Third
AAAH Conference:
Globalisation and its Implications for Health Care and
Human Resources for Health
Organised by
Asia - Pacific Action Alliance on Human
Resources for Health (AAAH)
Ministry of Healthcare & Nutrition Sri Lanka
Public Health Foundation of India (PHFI)
,
12-15 October 2008
Colombo/Kandy (Sri Lanka)
Concept Note and Conference Background
Globalisation is one of the key processes defining
the social, economic and political context of countries
and societies in the world today. It has led to the
intensification of cross national, cultural economic,
political, social and technological interactions and
also the establishment of transnational structures that
affect. It presents opportunities for increased sharing
of knowledge, information and scope at the global level
to address the determinants of health. However economic
globalization that has been one of the fundamental driving
forces behind the overall process has also been associated
with adverse impacts on poverty and human health. The
policies of economic reform pushed by global institutions
like the World Bank and the IMF set the context today
and have had impacts on several critical distal and
proximal determinants of health. These determinants
interact with and between different domains of society
and health in dynamic ways to affect health at the population
level. These processes have affected access to food,
employment, water and sanitation services thus having
a marked effect on the environmental and physical health
of populations. Additionally the reform processes have
resulted in rising costs of health services by pushing
privatization and cuts in government spending on health.
Globalisation in health services has also contributed
to aggravated migration of health personnel –
doctors, nurses, technicians, specialists etc from developing
to developed countries. Foreign direct investment in
the health sector has led to the emergence of large
corporate hospitals in urban areas which encourage the
movement of skilled health workers such as physicians
from the public to the private health sector. These
outflows have adverse implications for equity, quality
and availability of health services and become more
pertinent in the context of growing health inequalities
within and between countries and reversal of health
gains in the last two decades.
Today the populations in developing countries have to
contend with epidemiological and demographic challenges
posed by the double burden of disease and the health
problems of aging populations. The resurgence of communicable
diseases like TB and Malaria and the spread of HIV/AIDS
(together accounting for almost six million deaths per
year) is coupled with the growing prevalence of non
communicable diseases like cancer, cardio vascular diseases,
diabetes mental illness and injuries causing much suffering
and mortality. The burdens and challenges of ill health
are higher and imply greater costs for populations living
in these contexts and particularly for the marginalized
sections therein. In 2005, chronic diseases accounted
for 35 million deaths, of which 80% occur in low- and
middle-income countries. In the context of communicable
diseases, treatment and cure is intrinsically linked
to control and prevention. Similarly chronic ailments
of a non communicable nature require long term palliative
and rehabilitative treatments besides cure.
Accessible and well functioning health services have
been known to play an important role in mitigating social
inequalities in a society. The reform process has encouraged
the perception of health as a private good thus undermining
the principle of universality. It has thus dented the
commitment to build a comprehensive, publicly funded
healthcare system operating in an integrated manner
to provide various at levels preventive, promotive,
curative and rehabilitative care as espoused in the
Alma Ata Declaration on Primary Health Care (1978).
It has brought about changes in the structures of provisioning
and financing of public health services by encouraging
privatisation, rising costs of pharamaceuticals and
migration of health workers that have exacerbated problems
in the arenas of availability, accessibility and cost
of health services. Hence the poorest populations of
many transitional economies are losing access to even
the basic medical services due to the systematic privatization
of health services. All of these processes have translated
to a much narrower interpretation of the welfare functions
of the State and has led to rapidly declining trust
in public service systems.
Health care services and human resources for health
are two critical, interrelated proximal determinants
of health status and well being of a population. The
availability and delivery of good quality health care
is also hinged upon the existence of a capable and motivated
health workforce that is suitably trained for different
levels of care and is adequate in number and distribution.
A large body of documented evidence shows that the quality
and strength of the health work force are associated
with positive health outcomes like immunization coverage,
outreach of primary care, and infant, child and maternal
survival. However low priority accorded to appropriate
training, supervision, inefficient usage of the existing
workforce, poor working conditions and skewed distributions
due to urban concentrations have been some of the traditional
problems affecting health workforce in developing countries.
According to the report of the Joint Learning Initiative
health workforce in the developing and least developed
countries today stands challenged in the face of the
double burden of disease and new problems like HIV/AIDS,
the lack of adequate investment in the health sector
(exacerbated due to reduced public spending on health)
and the migration of skilled personnel like nurses and
doctors to developed countries. The reduction in public
spending on health besides affecting infrastructural
and logistical aspects of health services has also led
to immense workloads and poor working conditions with
unsatisfactory remuneration. These act as push factors
for skilled personnel to seek better opportunities.
