CNS: Why are health workers important?

Ireland is, in percentage terms, among the biggest recruiters of foreign trained nurses and doctors among OECD countries. According to Professor Brugha of Royal College of Surgeons of Ireland (RCSI), at the Irish Forum for Global Health's Conference on the Global Health Workforce, by 2008 a two-fold higher percentage of foreign trained nurses were registered in Ireland compared to the OECD country ranked second. While ranked second in 2008 for recruiting foreign trained doctors, the rapid upward trend between 2000 and 2010, along with Ireland's recent recruitment drive in India and Pakistan, mean that Ireland is likely to now rank first for recruiting foreign-trained doctors.

The Global Code of Practice on the International Recruitment of Health Personnel, which was adopted by all countries at the World Health Assembly in 2010, urges countries that recruit health personnel internationally to comply with ethical principles and practices. The first of these is that the Code discourages active recruitment from developing countries facing critical shortages of health personnel. Ireland has become overly dependent on foreign trained doctors and nurses, many from middle income and some from low income countries. According to Professor Brugha, the effects of outward migration of expensively trained health professionals on these sending countries health systems need to be researched.

More attention needs to be paid by health policy makers to the central injunction of the Global Code: every country should implement effective health workforce planning, education, training and retention strategies to sustain a health workforce that is appropriate to its needs. Ireland provides first class undergraduate and postgraduate training for doctors. However, an unknown number of Irish doctors leave after graduation, or after undergoing specialist training. This represents, from Ireland's perspective, a huge waste of an expensive and precious resource.

It should also be noted that the quality and breadth of contributions at this Conference, as well as the announcement yesterday (2nd February) by the Minister of State for Trade and Development on the ESTHER initiative, testify to how well Ireland is performing on some other elements of the Global Code. Partnerships between Irish health professionals, researchers and NGOs with partners in Africa, many of which are supported by Irish Aid, are contributing to training and capacity-building of the health workforce

in some of the poorest countries on the planet.

Some of RCSI's initiatives in this area are models of good practice: COST-Africa - which is a research intervention to bring life-saving major surgery to districts and rural populations of Africa, and the COSECSA initiative to train African doctors as specialist surgeons, are together addressing the health workforce crisis and the surgically avoidable burden of disease in Africa. This is preferable by far to bringing African doctors and other health workers to Europe and America for training, where the risk is that they will not return to their countries. Supporting the undergraduate training of doctors and nurses in middle income countries is another sensible strategy for addressing the global health worker shortage crisis, as some of these countries are major recruiters of doctors and nurses from much poorer countries.

This conference is putting the spotlight on many Irish contributions to strengthen the workforce in other countries, especially in Africa. It also represents an opportunity to build global health workforce partnerships between researchers, practitioners and policy makers. However these must be matched by equal attention to effective health workforce strategic planning and management in Ireland.

An essential component of any comprehensive national workforce policy and strategy, and a requirement of the Global Code on the International Recruitment of Health Personnel, is the establishment of an effective information system for tracking entries and exits from the national health workforce. Ireland needs to be able to monitor and report the numbers of overseas and Irish trained doctors and nurses entering and leaving the workforce. It also needs to be able to model and predict future needs and shortfalls, by type and speciality of health worker, so as to plan, train and retain a health workforce appropriate to Ireland's needs.

Researchers from the Division of Population Health Sciences at RCSI and the Centre for Health Policy and Management at TCD are in discussions with the Irish Medical Council with a view to providing the Department of Health with the information it needs to report to the World Health Organization in May 2012 on Ireland's performance in implementing the Global Code. At a time when huge demands are being put on the public sector, Irish academics and researchers need to support national policy makers through partnerships of this kind, so as to demonstrate Ireland's significant and ongoing contributions to Global Health.