In a context of heightened awareness of the phenomenon of migration by healthcare professionals, coinciding with the development of the WHO’s Code of Practice on the International Recruitment of Health Personnel, the MPDC action was intended to contribute towards the effective management of migratory flows of doctors and nurses in the Ibero-American and EU space, by analysing the practical implementation of experiences of migration-flow management based on bilateral agreements, increasing the capacity of countries in the region to be fully aware of the migration process and its effects, improving processes for planning human resources, obtaining knowledge of the impact of the migration process on health services, and further strengthening the ministerial capacities and networking already begun in Ibero-American countries.
Work was done in the following areas:
- Analysis of the design, practical implementation, systematisation and socialisation of experiences of managing migration flows that foster mutual benefit and the drawing-up of best practices to foster their application in the Americas and other WHO regions that could put them to positive use.
- Improving information and exchange systems between countries to monitor the efforts made and the migration phenomenon in the health sector.
- Training in planning human resources with a view to achieving self-sufficiency, taking into account the migration phenomenon.
- Analysis of the impact of migration by healthcare professionals on health services at different levels in provider countries and the associated economic impact.
- Strengthening the RIMPS and supporting the implementation of its action plan for responsible management of migration.
Here are some of the most relevant conclusions and lessons learned after reflecting on the running of this initiative, which may be of interest for similar projects:
Political liaison between the countries involved is essential in order to build shared agendas to tackle the phenomenon of migration as a whole, in terms of managing information on migration flows and strategies to ensure sufficient supply while maintaining the workforce and professional development. This liaison can and should be managed and studied in order to obtain lessons learned, as has been done with this action.
Ministerial networks, like the RIMPS, are an excellent instrument for fostering this liaison and implementing a consensus in the relevant countries on the resulting strategies, proving to be an effective instrument for turning global policies into action at a national level. However, this “political/technical” space in turn needs support and maintenance strategies that are difficult for a single technical secretariat to handle alone, no matter how effective it may be. Constant changes at ministries mean that political commitments constantly have to be renewed in existing cases of dialogue — ministerial sector meetings, subregional-integration spaces — and in this sense the role of the PAHO/WHO and other support institutions is crucial.
The RIMPS allows intervention strategies to be devised that are based on multilateral dialogue, which is essential when addressing the issues arising out of the phenomenon of migration by health professionals, making it possible for stakeholder countries to exchange information and for work and group initiatives to be developed at regional and international forums. It also enables funding to be obtained, thanks to its own nature (as a network in the framework of the Ibero-American Secretariat General) and because of the match between its goals and strategies and targets for international development aid. A political and technical space has been consolidated in consonance with the WHO’s global code to strengthen international dialogue, in this case in such a large geographical space as the Ibero-American regions.
Professional networks have proven to be powerful instrument for fostering and developing political dialogue and transferring political undertakings to technical fields and obtaining results. Studying how to strengthen networking among members and making the sharing of information both useful and desirable — especially in such a sensitive topic area as that of migration by professionals — has become a development area to be strengthened going forward.
The flow-management experiences reviewed show that initiatives are already in place in the region, all with advantages and setbacks that can be taken into account when developing new proposals and formalising multilateral agreements for the appropriate management of migration flows. Fostering circular migration and the integration of professionals who return after migrating clearly contributes towards improving countries’ health systems.
Information systems, although they have improved considerably, are still lacking when it comes to characterising the migration phenomenon. The mandate granted by the conference of Ibero-American Health Ministers to the RIMPS Technical Secretariat, which this action has fostered through the RIMAIS, to work on an effective communication system for characterising the phenomenon, has mobilised the will and resources needed to develop an IT application with a module for characterising migration and a standardised register of professionals to work with. Again, the RIMPS has proven to be a key instrument for developing initiatives of this kind.
We still find that the migration phenomenon calls for multisector cooperation and coordination (migration, health, employment, national statistics, etc.), both in countries of origin and in destination countries, to assure rights in the migration process and equal treatment in destination countries. This partnership is particularly relevant if we wish to explore the economy of migration in greater depth, and we believe this could benefit from the methodological development that our proposal offers.
Analysis of the impact of migration by healthcare professionals should be extended to include a vision of the effects involved for migrating professionals or those for HR-management systems on the loss of resources (paying attention to this question when there is an increase), but that is not all; it should be extended to incorporate the visions of the teams that these professionals join, those of outgoing and incoming professionals, while also exploring social perceptions of the phenomenon to counter inaccurate ideas and intervene to address foreseeable issues that could affect these people’s basic rights.