Meager outlays for the health sector in public spending
have also impinged on training, supervision and monitoring
of workers in the public health sector, leading to inadequately
trained workers who are unable to deliver good quality
care.
The growing corporate sector in health care with its
better pay and working conditions provides a pull factor
for personnel from the public sector. Additionally,
globalisation has contributed to accelerated international
migration of skilled health personnel from resource
poor areas to developed countries. In 1996 of the 110000
nurses from foreign countries in the USA 43% were from
Philippines and 9% from India. Data shows that 56% of
all migrating physicians move from developing countries
such as India, Philippines and South Africa to developed
countries while only 11% move in the reverse direction.
This migration is prompted by better wages and working
conditions. The permanent flow of skilled health professionals
entails significant costs for the host country and also
translates into rising costs of health care in the source
countries. According to the World Health Report 2006
–“…. workforce crisis many of the
poorest countries is characterized by severe shortages,
inappropriate skill mixes, and gaps in service coverage.”
All of these factors are leading to severe regional
imbalances in care and a failure to change and adapt
to new health challenges at hand.
AAAH Conference Plans
The critical challenges posed by globalization for human
resources for health have made it a prioritized theme
for discussion and resolution. The AAAH therefore plans
to host its next meeting on this theme. The theme ‘Globalization
and its implications for Health Care services and Human
Resources for Health found wide support at Beijing where
participants pointed out the need to address this critical
aspect through policy oriented recommendations based
on intersectoral strategies and regional frameworks.
The AAAH meeting planned in Sri Lanka in September 2008
would provide the forum for such exchange of ideas and
knowledge and to identify the opportunities presented
in the current context under this broad theme. The framework
for papers and discussion at this conference have been
derived from a conceptual framework seeking to the linkages
between the globalization process and population health.
The papers to be commissioned for this conference would
need to reflect institutional, economic, socio-cultural
and environmental aspects of globalization in its interface
with health care and human resources for health. The
topics given below are drawn from this conceptual framework.
CONFERENCE OBJECTIVES
• To follow up on HRH activities in member countries
at the regional and global level after the 2nd conference
held in 2007, and to review the progress the countries
have made in reaching the objectives established in
“The AAAH Workplan 2008-2009”.
• To share experience generated from AAAH members,
including WHO and other international agencies, platforms
or alliance (eg. Global Health Workforce Alliance, GHWA)
assisting the countries to address the globalization
and its implications for health care and human resources
for health.
PARTICIPATION
The participants will be drawn from 15 AAAH member countries,
and a minimum of 3 participants per country are expected
for each multi-stakeholder team which may include various
interest groups such as the Ministry of Health, professionals,
academia, government, non government organization, and
the private sector. Resource persons from international
agencies, other global or regional alliances and platforms,
and other countries in the Asia-Pacific region that
are considered as potential new members for AAAH will
also be invited.
PROGRAMME THEMES
Under the theme ‘Globalisation and its implications
on health care services and human resources for health’,
there are six sub-themes as follows:
1. Structures of Global Governance, health care and
HRH
• Changing roles of multilateral institutions
and international NGOs in The Health Sector- Implications
for the health workforce
• National Disease control programmes
2. Public Sector Reform, privatization and decentralization:
Implications for human resources in health
• The weakening of Public Health Service Systems:
Withdrawal of the State
• Privatisation and Changing ethos of care
• Corporatisation o f Health Care
• Gender in care giving and receiving: Effects
of Privatisation
• The changing role and place of traditional healers
and practitioners in the Asia Pacific Region- Issues
of Integration
3. Trade in Health services/migration
• Trade in Health Services- Health care outsourcing
from developed countries and the implications on health
service demands in the Asia & Pacific region.
• Medical tourism and health workforce management
• Gender and health workforce in the globalized
Asia pacific
• Health workforce migration in the Asia &
pacific region - scope of the problems and potential
solutions
• Health Work force and Emergency Response to
regional health catastrophes
4. Epidemiological & Demographic Transition: Coping
with new challenges
• Double Burden of Disease- New Challenges for
health work force
• Health Care for Chronic Ailments- Role of Health
workers
• Emergency preparedness of health workers
5. Training and Education of the Health workforce
• Scaling up the education and production of health
workers
• New model of communication and technology diffusion
for continuing education of the workforce
• Changing institutions- is there a role for cross-country
harmonization of workforce skills and their certification?
• Globalization and cross country health &
medical education
6. Globalisation, Social Change and Health
• Eroding Social Cohesion- Implications for care
of the elderly and the disabled
• Cultural aspects of globalization and changing
perceptions and expectations of patients in health care
• Quality in care
