MMI Network News, June 2010
On May 20, 2010, the resolution on ”Global Code of Practice on the International Recruitment of Health Personnel" was unanimously adopted by the 63rd World Health Assembly. The passing of this resolution is a historical moment, as it is only the second code of conduct ever that has been adopted by all member states of the world Health Assembly. The Code of Practice sets forth ten articles advising both source and destination countries on how to regulate the recruitment of health personnel in a way that mitigates damage to low-income countries struggling to meet the basic health needs of their populations in a setting of serious workforce deficits. The Code recognizes “the severe shortage of health personnel … [which] constitutes a threat to the performance of health systems and undermines the ability … to achieve the Millennium Development Goals.” The Code takes into account both the right of health personnel to migrate, as well as the right of populations to the highest attainable standard of health.
It was not at all an easy thing to get the Code adopted by the World Health Assembly. On its opening day on May 17, the Assembly appointed a drafting committee to revise a draft that had previously been approved by the World Health Organization’s executive board in January 2010. The drafting committee, attended by delegates from dozens of countries, and chaired by Thailand’s Ministry of Health delegate Dr. Viroj Tangcharoensathien, worked through the night until 4:30 in the morning of the 20th May to arrive at a compromise that balances the interests of countries that lose and countries that gain health workers through migration. The United States delegation played a significant part in the negotiations in the drafting committee, however. As a major “receiving country,” with 25 percent of its physicians imported from abroad (and two-thirds of them from lower income countries), the U.S. argued for a weaker Code than was preferred by delegates from African countries, which lose a large proportion of their trained doctors to European and American practices. Norway’s delegation, headed by Dr. Bjørn-Inge Larsen, Director-General, Norwegian Directorate of Health, was an important advocate for the interests of low-income countries. Norway developed a 2007 “framework on global solidarity” pledging to refrain from recruiting health workers from developing countries.
Although some of the wording of the final code has been watered down, the essence remains intact: rights-based protection and support for health workers and health systems in the context of global health care worker migration. Last week I spoke with Dr. Magda Awases, who is a senior officer on human resources for health at the WHO regional office for Africa. She conducted research and provided technical recommendations that led to resolution WHA 57.19, “International migration of health personnel: a challenge for health systems in developing countries”, in 2004. This resolution requested the development for a code of practice and strategies to mitigate health care worker migration. She explained to me that the initial idea was to establish "the development of government-to-government agreements, as well as mechanisms to mitigate the adverse impact on developing countries, including means for the receiving countries to support the strengthening of health systems, in particular human resources development, in the countries of origin". When I discussed with her the articles of the code, we both concluded that this element of compensation for health care worker loss to their health systems of origin is carefully avoided in the final Code.
In this sense, one could regard the code as a glass filled either half empty or half full. By realizing all the years of efforts and dialog it took to reach consensus upon this code, the best will be to regard the glass as half full. We do now have a tool to jointly look at international health workers migration in a constructive way.
However, the mere presence of the Code itself does not lead it automatically to be implemented. Our role as medical professionals and civil society organizations is to guide countries and policy makers to implement the code:
- First of all, awareness raising and communication on the global code needs to conducted at regional and country levels. There is not only need for a dialog within the health sector, but this should include representatives of labor, migration, public services, education, development cooperation, financing departments (etc) as those policies also effect the health workforce. Non-public actors as private providers, recruitment agencies, labor unions, professional associations and faith based institutions and NGOs should be included in these dialogs at national levels.
- Secondly, there is a need for a harmonized and structured way for data collection and analysis to look at the trend of health workforce mobility and recruitment practices, and the impact is has on health systems and access to care in both receiving and sending countries.
- Consecutively a solid framework (e.g. a national score card) for monitoring the code must be developed. WHO will take a leading role in that exercise.
- These steps are essential before bi- and multilateral agreements, as well as protective legislation within countries that have a critical shortage of their health workforce can be implemented.
These processes are to take place at both national, regional and international level. Civil society organizations can play a role in linking those levels as NGOs are well connected to the grassroots work and also have a role to play by engaging in the regional and global dynamics.
Remco van de Pas, Wemos Foundation
Programme Officer Human Resources for Health
MMI Network Event: MMI
MMI Assembly and Board meeting, Geneva, 20 May 2010
Welcome to Smile Train Italia and Wemos!
As in the previous years, the Annual Assembly of the Medicus Mundi International Network took place in Château de Bossey near Geneva. This year's General Assembly was a milestone in the development of our Network: The Assembly adopted a Network Strategy for the next five years. The election of the Board and of Nick Lorenz as new Chairperson (following Guus Eskens who had to step back having completed two terms: see photo) and the admission of two new members (Wemos Foundation and Smile Train Italia) were other highlights of the meeting.
The full Assembly documentation is available in the internal section of the MMI ePlatform. Use your own user name and password or ask the secretariat for temporary access.
Smile Train Italia website: www.smiletrain.it
Wemos website: www.wemos.nl
MMI Network Event: Organisation
“We will make the MMI Network a real community
of change for strengthening health systems”
MMI Network Strategy 2011-2015
The “MMI Network Strategy 2011-2015” is a general framework which explains how our Network shall pursue its vision and carry out its operational mission during the five years ahead. Our strategic choices for the next years presented in this document are based on a broad agreement of the Network members that they are promising ones:
1. We will focus joint ventures on issues related to health systems strengthening.
2. We will develop new spaces and tools for sharing know-how and joining forces.
3. We will focus joint international advocacy on the WHO.
4. We will develop new partnerships between NGOs and research institutions.
MMI Network Document
„Work in (good) progress”
MMI Annual Report 2009
“…and what will the future bring for the Medicus Mundi International Network? New members, a new president, new leadership and a new strategy only? I guess this will largely depend on the amounts of time and energy that we all are prepared to invest in this new plan! Cooperation of members on issues related to health system strenghtening in less developed countries will be the joint and common agenda of all Network members – with a strong focus on advocacy towards international policy makers. By doing that we will try to transform the MMI Network into a real community of change. The future of Medicus Mundi International is in its members’ hands. It was an privilege to serve on our Board as the MMI president.” (Guus Eskens, MMI President 2004-2010)
MMI Network Event
World Health Assembly
Geneva, 17-21 May 2010
The agenda of this year's World Health Assembly included, among other items, the implementation of the International Health Regulations; the global strategy and plan of action regarding public health, innovation and intellectual property; the monitoring of the achievement of the health-related Millennium Development Goals; and the draft global code of practice on international recruitment of health personnel.
As an organization in official relations with WHO, the Medicus Mundi International Network was invited to appoint representatives to the Assembly and to make statements under items concerning technical issues. The MMI Network focused its joint activities on advocacy related to the WHO code of practice on international recruitment of health personnel. We organized, together with other civil society organizations, a side event on the implementation and monitoring of the code. We are proud of having been part of the civil society alliance advocating for the adoption of the code – and we intend to play a role in its implementation.
WHA reports and documentation:
Side event documentation:
MMI Network paper
A stronger voice of civil society at the World Health Assembly?
“Many civil society organizations interested in 'making WHO work better' (title of a Global Health Watch discussion paper, 2006) were frustrated by the way the World Health Organization limited the role and impact of civil society at this year’s World Health Assembly. But we could have done better ourselves...” (Thomas Schwarz, MMI Executive Secretary)
This issue of the MMI Network news is an atypical one, as there is not enough space to include the news and resources published on the electronic platform of the MMI Network and in the “MMI updates” on Twitter. So please stand by until the next issue in early July ... or, even better, send us your news and resources for our ePlatform and this newsletter!
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