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Better management of health workforce migration

09 July 2010 -- High-income countries are increasingly dependent on doctors and nurses who have been trained abroad. But the migration of health workers weakens the health systems in the countries of origin. WHO's Code of practice on the international recruitment of health personnel aims to achieve a balance between the interests of health workers, source countries and destination countries.

Transcript of the podcast

Veronica Riemer: You're listening to the WHO podcast and my name is Veronica Riemer. In this episode we look at problem of migration of health workers and a new code to regulate international recruitment.

Many health workers, such as doctors, nurses, pharmacists, laboratory technicians – as well as management and support workers - migrate to high-income countries to earn more money, to increase job satisfaction and career or training opportunities. Others move away from political instability, war, and the threat of violence in the workplace.

Demand for health workers is increasing in high-income countries, where health systems can depend heavily on doctors and nurses who have been trained abroad. But migration of health workers results in financial loss and weakens the health systems in the countries of origin.

In May 2010, a new Code of practice on the international recruitment of health personnel was adopted at the 63rd World Health Assembly. It aims to achieve a balance of the interests of health workers, source countries and destination countries, with an emphasis on redressing the negative effects of health worker migration on countries experiencing a health workforce crisis. Rhee Hetanang, Counsellor at the Permanent mission of Botswana based in Geneva, who was involved in negotiating the new Code, tells us why Botswana supports its introduction.

Rhee Hetanang: The negotiations for the WHO code of practise is a major milestone in Botswana because we believe it is a delicate balance following negotiations that were tough. We believe that it was hard work by all the Member States who engaged in the negotiations. We believe it is a very useful package that Member States and all the stakeholders involved in the international recruitment of health personnel can refer to and use as a useful reference in drawing up cooperation between themselves and in undertaking ethical recruitment, because ethical recruitment has been the major concern throughout.

We believe that the code will be particularly useful for Botswana as a tool that we can use to strengthen our health system; because the code provides mechanisms for data gathering and research and information exchange as well as monitoring and compliance and implementation.

We have encouraged other countries to use this code. We believe that it is voluntary in nature but it is universal in scope and we believe that if implemented it will be very useful for us as a country and the international community.

Veronica Riemer: Fransisco Campos, is the Secretary for Labour and Education Management in Health within Ministry of Health Brazil. Although Brazil does not face the drain of skilled personnel, he recognizes that many of the poorest countries of the world are confronting a crisis in migration of health professionals. Solutions will come through improved domestic training of health workers, and fairer treatment and better pay for those who may face difficult and often dangerous working conditions.

Fransisco Campos: All the population in the world has the legitimate rights to migrate if they want to but at the same time have to consider that the investments that the country, especially the poorest ones do in the education of the health professionals, must be taken into consideration as well. So we cannot just prioritize the legal rights, but we cannot say that workers don't have the right to migrate. They can do that, but if they do, there is a way to create some mechanisms to compensate and to give to the countries that are loosing them the opportunity to train other ones or be compensated by this.

If we ask ourselves, what this code really means, it is exactly creating a system of information and evidence-based data, that can allow in the future to have further decisions that go beyond the voluntary Code. We in Brazil respect that the international solidarity will be of value in the international diplomacy and this Code will be in our point of view the first step in order to have in the world a better system of health, universal access that are the values we have been pursuing for a long while.

Veronica Riemer: For the last five decades Norway has faced a fluctuating shortage of physicians, mostly driven by an increasing demand for advanced specialized care. Bjorn Inge Larssen Norway's Chief Medical Officer welcomes this international policy for the recruitment of health personnel as a way to reduce dependency on migrants through the education and training of more health workers at home and by making better use of the existing workforce.

Bjorn Inge Larssen: Norway is one of those countries where we over the next 10 to 20 years will need a lot more health resources because the population is ageing and this code clearly states that countries need to plan for their own needs of health personnel. We need to have an evidence based planning of that and we need to make sure that we take the responsibility of educating the health personnel we have. So this is a very clear message to Norway. We are to plan clearly what we need for our health services, and we are to educate that ourselves. We will increase education of some of our groups of health personnel. Norway has been planning that for a couple of years. But this will have consequences for the way work on this. The education of health personnel will probably now be more important when we are working with other countries to improving their systems.

Veronica Riemer: That's all for this episode of the WHO podcast. Thanks for listening. For more information about the Code, you can access see the links on the transcript page of this podcast. For the World Health Organization, this is Veronica Riemer in Geneva.

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