International recruitment of health personnel: a WHO code of practice

1. International recruitment of health personnel: a WHO code of practice World Health Editors NetworkMaking Global Health NewsGeneva 17-18-May 2009 Jean-Marc Braichet, Coordinator Health Workforce Migration and Retention Team Department of Human Resources for Health World Health Organization, Geneva

2. International and internal migration: complementary but different responses required • Responses to international migration of HRH - bilateral agreements (e.g. South Africa - UK; Philippines - Japan, etc.) - regional codes (e.g. Pacific code) - draft global code of practice on the international recruitment of health personnel • Responses to internal migration: - national measures

3. WHO is developing to major and complementary projects • Developing a draft global code on the international recruitment of health personnel • Implementing a programme which aims to improve the retention of health workers in rural and remote areas

4. Main objectives of a WHO code of practice • To establish and promote voluntary principles. • To serve as an instrument of reference. • To provide guidance. • To facilitate and promote international discussion and advance cooperation.

5. Process to develop a WHO code of practice on the international recruitment of health personnel 1/2 • Jan08 Mar08 April08 May08 June08 July08 August08 Sept08 Oct08 Tallinn Euro Ministerial EB Migration Progress Report Public Hearings PAC – TWG meeting Kampala Forum G8 Summit Drafting of the Code Launch of Global Dialogue on Migration Manila Forum • Draft Code Draft Outline for a Code

6. Process to develop a WHO code of practice on the international recruitment of health personnel 2/2 • Jan09 May09 June09 July09 August09 Sept-October 09 January10 March10 May10 ------------ Consultations ---------- WHO RCs Progress Report for EB Progress Report for EB Draft Resolution Draft Code Global consultation? Background Paper Technical Briefing WHA09 Draft Code for the WHA? • Draft Code

7. A WHO program on increasing access to health workers in remote & rural areas through improved retention For at least three main reasons: • needs clearly identified • calls for action • renewal of PHC

8. 1- Need has been clearly identified in all countries Inequitable distribution of health workers

9. A programme built on three strategic pillars • 1- Building the evidence base on effective retention strategies • literature reviews, expert consultations, synthesis of the evidence, identification of knowledge gaps and commissioning research • 2- Supporting countries to evaluate and adapt retention strategies • work with interested countries to evaluate past and on-going strategies and to develop and implement country-specific plans • 3- Developing and disseminating global recommendations on increasing access to health workers in remote and rural areas through improved retention • a time-bound participatory process involving all relevant stakeholders following the steps set out by the WHO Guidelines Review Committee

10. An ongoing calendar

11. Thank you for your attention !

12. Definitions No consensus on a definition for “rural areas” - usually defined as “non-urban” Each country has its own definition based on: the settlement profile: population density availability of economic structures the accessibility from an urban area: distance in kilometres or hours drive. Remote/underserved = areas where relatively poorer populations reside: remote rural areas; small or remote islands; urban slum areas; areas that are in conflict or post-conflict; refugee camps; areas inhabited by minority or indigenous groups* * Not specifically included in the current literature review

13. A complex issueno ‘single bullet’ type of answer Ministry of Finance Health workers Ministry of Labour Ministry of Health Ministry of Higher Education Professional Associations Civil Service Commission Ministry of Public Administration Populations/Communities Ministry of Transport

14. Categories of interventions

15. How can we measure “success”? Disparities in the rural/urban ratio of health workers to population density Percentage of health workers to choose to work in rural areas as a consequence of an intervention Vacancy rates Duration in post Service utilization rates (before and after) Patient satisfaction surveys Health workers satisfaction surveys Health outcomes (confounding factors!) GP density per 1000 pop France: General Practitioner density

16. Guiding principles of a WHO code of practice 1/2 • The code is voluntary. • The individual right "to leave any country, including [one's] own". • Right of everyone to the enjoyment of the highest attainable standard of health. • International recruitment can make a legitimate contribution to the development and strengthening of a national health workforce. • The development of voluntary international standards and the coordination of national policies on international health worker recruitment.

17. Guiding principles of a WHO code of practice 2/2 • International recruitment of health personnel should be conducted in accordance with the principles of transparency, fairness and mutuality of benefits. • The specific needs and special circumstances of countries should be considered. • Effective national and international data gathering, research and information sharing are essential.