IFMSA Policy Statement Human Resources for Health

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1 IFMSA Policy Statement Human Resources for Health Location: Taipei, Taiwan. Date of Adoption: August 9 th Date of Expiry: August 9 th Summary We, the International Federation of Medical Students Associations (IFMSA), affirm that the quality and quantity of the health workforce in any given country play a significant role in improving health outcomes and achieving greater equity in health locally, nationally, regionally and globally. The shortage and inequitable distribution of healthcare professionals is recognized as one of the fundamental constraints to achieving progress on the current health-related Millennium Development Goals, as well as realizing Universal Health Coverage, as a key component for health and the post-2015 development agenda discussions. We believe that the human resources aspect of all health systems is generally underfunded and undervalued in regards to health planning and financing. Furthermore, we acknowledge the importance of international standards in medical education and healthcare delivery in improving the quality of healthcare all over the world, as well the improvement of social conditions in which the health care professionals work. We call upon governments to give utmost commitment to addressing the health workforce crisis and to set out a clear vision and plan for their health workforce. We call upon development partners and non-governmental organizations to work with national governments to ensure that collaboration can ensure these efforts are realized. We call upon educational institutions, especially medical school to provide transformative health education that produces future health professionals equipped with competencies that are useful for responding to the health needs of local communities. Introduction Quantity Currently over 1 billion people worldwide lack access to quality health services [1]. The WHO estimates that an additional 4.3 million doctors, nurses and midwives are needed [2] ; and this shortage is predicted to exacerbate - by 2025 an extra 8.5 million healthcare workers will be needed. Not only is there a huge shortage of qualified health workers worldwide, but there is also an imbalanced skill mix and uneven geographical distribution within and between countries. Of the 57 countries with critical shortages and misdistribution of health workers, 36 are in Sub-Saharan Africa, 6 are in South-East Asia and 5 are in Latin America and the Caribbean [2].

2 Despite this, there are nowhere near enough health professionals being educated [1]. Again, the education of health professionals has uneven geographical distribution, especially in Africa, where the healthcare needs are actually the greatest. Increasing the number of health professionals graduating from education programs will not be enough. The shortage of professional workers is compounded by the fact that their skills, competencies, clinical experiences and expectations are often poorly suited to the healthcare needs of the population they serve [1][4][5]. The benefits of up scaling the health workforce in countries around the world are potentially enormous. There are different studies which show a direct and positive link between the size of a national health workforce and population health outcomes such as vaccination rates, infant, child and maternal survival rates and cardiovascular health [3][6]. In 2006, the World Health Report stated that...the dire shortage of health workers in many places is among the most significant constraints to achieving the three health related Millennium Development Goals (MDGs): to reduce child mortality, improve maternal health and combat HIV/AIDS and other diseases, such as tuberculosis and malaria [3]. The WHO has also called for appropriate investment in human resources for health in order to achieve Universal Health Coverage in all of its member states [7]. There have been numerous calls at the international level for an adequately trained health workforce [7][8][9]. The Global Health Workforce Alliance was founded in 2006 as a global partnership and a joint platform for health workforce planning. There have been several publications from the GHWA in this time, including a strategy for [10]. Quality The importance of international standards in medical education and healthcare delivery in improving the quality of healthcare all over the world is being recognized as fundamental by some global organizations. [11][12][13][14]. However, regulatory mechanisms which ensure the quality of education are rarely standardized and inconsistently applied, especially in the case of private sector institutions [1].Presently, we are observing an increase in the number of medical schools globally [16]. However, efforts to deliver high quality education faces various challenges, such as medical education institutions lacking basic infrastructure and equipment and staff, as well as static and fragmented educational methods [1]. In this context, there is a need to develop an international accreditation system for medical education to ensure the quality of medical education around the world, in collaboration with governments to ensure its consistent implementation. As the quantity of healthcare professionals increases, it is important that the quality of education is not compromised [17]. Social and Economic Conditions Social and economic conditions are one of the main determinants of the lack of retention of Health Care professionals in the areas where they are most needed, such as salaries, career development, good infrastructures are the first step to ensure the retention of health care professionals on the areas they are most needed. [18] The lack of publicly-funded medical education in many areas of the world also leads to inequitable access to medical education [16]. Migration of Professionals According to the Article 13 of the Universal Declaration of Human Rights, everyone has the right to freedom of movement and residence within the borders of each state and everyone has the right to leave any country, including his own, and to return to his country. [219]

3 Health workforce migration will continue to have effects on both medical education and national healthcare delivery. However, it must actively aim to create a positive impact in all affected countries, since a change in health care planning can affect directly one full region. [2] Taking this in consideration, it is fundamental to follow the recommendations of the WHO Global Code of Practice on the International Recruitment of Health Personnel, in such a way that the problems related to migration can be reduced. [21] Main Text The IFMSA supports the work of the World Health Organization and the Global Health Workforce Alliance in their work on human resources for health, and calls for action from the following parties: 1. Governments a. To set out a clear vision for their respective health workforce, with short-, medium- and long term actions and goals: i. This must include collaboration with health students, health ministers, education ministers, finance ministers and labor and civil service sectors, and should also include collaboration with national and international bodies, as well as public-private partnerships. ii. Health workforce plans must be based on data collected on current health workforce trends, as well as predicted trends in health workforce requirements. The disease patterns and health requirements of each country, as well as detailed data on the make-up of the health workforce. iii. In order to implement these plans, governments must expand regional and national observatories on the health workforce, for further understanding of elements including production, recruitment, deployment, retention and mobility, as well as health workforce migration between countries. iv. The make-up of the health workforce in these countries must be appropriate to their own national context, but must increase community and mid-level health workers alongside the expansion of education and training for more highly trained and specialized health workers. v. There must be quality assurance systems for medical education and training, including accreditation, indicators of progress and methods for quality standards monitoring and improvement. vi. These workforce plans must address cultural issues, especially where discrimination in the education sector means that girls have less chance of gaining a full education, and thus will not achieve highly valued positions. vii. Mechanisms for accountability for HRH results must be an integral part of these workforce plans. viii. The implementation of these health workforce plans must be provided with appropriate investments on behalf of governments. b. Invest in their health workforce as a key element of strengthening national health systems. They should allocate sufficient resources from their domestic budgets to adequately staff their health

