Christoph Aluttis

The workforce for health in a globalized context - global shortages and international migration

The ‘crisis in human resources’ in the health sector has been described as one of the most pressing global health issues of our time. The World Health Organization (WHO) estimates that the world faces a global shortage of almost 4.3 million doctors, midwives, nurses, and other healthcare professionals. A global undersupply of these threatens the quality and sustainability of health systems worldwide. This undersupply is concurrent with globalization and the resulting liberalization of markets, which allow health workers to offer their services in countries other than those of their origin. The opportunities of health workers to seek employment abroad has led to a complex migration pattern, characterized by a flow of health professionals from low- to high-income countries. This global migration pattern has sparked a broad international debate about the consequences for health systems worldwide, including questions about sustainability, justice, and global social accountabilities. This article provides a review of this phenomenon and gives an overview of the current scope of health workforce migration patterns. It further focuses on the scientific discourse regarding health workforce migration and its effects on both high- and low-income countries in an interdependent world. The article also reviews the internal and external factors that fuel health worker migration and illustrates how health workforce migration is a classic global health issue of our time. Accordingly, it elaborates on the international communitys approach to solving the workforce crisis, focusing in particular on the WHO Code of Practice, established in 2010.

Public health and health promotion capacity at national and regional level: a review of conceptual frameworks.

The concept of capacity building for public health has gained much attention during the last decade. National as well as international organizations increasingly focus their efforts on capacity building to improve performance in the health sector. During the past two decades, a variety of conceptual frameworks have been developed which describe relevant dimensions for public health capacity. Notably, these frameworks differ in design and conceptualization. This paper therefore reviews the existing conceptual frameworks and integrates them into one framework, which contains the most relevant dimensions for public health capacity at the country- or regional level. A comprehensive literature search was performed to identify frameworks addressing public health capacity building at the national or regional level. We content-analysed these frameworks to identify the core dimensions of public health capacity. The dimensions were subsequently synthesized into a set of thematic areas to construct a conceptual framework which describes the most relevant dimensions for capacities at the national- or regional level. The systematic review resulted in the identification of seven core domains for public health capacity: resources, organizational structures, workforce, partnerships, leadership and governance, knowledge development and country specific context. Accordingly, these dimensions were used to construct a framework, which describes these core domains more in detail. Our research shows that although there is no generally agreedupon model of public health capacity, a number of key domains for public health and health promotion capacity are consistently recurring in existing frameworks, regardless of their geographical location or thematic area. As only little work on the core concepts of public health capacities has yet taken place, this study adds value to the discourse by identifying these consistencies across existing frameworks and by synthesising them into a new framework. The framework proposed in this paper can act as a theoretical guide for academic researchers and institutions to set up their own public health capacity assessment. Significance for public health As the concept of public health capacities is increasingly debated across countries and national/ international organizations, there is no consensus on the main dimensions of public health capacity. This paper therefore provides a rigorous review of currently existing frameworks, which describe public health capacities at the national or regional level. The main objective is to highlight commonalities among these frameworks, and propose a country-level framework which integrates all reoccurring dimensions. Such a comparison can yield vital information on those dimensions for public health capacities, which are common across all frameworks, and hence could be considered indispensable, irrespective of their context or geographic origin. As such, this review and the subsequent presentation of a conceptual framework is targeted at academic researchers and policy makers, who are interested in setting up a capacity mapping process and who are looking for concepts and frameworks on which they can base their work.

Improving the assessment and attribution of effects of development assistance for health.

2–5 When showing eff ect, donor agencies and countries need to address two challenges: fi rst, accurate estimation of the eff ects of investments in diff erent areas (eg, vaccines or health systems) on health outcomes; and second, attribution of the eff ects to specifi c investments. There are methodological challenges in establishing a relation between DAH and health outcomes (appendix p 1). 6,7 The validity of the results presented by major funding agencies has been questioned because of weaknesses in models used to estimate outcomes, in appropriate counterfactuals, and overgenerous assumptions of investment eff ects. 8 Attribution of health outcomes to external investments by specifi c agencies has also proved to be challenging because of the multiplicity of funding sources. 9 Further, methods that attribute health eff ects to single interventions or specifi c funds do not refl ect the vital contribution of health systems to health outcomes. 3,5,10,11

Global health in the European Union - a review from an agenda-setting perspective

