International recruitment of health personnel: WHO code of practice will be
send to 63rd WHA for approval
Basel and Geneva, 21 January 2010 | The issue of health workforce migration was
yesterday on the agenda of the WHO Executive Board: The 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
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 (MMI) 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. In a
letter to the MMI Executive Board, HWAI welcomed the new draft of the Code,
urging the Executive Board to submit it to the 63rd World Health Assembly in
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 send to 63rd WHA for approval
Our representative 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.
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