’t measures to compensate for the consequences of such emigration,” Leschhorn said.

Developing countries can only be tapped for healthcare workers if the recruiting country provides technical or financial support for the local healthcare system, for example in the form of aid for education or the construction of health stations.

Swiss support

Leschhorn sees one sticking point in Switzerland itself.

“The biggest headache the Federal Health Office has with the WHO proposal is the demand that all countries should train enough healthcare workers themselves,” he said.

This was not immediately recognisable as a problem.

“Switzerland immediately supported the idea of a practical and efficient code,” said Jean-Daniel Biéler, deputy head of the international section of the Federal Health Office at a WHO conference in Geneva last week.

He added that the immigration of healthcare workers would be the topic at the next national health discussion, at which the government focuses every year on one issue of public health.

Biéler made it clear however that the concept of self-sufficiency and compensation needed to be reformulated. “Only then could Switzerland endorse the conditions,” he said.

International programmes

Leschhorn accepts that significant efforts have been made to close the holes, such as strengthening education, introducing measures to keep people in jobs longer and improving work conditions.

The conference of cantonal health directors presented a report at the end of 2009 which covered suggestions for the centralising of healthcare education, something that is currently largely a matter for the cantons.

Leschhorn also admits that not all problems have their origins in the rich industrial countries, pointing out that immigration also exists in developing countries because care workers switch from primary healthcare to tempting international programmes such as the Global Fund.

“These staff are then lacking from primary healthcare,” he said.

Renat Künzi, (Translated from German by Thomas Stephens)

Staff shortfall

There are around 330,000 care and therapy specialists in Switzerland, but despite this requirements are not necessarily met.

For non-academic health professions, around 13,000 to 16,000 new workers are needed each year in Switzerland.

Annually, there is a shortfall of around 4,500 trained health specialists.

The biggest needs are in the care sector, which has a shortfall of around 2,400 employees.

Some studies reckon that Switzerland will have a shortfall of 25,000 employees in the health sector; others put that figure as high 45,000.

In 2020, the over-65 age group will have increased by 34 per cent over 2006. At the same time, the working population will have increased by four per cent.

The ongoing situation has forced hospitals to recruit abroad, with foreign personnel making up to 55 per cent of staff.

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