Key questions on the WHO Code

1. Key questions on the WHO Code Ethical Integration of Health Professionals Panel Terry Goertzen Canada

2. Global snapshot- 2006

3. WHO Global Code of Practice on the International Recruitment of Health Personnel Article 1- Objectives (4) To facilitate and promote international discussion and advance cooperation on matters related to the ethical international recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries Article 7- Information exchange 7.1 Member States are encouraged to, as appropriate and subject to national law, promote the establishment or strengthening of information exchange on international health personnel migration and health systems, nationally and internationally, through public agencies, academic and research institutions, health professional organizations, and subregional, regional and international organizations, whether governmental or nongovernmental.

4. Proposition • That this session be “recorded” and documented, along with the presentations, to achieve Objective 4 of the Code by having an international discussion and advancing cooperation, as well as fulfilling the information exchange outlined in Article 7 (Chatham House rules) • The report can be used by participating countries/stakeholders as they prepare to report on activities related to implementation of the Code (Article 9.4).

5. Immigration and HRH Policy Contexts in Canada, the U.S., the U.K. & Australia: Ivy Lynn Bourgeault Rishma Parpia Elena Neiterman Yvonne LeBlanc Jan Jablonski

6. Overview For each of Canada, the U.S., the U.K. & Australia: • Immigration Policy • HHR Regulation • HHR Supply Policy

7. Canada – Immigration Policy • Federal jurisdiction; three categories: refugee, family class and economic class based on a points allocated to social capital • Some provincial input through PNP for shortage occupations

8. Canada – HHR Regulation • Specialty certification is nationally based • Licensure and professional regulation is provincial/territorial based • A harmonization process is underway in response to the Agreement on Internal Trade

9. Canada – HHR Policy • HRH Policy is largely a provincial jurisdiction with recent coordinative involvement by the ACHDHR • HRH has waxed and waned from perceived surpluses in the 1990s to current or projected shortages for both medical and nursing HR.

10. US – Immigration Policy • Federal jurisdiction; two paths to immigration: permanent (immigrant admission) and temporary (non-immigrant admission). • Major route for foreign skilled healthcare workers is admission through the permanent category.

11. US– HHR Regulation • Licensure and professional regulation is state/territorial based.

12. US– HHR Policy • HRH ‘policy’ has not real coordinated jurisdiction. • There has been a history of perceived oversupply of both physicians and nurses as early as the 1980s. • Currently, there are projected shortages for both medical and nursing HR.

13. UK– Immigration Policy • Federal jurisdiction; five routes to entrance: (1) economic migrants; (2) temporary workers and visitors; (3) family category; (4) students; and (5) refugee and asylum seekers • Major route for health care workers is through economic path (Tier 2)

14. UK– HHR Regulation • Licensure and professional regulation are based at the UK-level

15. UK– HHR Policy • HRH policy has largely been at the UK-level, but more recently, this has been devolved to the different nations • The 1980’s and 1990’s were marked with shortages in funding and supply of HRH • Starting 1997 and until early 2000s active expansion of HRH including domestic production and international recruitment • Recent change include a move to self-sufficiency and a focus on domestic production of HRH

16. Australia– Immigration Policy • Federal jurisdiction; two categories: permanent and temporary migration. • Recently, major route for non-citizens is through long-term temporary migration programs.

17. Australia– HHR Regulation • Prior to 2010, licensure and professional regulation was state/territorial based. • Effective 2010, a centralized body, AHPRA regulates the medical and nursing profession through nationally consistent legislation.

18. Australia– HHR Policy • HRH policy is largely a federal jurisdiction with some input from the states/territories. • There has been a shift from a perceived oversupply to significant shortages for both medical and nursing HR.

19. Proposition • That this session be “recorded” and documented, along with the presentations, to achieve Objective 4 of the Code by having an international discussion and advancing cooperation, as well as fulfilling the information exchange outlined in Article 7 (Chatham House rules) • The report can be used by participating countries/stakeholders as they prepare to report on activities related to implementation of the Code (Article 9.4).

20. Sustainable health workforce development, discouraging active recruitment from developing countries 3.6 Member states...to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training and retention strategies that will reduce their need to recruit migrant health personnel 5.1 Member states should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers

21. Sustainable workforce questions The Code describes “establishing effective health workforce planning” . Are we becoming more self-sufficient in the four countries, and less reliant on international recruitment? From the papers presented, or your own area of expertise are we actively discouraging recruitment of health personnel from developing countries? • How does India & the Philippines fit?

22. Data The Director-General to rapidly develop, in consultation with Member States, guidelines for minimum data sets Article 3- Guiding principles 3.7 Effective gathering of national and international data, research and sharing of information Article 7- Information exchange 7.2 (b) progressively establish and maintain updated data from health personnel information systems

23. Data question Do we have good data that helps to inform the state of ethical recruitment in each country? • Where are there gaps? Is there an existing minimum data set within this collaborative, and if not, what would it take to develop it? • Not just for medicine, but also nursing and other mobile professions

24. Are we being fair to those who come and those who are here? Article 4- Responsibilities, rights and recruitment practices 4.4 Migrant health personnel should be hired, promoted and remunerated based on objective criteria, such as levels of qualification, years of experience and degrees of professional responsibility on the basis of equality of treatment with the domestically trained health workforce 4.6 Member States and other stakeholders should take measures to ensure that migrant health personnel enjoy opportunities and incentives to strengthen their professional education, qualifications and career progression on the basis of equal treatment....should be offered appropriate induction and orientation programmes

25. Fairness questions On 4.6, taking measures to ensure migrant health personnel enjoy opportunities, incentives...induction and orientation programmes. • Are there some best or promising practices in the four countries to point to? • What are the barriers and facilitators to establishing such programmes?