Human resources for health team

Reflections on the WHO Global Code of Practice on the International Recruitment of Health Personnel

This week, the 73rd World Health Assembly (WHA) is convening virtually to deliberate on core global health related challenges facing its Member States. Alongside the COVID-19 pandemic, a key challenge is the global shortage of health workers and how to properly and ethically manage the international recruitment of health personnel without negative impact on the countries with critical shortages.

The WHO Global Code of Practice on the International Recruitment of Health Personnel (hereafter: the WHO Code) is the instrument adopted in 2010 to support Member States in this challenge. During the WHA73, one of the agenda items is the Expert Advisory Group report on the second review of the relevance and effectiveness of the Code. The report was submitted to the member states in May, requesting the WHA to note the report and (among others) implement its recommendations.

The Health Workers for All Coalition asked a few of its members closely following the Code to share their reflections on the current pandemic in relation to health workforce shortages and the WHO Code.

Note: The views expressed are those of the individual Health Workers For All Coalition members and do not necessarily represent the collective standpoint of the Coalition membership.

Borderless employees

Dona Anyona

Dona Anyona is Regional Policy Manager at AMREF Health Africa, based in Kenya. One of the projects she is working on is developing an African hub on the mobility and migration of health workers that is a one stop shop for governments, policy makers, donors, and medical professional associations on health worker mobility and migration on the continent.

“Pre-COVID-19, the migration of health workers was majorly impacted by factors such as remuneration, family situation, educational aspects, etc.  As a result, health workers migrated at will or circumstantially based on the prevailing conditions. The COVID-19 pandemic has severely restricted health worker movements, and its impact is already felt.  

As health workers are “borderless employees”, their mobility should always be facilitated to ensure that they are able to migrate and discharge their duties where needed with a lot of ease.”

Mutually beneficial migration

Graeme Chisholm

Graeme Chisholm is a Senior Learning and Policy Manager at THET Partnerships for Global Health, based in the United Kingdom, and has for a long time followed and engaged on the WHO Code.

“A trained health workforce providing safe high-quality care is critically important to an effective response to COVID-19. Institutional health partnerships based on the idea of mutually beneficial learning are making an important contribution. A focus on infection prevention and control is paramount. But psychosocial as well as physical support will be vital at this moment of crisis, alongside a renewal of government’s commitment to work in partnerships to educate, recruit and retain health workers in sufficient numbers to ensure sustainable workforce planning and mutually beneficial migration.”

A global scramble for doctors and nurses

Dr Ouma Oluga

Dr Ouma Oluga (Kenya) currently serves as the Chief Officer of Health in the newly created Nairobi Metropolitan Services (NMS).   He is the previous Secretary General for the Kenyan Medical Practitioners and Dentists Union (KMPDU).

“The COVID pandemic triggered a global scramble for doctors and nurses as there was for ventilators, essential medicines and commodities. It will be a long time before the global movement of health workers during the pandemic situation will be documented. But one thing is so far for sure: the recruitments did not follow WHO standards. 

A pandemic such as COVID-19 is unique in the way that it affected the entire world eco-system of jobs. We have already seen loss of millions of jobs in what were referred to as non-essential sectors and industries. But the health sector demanded more and more workers as the infection rates went higher each month. And while many countries began to worry about the health worker shortages when thousands were taken into isolation or quarantine and thousands of others were unfortunately lost to the pandemic, the trend of recruitment of health workers became unchecked.”

As civil society organisations, the challenge is ours

Thomas Schwarz

Thomas Schwarz is Executive Secretary with Medicus Mundi International (MMI), based in Switzerland, and has been actively and passionately involved in advocacy around Human Resources for Health for many years.

 “The second Expert Advisory Group (EAG) report is much more concrete and hands-on than the first one in 2015, and the recommendations are all relevant, but at the same time challenging and highly complex. This is, for example, true for the proposed new calculation of critical shortages, for the integration of Code and National Health Workforce Accounts reporting, and for the full involvement of non-state actors in this member states instrument. Many noteworthy details, e.g., the approach to “better understand and improve the lived experience of migrant health workers”, and some continued blind spots such as how to apply the Code in the field of health worker mobility within regionally integrated political and economic spaces (take the European Union) are also left unaddressed.  

As civil society organisations, the challenge is ours. After a number of initiatives there is still no established interface between the WHO/Code Secretariat and civil society on health workforce (mobility) issues. CSO representation in the EAG was not fully transparent, and the job would have been a difficult one anyhow, because which CSOs and CSO networks have the technical capacity, historical and political background and the means to keep the pace? The issue is the same as with WHO and Member States: Attention (priority), leadership, capacity, money.” 

We need transparency on bilateral agreements for health worker mobility

Denis Bukenya

Denis Bukenya is the Executive Director of HURIC, the Human Rights Research Documentation Center, in Uganda and active within the Ugandan chapter of the People’s Health Movement.

“The biggest challenge with the Code is that of bilateral agreements signed between the source and destination countries. Uganda has many such agreements that are not disclosed to the public. It is feared that civil society and health rights activists will be very critical of the agreements. Yet there are officers in the government with financial gains in such agreements.

If I was an official delegate in the discussions on the relevance and effectiveness of the Code, I would push for a clause that advises more disclosure of the Bilateral Agreements because low-income countries are suffering from poorly crafted Bilateral Agreements that are only benefiting the country of destination and a few individuals in the drafting team. With improved transparency, CSOs and health rights activist can enable accountability towards both source and destination countries not adhering to the Code. And push for Governments to draw up extended plans for the training, financing, recruiting and retention of health workers.”

Photo: ‘COVID-19 testing (Madagascar – Tests (9))’ by World Bank Photo Collection via Flickr Creative Commons is licensed under CC BY-NC-ND 4.0

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