The initiative to improve planning processes for healthcare professionals that has been undertaken by the MPDC action is positively valued, and the training process that has now been revised and built into the PAHO and EASP virtual campuses will continue. The pilot scheme adapting this course into Portuguese calls for certain adjustments to be made in order for it to be subsequently replicated. These adjustments are still under study at the time of drafting this report, in partnership with the WHO’s Africa office.
As mentioned, it has become clear that the phenomenon of migration by professionals continues to be yet another of the many complex factors behind the lack of human resources in healthcare in the countries. Working on the topic of migration therefore means coming up with solutions, ideas and proposals to address the work being done in other related sectors.
It is still of paramount importance to keep working on the creation of information and registration systems, on improving processes and implementing HR-planning strategies, and on improving professional and employment conditions for people working in the health sector in countries of origin, all with a view to building effective, efficient and equal-opportunities health systems.
Coordinated work by three institutions that have such different characteristics, such as those involved in this action — a Latin American sector ministry (Uruguayan Ministry of Public Health), a technical-support body within the United Nations system (PAHO/WHO) and an institution specialising in public-health knowledge management in Europe (EASP) — poses a challenge that can only be overcome by integrating into the action matching or complementary objectives of the three institutions, such that the action represents an opportunity to work in synergy-based partnership, avoiding duplicating efforts and creating significant economies of scale.
Creating synergies between the objectives of the action and those of the institutions involved, strengthening existing areas, by avoiding duplication and wasted effort, benefiting from team work and task-sharing, makes it viable to develop an action on this scale, which would not be feasible for one institution alone. This partnership and integration of activities into common strategies enriches the process, providing complementary experiences and approaches, different perspectives in analysis and generates a better understanding of the needs (different and joint ones) that the countries must address in their distinct roles as senders and receivers of migration of subject to both.
Likewise, these factors have enables us to determine the specific areas to continue to work on going forward in this area, which are:
- Political dialogue, as the basis for reaching agreements on a global scale.
- Strategies to retain professionals or build their loyalty.
- Bi- and multilateral agreements on migration by healthcare personnel.
- Information/registration systems for professionals.
Continuing to support the WHO’s Global Code of practice on the International Recruitment of Health Personnel, which, despite its limitations, is still a good instrument for dialogue and commitment.
The best practices developed by the Steering Committee include the creation of a manual of standards and procedures for managing the action, clarification of the regulatory framework, transparency in management, participation in decision-making for the design of operational plans, and regular accountability between the partners. Also of interest is the creation of a technical secretariat with the capacity to monitor processes not only administratively, building in technical components that have enabled methodologies to be standardised and protocols to be defined for the development of the work contracted, as well as permanent contact and monitoring with the research groups or consultants handling the specific tasks undertaken in the framework of this action. The protocols and methodological proposals used can be accessed from the MPDC website and are fully replicable by any other expert groups interested.
The project’s website has shown its usefulness both as a vehicle for communication between the people who are directly involved and as a depository for documents on all the administrative processes developed over the course of the project, as well as for disseminating the products and results of the action and making them available for any interested persons or institution, requiring it to be updated constantly.
Consolidation of the RIMPS as an Ibero-American network under the auspices of the Ibero-American Secretariat General strengthens and sets out the political will that exists in the region to continue working on this topic and facilitates its incorporation into the strategies international-aid strategies and subregional-integration spaces that are under way in Latin America, strengthening the design and development of intervention strategies based on multilateral dialogue.
We trust that the lessons drawn from these experiences will be found to be use by any group interested in the topic of professional migration, specifically in the healthcare area, in seeking mechanisms and experiences for the effective management of professional flows, which, while respecting the rights of those who decide to migrate, will enable processes to be built that not only do not widen the gap in the capacity of health systems to address their populations’ basic needs but actually contribute towards a new vision of fairer and more equal healthcare worldwide.
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Contribution by Andalusian School of Public Health (EASP) to the Annual Report 2017 of the MMI Network
Author: Juan Ignacio Martínez Millán, Director of Action MPDC and Lecturer of International Health at the EASP
For further information on this action and access to all the products generated as part of it, please visit www.mpdc.es.