4 systems, ensuring that external support is complementary and additional; and use these resources adequately, efficiently and equitable. c. Provide appropriate training, supervision and remuneration to all community level workers and increase geographical distribution to ensure full access to essential services at community level, recognizing that mid-level cadres and non-physician clinicians and are the mainstay of health services delivery in many resource-poor settings. d. Make the WHO Global Code of Practice of International Recruitment of Health Personnel a core component of bilateral, national, regional and global responses to the challenges of health personnel migration and health systems strengthening. e. Develop regulatory mechanisms for accrediation of medical education in accordance with WHO/WFME standards, and ensure their consistent implementation, especially in private medical education providers. 2. Development partners a. Support health system strengthening in developing countries and countries with economies in transition that are experiencing critical health workforce shortages and/or have limited capacity to implement the objectives of the WHO Global Code of Practice of International Recruitment of Health Personnel. b. Commit a significant proportion of their financial support to a country as dedicated funding for a country s health plan, in agreement with the recipient Government. i. 50% of development aid for health should be spent on strengthening health systems, with 50% of this amount being spent on health workforce plans which incorporate education and training, in line with recommendations from the World Health Report Non-governmental organizations a. Local, regional and international organizations concerned with health care delivery to build partnerships aligned with the health workforce plans and policies of the countries in which they operate. b. 4. Medical schools a. Medical Education institutions to provide transformative medical education to support the scaling up of health workers which are community-, competency- and team-based, and relevant to the population which they will one day serve. b. Develop standards and accreditation systems according to the World Federation of Medical Education and World Health Organization Guidelines to improve the quality of education and training as well as service provision. c. Provide distance learning opportunities as an alternative to education and training abroad. d. Strengthen national health research systems and ensure North-South, South-South, South-North partnerships for human resources for health research.

5 e. Research and evaluate the role of new technologies to enhance education, training and management of health professionals. f. Universities should take steps to ensure that students from all socio-economic backgrounds have fair access to healthcare careers and to provide education and training opportunities to students from rural and remote locations. g. To incorporate into the medical curriculum topics on health inequities and social determinants of health in their respective countries. 5. IFMSA's Commitments a. To support the WFME Global Standards on Medical Education and the WHO/WFME Guidelines for accreditation of Basic Medical Education, which ensure the correct education of medical professionals. b. Create the opportunities for medical students such as global meetings, workshops, surveys, trainings, and international clinical and research exchanges to harness their deep involvement in the transformation of medical education to address current global and local health workers challenges. c. Medical students and National Member organizations to advocate to their national governments and medical education institutions to ensure that health workforce planning is a national and global priority, and that health workforce migration does not compromise the healthcare requirements of other countries or regions. References 1. World Health Organization (2011). Transformative scale-up of health professional education: an effort to increase the numbers of health professionals and to strengthen their impact on population health. 2. Task Force for Scaling Up Education and Training for Health Workers, Global Health Workforce Alliance (2008). Scaling Up, Saving Lives 3. World Health Organization (2006). The World Health Report 2006: working together for health. 4. Frenk et al (2010). Health Professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet. 5. World Federation for Medical Education (2012) The State of Medical and Health Care Education: A Review and Commentary on the Lancet Commission Report. World Medical & Policy Volume 4, Issue Article 9 6. World Health Organization (2006). Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies (Chapter 2: Health Workforce). 7. World Health Organization: Transforming health workforce education in support of universal health coverage. 23rd Resolution adopted at the 66th World Health Assembly, Geneva. May United Nations: The Future We want. Adopted by the heads of state and government and highlevel representatives, Rio De Janeiro June, 2012.

6 9. United Nations: Gloabal Health and Foreign Policy. Resolution adopted at the 67th General Assembly, New York. 12 December The Global Health Workforce Alliance (2012). Strategy : Advancing the Health Workforce Agenda within Universal Health Coverage 11. WFME (2003) Global Standards for Quality Improvement global standards on Basic medical education 12. WFME (2003) Global Standards for Quality Improvement global standards on Postgraduate Medical Education 13. WFME (2003) Global Standards for Quality Improvement global standards on Continuing Professional Development (CPD) of Medical Doctors 14. WHO/WFME (2005). Guidelines for Accreditation of Basic Medical Education 15. Pulido, Pablo; Cassimatis, Emmanuel. (2012) Presentation of the X Ibero American Session in the Association for Medical Education in Europe 16. Christophe Segouin, Brian Hodges, and PierreHenri Brechat, Globalization in health care: is international standardization of quality a step toward outsourcing? International Journal for Quality in Health Care 2005; Volume 17, Number 4: pp Das, J et al (2012). In urban and rural India, A standardized Patient Study Showed Low Levels of Provider Training and Huge Quality Gaps. Health Affairs; vol. 31 no World Health Organization (2011). Increasing access to health workers in remote and rural areas through improved retention. 19. United Nations (1948) The Universal Declaration of Human Rights 20. Blacklock et al. Effect of UK policy on medical migration: a time series analysis of physician registration data. Human Resources for Health 2012, 10:35 World Health Assembly (2010) Resolution on the WHO Global Code of Practice on the International Recruitment of Health Personnel

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