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:
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
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.
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:
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