So far little tangible progress has been reported by the EU Member States as to what concrete actions they are pursuing in order to create sustainable health systems without relying on migrant labour to fill gaps. In its briefing paper, EPHA calls on EU Member States to fully implement the Code and on civil society organisations to advocate for its implementation at national level.


Migration of qualified health personnel is contributing to brain drain and financial loss, with the result that some countries’ health systems - mainly in the developing world, but also in the poorer regions of Europe- are severely strained. Access to healthcare is becoming increasingly inequitable and lives are being put at risk.

As signatories of the WHO Global Code of Practice on the International Recruitment of Health Personnel, Ministers of Health agreed to:
- stop recruiting health workers from developing countries unless agreements are in place to protect the health workforce; and
- provide technical and financial assistance to strengthen these countries’ health systems.

However, these commitments are based on voluntary principles and practices — compliance will depend on capacity and political will. Apart from a scoping exercice undertaken by Action for Global Health (AfGH) in the five largest EU countries, insightful data on implementation in EU-27 Member States are still missing. This is further complicated by the fact that the WHO Code only addresses the public sector, thereby neglecting the role that recruitment agencies play in filling human resources for health (HRH) shortages, thereby undermining HRH provision in poorer countries and regions.


EPHA supports the Action for Global Health recommendations contained in its 2011 report, which urge EU Member States to take immediate action to simultaneously tackle the push and pull factors driving the international migration of health personnel. This begins with full implementation of the WHO Code and the EU Programme for Action through clear, time bound national action plans with measureable goals and SMART and gender-sensitive indicators.

In addition, domestic and development cooperation policies must be coherent in order to attain the Health MDGs. EU Member States should fully fund health systems strengthening, ensuring that 25% of all health Overseas Development Aid (ODA) is allocated to national health workforce strategies and reaching the global target of an additional 3.5 million new health workers by 2015.

At the same time, EU governments need to close demand gaps by planning their HWF needs more effectively and proactively.

Advocacy at EU and national levels is needed in order to disseminate the WHO Code and support its provisions given the continued squeeze on European health systems. For EPHA, tracking the implementation of the Code’s provisions at Member State level will be an advocacy instrument for highlighting key messages related to HWF, such as sustainable recruitment and retention policies. In particular, EPHA plans to work with MEPs and upcoming Council Presidencies to move forward the Code’s stipulations.

For futher information

- Addressing the Global Health Workforce Crisis: Challenges for France, Germany, Italy, Spain and the UK

- WHO website - health workforce section

Related EPHA articles

- article 4078
- article 4604
- article 4294
- article 4282
- Council Conclusions on investing in Europe’s health workforce of tomorrow: Scope for innovation and collaboration
- article 4079

Last modified on December 16 2011.