This review attempts to analyse the global health agenda-setting process in the European Union (EU). We give an overview of the European perspective on global health, making reference to the developments that led to the EU acknowledging its role as a global health actor. The article thereby focusses in particular on the European interpretation of its role in global health from 2010, which was formalised through, respectively, a European Commission Communication and European Council Conclusions. Departing from there, and based on Kingdons multiple streams theory on agenda setting, we identify some barriers that seem to hinder the further establishment and promotion of a solid global health agenda in the EU. The main barriers for creating a strong European global health agenda are the fragmentation of the policy community and the lack of a common definition for global health in Europe. Forwarding the agenda in Europe for global health requires more clarification of the common goals and perspectives of the policy community and the use of arising windows of opportunity.This review attempts to analyse the global health agenda-setting process in the European Union (EU). We give an overview of the European perspective on global health, making reference to the developments that led to the EU acknowledging its role as a global health actor. The article thereby focusses in particular on the European interpretation of its role in global health from 2010, which was formalised through, respectively, a European Commission Communication and European Council Conclusions. Departing from there, and based on Kingdons multiple streams theory on agenda setting, we identify some barriers that seem to hinder the further establishment and promotion of a solid global health agenda in the EU. The main barriers for creating a strong European global health agenda are the fragmentation of the policy community and the lack of a common definition for global health in Europe. Forwarding the agenda in Europe for global health requires more clarification of the common goals and perspectives of the policy community and the use of arising windows of opportunity.

Global health and domestic policy - What motivated the development of the German Global Health Strategy?

ABSTRACT In 2013, the German government published its national Global Health Strategy, outlining principles and focal topics for German engagement in global health. We asked the question of why Germany has decided to establish a national policy framework for global health at this point in time, and how the development process has taken place. The ultimate goal of this study was to achieve better insights into the respective health and foreign policy processes at the national level. This article reports on the results of semi-structured interviews with those actors that were responsible for initiating and drafting the German Global Health Strategy (GGHS). Our study shows that a series of external developments, stakeholders, and advocacy efforts created an environment conducive to the creation of the strategic document. In addition, a number of internal considerations, struggles, and capacities played a decisive role during the development phase of the GGHS. Understanding these factors better can not only provide substantial insights into global health related policy processes in Germany, but also contribute to the general discourse on the role of the nation state in global health governance.

Europeanisation of health systems: a qualitative study of domestic actors in a small state

BackgroundHealth systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle. Yet, recent developments including the patients’ rights and cross-border directive (2011/24 EU), as well as measures taken following the financial crisis, appear to be increasing the EU’s influence on health systems. The aim of this study is to explore how health system Europeanisation is perceived by domestic stakeholders within a small state.MethodsA qualitative study was conducted in the Maltese health system using 33 semi-structured interviews. Inductive analysis was carried out with codes and themes being generated from the data.ResultsEU membership brought significant public health reforms, transformation in the regulation of medicines and development of specialised training for doctors. Health services financing and delivery were primarily unaffected. Stakeholders positively perceived improvements to the policy-making process, networking opportunities and capacity building as important benefits. However, the administrative burden and the EU’s tendency to adopt a ‘one size fits all’ approach posed considerable challenges. The lack of power and visibility for health policy at the EU level is a major disappointment. A strong desire exists for the EU to exercise a more effective role in ensuring access to affordable medicines and preventing non-communicable diseases. However, the EU’s interference with core health system values is strongly resisted.ConclusionsOverall domestic stakeholders have a positive outlook regarding their health system Europeanisation experience. Whilst welcoming further policy developments at the EU level, they believe that improved consideration must be given to the specificities of small health systems.

Special issue "Facets of Global Health: Globalisation, Equity, Impact and Action". Preface.

The collection of articles in this special issue provides a broad overview on various facets of global health, and it attempts to establish the link between globalisation and its manifestation and impact on the regional and local levels. The idea for this collection was first conceived during the 13th World Congress on Public Health, held in Addis Ababa, Ethiopia, 23–27 April 2012, and evolved out of deliberations regarding the lack of comprehensive, dedicated and affordable textbooks for teaching global health. In the aftermath of the World Congress, a group was established to develop a first collection of articles for such textbooks. This special issue is the result of a collaboration that brought together representatives from the World Federation of Public Health Associations (WFPHA), the African Federation of Public Health Associations (AFPHA) and the Department of International Health at Maastricht University. Because global health is an emerging multisectoral field linking (among others) health, trade, governance and foreign policies, development and humanitarian aid, the topics that can be covered in one special issue are necessarily limited. This collection of articles focuses therefore on aspects of governance, international relations and global health policies and on the role of health systems and health systems design including health system reform, primary care and the globalized health workforce. Further facets that are discussed include global health ethics and education. Other important aspects such as global health and global environmental change or global health and urbanisation have not been covered in this special issue but all articles intend to provide an up-to-date overview of the rapidly growing global health literature. (Published: 13 February 2014) Citation: Glob Health Action 2014, 7 : 23696 - http://dx.doi.org/10.3402/gha.v7.23696 This paper is part of the Special Issue Facets of Global Health: Globalisation, Equity, Impact, and Action. More papers from this issue can be found here .