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GATS and the migration of Human Resources for Health (HRH)

Meeting of the Technical Subgroup of the task force of International Trade in Services on the Movements of Natural persons – Mode 4 OECD, Paris, September 15-16, 2004WHO. GATS and the migration of Human Resources for Health (HRH). Dr Khassoum Diallo EIP/HRH WHO Geneva. Outline.

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GATS and the migration of Human Resources for Health (HRH)

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  1. Meeting of the Technical Subgroup of the task force of International Trade in Services on the Movements of Natural persons – Mode 4OECD, Paris, September 15-16, 2004WHO GATS and the migration of Human Resources for Health (HRH) Dr Khassoum DialloEIP/HRHWHOGeneva

  2. Outline • GATS and the migration of health workers • Mode 4 Commitments for health services • Issues of concern • Beyond GATS, migration of HRH • HRH migration monitoring strategies • Data sources and indicators

  3. GATS and migration of SHPs** Skilled Health Professionals General SHP migration issues GATS/Mode 4-specific issues

  4. Services and commitments under Mode 4 • Mode 4 • Health Services in GATS • Business • Prof. Services h. Medical and Dental services (9312) j. Services provided by midwives, nurses, physiotherapists and paramedical personnel (93191) 8. Health related and social services (other than those listed under 1.A.h-j) • Hospital services (9311) • Other Human health services (9319)

  5. Issues of concern • "Unbound" commitments : Do they influence stocks and flows • What basic evidence exist ? What can we learn from it? How do we create new evidence? • What evidence for policy makers on the impact of GATS on health systems or on economy • What for further negotiations • Time issue

  6. Beyond GATS: Migration of health workforce • What is the size of the problem? • What is the impact of HRH migration on developing countries health systems and labour markets? • What policy responses have there been? • What strategies for monitoring HRH migration?

  7. Flows of HRH: Numbers Types (disaggregated) Length of stay Financial flows: Value of trade Remittances Investment in training Impact on health system performance & financing Salary levels Structure of the labour market Barriers/facilitators Human resource strategies (methods of recruitment) Financial compensation mechanisms ?? Impact of other sectors Definition of “temporary” Other areas of interest

  8. Probability of employment at destination Probability of not being deported Relative earnings if employed at destination Probability of employment at community of origin Total costs of movement (financial and psychological) Decision to migrate From Stalker (2000)

  9. Strategies to monitor HRH migration - 1 Receiving countries: • Formal registration • Data source : Regulatory bodies and professional associations registries • Number and % of foreign workers by occupation • Considering inter-country agreements

  10. Strategies to monitor HRH migration-2 Sending countries: Voluntary "Exporters" • Formal registration and recording • Data source : Governments, HTIs, Regulatory bodies and professional associations, Recruitment agencies based in the country • Number of workers sent abroad by occupation: Ratio vs. current staff or vs. outputs • Considering inter-country agreements

  11. Strategies to monitor HRH migration - 3 Sending countries: Non-Voluntary "Losers" • No formal registration and recording • Data source : Governments, Private health sector records • Strategy 1: Statistics from main receiving countries (e.g. represents 80% of external workers. • Strategy 2: Attrition-based • Big Assumption: The remaining is expected to be international migration

  12. Other data sources Prof. Assoc & Regulatory bodies registers Institutional data e.g. schools, health Facilities, MoH GATS mode 4 Censuses and specific surveys Temporary flows, Recruitment Agencies, Working Visas Immigrant community associations

  13. Potential Indicators • Inflows and outflows (numbers or ratios) • Skill-mix of health migrants • Share of migrants workers in national HRH (numbers or %) • Duration of stay (plan/entitlement) • Country of origin or destination • Level of HRH unemployment in country of origin • Remittances

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