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21 January 2010

International recruitment of health personnel: WHO code of practice will be sent to 63rd WHA for approval

photo: WHO

MMI, Basel and Geneva, 21 January 2010 | The issue of health workforce migration was yesterday on the agenda of the WHO Executive Board: The WHO Board discussed the revised draft code of practice and agreed to submit it to the Sixty-third World Health Assembly, in May 2010.

Migration of health personnel has been increasing worldwide over the past decades, especially from lower income countries whose health systems are already very fragile. To address this situation, the World Health Assembly adopted resolutions which called for the development of a Code of Practice on the International Recruitment of Health Personnel. In January 2009, the WHO Executive Board discussed a first draft of a Code of Practice, but requested further consultation among Member States, including through discussion by regional committees. Since then, all six regional WHO committees discussed the key issues related to the Code of Practice. The Medicus Mundi International Network submitted a statement to the meeting of the European WHO committee in September 2009. Since then, the WHO revised the code.

A stronger code

In its report to the WHO Executive Board, the WHO Secretariat pointed out that the revised draft was stronger than the previous one:

Two core themes identified by the regional committees and incorporated in the revised draft code were that Member States should strive to achieve a balance between the rights, obligations and expectations of source countries, destination countries and migrant health personnel, and that international health worker migration should have a net positive impact on the health system of developing countries and countries with economies in transition. To this end, Article 5 on mutuality of benefits has been strengthened. The revised draft text emphasizes that international health personnel should be recruited in a way that seeks to prevent a drain on valuable human resources for health.

In accordance with the views expressed by some regional committees, it also recommends that countries should abstain from active international recruitment of health personnel unless equitable bilateral, regional, or multilateral agreement(s) exist to support such recruitment activities.

In addition, voluntary technical and financial mechanisms to strengthen the development of health systems in developing countries and countries with economies in transition are proposed in Article 11.

The revised draft code also recommends that Member States should seek to strengthen the balance between the rights of health personnel to leave their countries and the right of everybody to the enjoyment of the highest attainable standard of health in order to mitigate the negative effects of migration on health systems.

In accordance with the discussion in some regional committees, the revised draft code also recommends strengthening the provision on self-sustainability by stating that Member States should, to the extent possible, strive to meet their health personnel needs from their own health workforce. In order to make national health workforces sustainable, the revised draft code includes new provisions recommending that Member States consider a variety of measures to retain health workers.

Civil society organizations welcomed the new draft

The Medicus Mundi International Network is a member of the Health Workforce Advocacy Initiative (HWAI), an international civil society-led coalition that works to support and strengthen human resources for health (HRH). In a letter to  the MMI Executive Board, HWAI welcomed the new draft of the Global Code of Practice on the International Recruitment of Health Personnel, urging the Executive Board to submit the Code to the 63rd World Health Assembly in May 2010.

MMI statement to the WHO Executive Board:
"Bring the Code to the 63rd World Health Assembly!"

As an NGO in official relations with the WHO, the Medicus Mundi International Network was invited to appoint a representative to the WHO Executive Board meeting. In her statement to the WHO Executive Board, the MMI representative Anke Tijtsma (Wemos, The Netherlands) welcomed the improvements made in this revised version of the Code: The amendments made have strengthened this vital document. The MMI Network especially welcomed the emphasis on the roles and responsibilities of destination countries in tackling the HRH crisis.

Nevertheless, the representative of the Medicus Mundi International Network raised several issues that would further strengthen the ability of State and non-State actors to adhere to the Code and enhance its overall impact.

The MMI representative concluded that it might be hard to reach consensus on the text of the Code. However, MMI urged the Executive Board to submit the Code to the 63rd World Health Assembly and to ensure that it will benefit the nations and their people who would suffer from a limited Code, which would result in weakened health systems unable to meet local need.

The Code will be sent to 63rd WHA for approval

Anke Tijtsma reported from the meeting that after a rather brief session on this agenda item with interventions of just over 20 Member States it was initially left open how to proceed. Suggestion were made to start a web-based consultation on the text of the Code. Fortunately, there were a number of delegations opposed to any further consultation as that would (according to e.g. Brazil, Paraguay and Zimbabwe) lead again to new rounds of debate without major improvements. The chair mentioned that the Code could be seen as a dynamic text! WHO DG Margaret Chan concluded that the whole process already took around six years, so it was time to stop more consultation, as most interventions made were suggesting to send it to the next WHA for approval. Dr Chan proposed to continue to collect suggestions and ideas for revision of the text so that Member states could still make their comments. These would then be collected but not incorporated into the text in this phase. The agenda item was finalised just after 18h in the evening.

Thomas Schwarz, Executive Secretary
Medicus Mundi International Network
21 January 2010


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