Poorer countries need their health staff too

Catherine Sykes of the World Confederation of Physical Therapy reminds us that strengthening our profession in every country will help to meet local needs.

Balancing workforce supply and demand is a preoccupation for UK health professionals, their organisations, managers and policy makers – particularly as winter comes and services get stretched to the limit.
The CSP is as aware of this as anyone.  Its newly launched workforce data model is a great tool for projecting supply and demand in the physiotherapy workforce until 2030. 
But supply and demand of health professions is also an international issue, and a complex one.
In the UK in September, NHS trusts warned that stringent rules on recruiting from overseas prevented enough nurses being able to come to the UK to help meet winter demand. 
But at the World Confederation for Physical Therapy (WCPT) international congress in Singapore a few months earlier, I’d heard another, contrasting story. 
Royson Mercado, president of the physiotherapy association in the Philippines, reported that there are only 1,000 to 2,000 physios working in his country to address the massive burden caused by natural disasters and disease. The majority of the 26,000 physios trained there since the 1960s have left to work abroad.
Health worker migration has been increasing worldwide over recent decades, especially from lower income countries with already fragile health systems.
That’s why the World Health Organization introduced a global code of practice on international health recruitment in 2010. It provides voluntary principles and practices for the ethical international recruitment of health personnel and to facilitate the strengthening of all health systems. 
So because of globalisation, every national supply and demand issue stands in an international context. Differences in pay and working conditions from country to country can have a huge influence on the way the workforce flows.  
Of course, there are potentially huge benefits from a globally mobile workforce. New perspectives and skills spread when people work in other countries. If they return, they bring these back to share and build the profession at home. But sometimes physiotherapists do not return to their home country. 
WCPT is trying to highlight the disparities in physiotherapy supply from country to country, by collecting international workforce data. This has revealed the extent of the variations. 
In 2013, for example, Ukraine, Malawi, Uganda, Ethiopia and Bangladesh all had 0.05 or fewer physiotherapists per 10,000 people, while Liechtenstein, Belgium and Norway had 25 per 10,000 or more. 
But there were marked variations even between countries with similarly high incomes: the Netherlands had 22.61 physios per 10,000 people, while the UK had 7.6 per 10,000. 
So addressing supply and demand on an international level is by no means a simple business. There is no right or wrong number of physiotherapists in a population. The aim must be national self-sufficiency everywhere – to make the profession strong in every country so that it can serve its own population effectively. The WCPOT supports all our member organisations around the world to do just that.
  • Catherine Sykes is WCPT professional policy consultant
Catherine Sykes WCPT professional policy consultant

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