Key questions on the WHO Code

Ethical Integration of Health Professionals Panel

Terry GoertzenCanada

Global snapshot- 2006

WHO Global Code of Practice on the International Recruitment of Health Personnel

Article 1- Objectives(4) To facilitate and promote international discussion and

advance cooperation on matters related to the ethical international recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries

Article 7- Information exchange7.1 Member States are encouraged to, as appropriate and subject to

national law, promote the establishment or strengthening of information exchange on international health personnel migration and health systems, nationally and internationally, through public agencies, academic and research institutions, health professional organizations, and subregional, regional and international organizations, whether governmental or nongovernmental.

PropositionThat this session be “recorded” and

documented, along with the presentations, to achieve Objective 4 of the Code by having an international discussion and advancing cooperation, as well as fulfilling the information exchange outlined in Article 7 (Chatham House rules)

The report can be used by participating countries/stakeholders as they prepare to report on activities related to implementation of the Code (Article 9.4).

CIHR/HEALTH CANADA CHAIR IN HEALTH HUMAN RESOURCE POLICY

Immigration and HRH Policy Contexts in Canada, the

U.S., the U.K. & Australia:Ivy Lynn Bourgeault

Rishma ParpiaElena NeitermanYvonne LeBlanc

Jan Jablonski

Overview

For each of Canada, the U.S., the U.K. & Australia:• Immigration Policy• HHR Regulation• HHR Supply Policy

Canada – Immigration Policy

• Federal jurisdiction; three categories: refugee, family class and economic class based on a points allocated to social capital

• Some provincial input through PNP for shortage occupations

Canada – HHR Regulation

• Specialty certification is nationally based• Licensure and professional regulation is

provincial/territorial based• A harmonization process is underway in response to the

Agreement on Internal Trade

Canada – HHR Policy

• HRH Policy is largely a provincial jurisdiction with recent coordinative involvement by the ACHDHR

• HRH has waxed and waned from perceived surpluses in the 1990s to current or projected shortages for both medical and nursing HR.

US – Immigration Policy

• Federal jurisdiction; two paths to immigration: permanent (immigrant admission) and temporary (non-immigrant admission).

• Major route for foreign skilled healthcare workers is admission through the permanent category.

US– HHR Regulation

• Licensure and professional regulation is state/territorial based.

US– HHR Policy

• HRH ‘policy’ has not real coordinated jurisdiction.• There has been a history of perceived oversupply of

both physicians and nurses as early as the 1980s.• Currently, there are projected shortages for both

medical and nursing HR.

UK– Immigration Policy

• Federal jurisdiction; five routes to entrance: (1) economic migrants; (2) temporary workers and visitors; (3) family category; (4) students; and (5) refugee and asylum seekers

• Major route for health care workers is through economic path (Tier 2)

UK– HHR Regulation

• Licensure and professional regulation are based at the UK-level

UK– HHR Policy

• HRH policy has largely been at the UK-level, but more recently, this has been devolved to the different nations

• The 1980’s and 1990’s were marked with shortages in funding and supply of HRH

• Starting 1997 and until early 2000s active expansion of HRH including domestic production and international recruitment

• Recent change include a move to self-sufficiency and a focus on domestic production of HRH

Australia– Immigration Policy

• Federal jurisdiction; two categories: permanent and temporary migration.

• Recently, major route for non-citizens is through long-term temporary migration programs.

Australia– HHR Regulation

• Prior to 2010, licensure and professional regulation was state/territorial based.

• Effective 2010, a centralized body, AHPRA regulates the medical and nursing profession through nationally consistent legislation.

Australia– HHR Policy

• HRH policy is largely a federal jurisdiction with some input from the states/territories.

• There has been a shift from a perceived oversupply to significant shortages for both medical and nursing HR.

PropositionThat this session be “recorded” and

documented, along with the presentations, to achieve Objective 4 of the Code by having an international discussion and advancing cooperation, as well as fulfilling the information exchange outlined in Article 7 (Chatham House rules)

The report can be used by participating countries/stakeholders as they prepare to report on activities related to implementation of the Code (Article 9.4).

Sustainable health workforce development, discouraging active recruitment from developing countries3.6 Member states...to create a sustainable

health workforce and work towards establishing effective health workforce planning, education and training and retention strategies that will reduce their need to recruit migrant health personnel

5.1 Member states should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers

Sustainable workforce questionsThe Code describes “establishingeffective health workforce planning” . Are we

becomingmore self-sufficient in the four countries, and

less relianton international recruitment?

From the papers presented, or your own area of expertise

are we actively discouraging recruitment of health

personnel from developing countries? How does India & the Philippines fit?

DataThe Director-General to rapidly develop, in

consultationwith Member States, guidelines for minimum

data sets

Article 3- Guiding principles3.7 Effective gathering of national and

international data, research and sharing of information

Article 7- Information exchange7.2 (b) progressively establish and maintain

updated data from health personnel information systems

Data question

Do we have good data that helps to inform the state of

ethical recruitment in each country? Where are there gaps?

Is there an existing minimum data set within thiscollaborative, and if not, what would it take todevelop it?Not just for medicine, but also nursing and other

mobile professions

Are we being fair to those who come and those who are here?Article 4- Responsibilities, rights and recruitment

practices4.4 Migrant health personnel should be hired, promoted andremunerated based on objective criteria, such as levels of qualification,years of experience and degrees of professional responsibility on the

basis ofequality of treatment with the domestically trained health

workforce4.6 Member States and other stakeholders should take measures toensure that migrant health personnel enjoy opportunities and

incentivesto strengthen their professional education, qualifications and careerprogression on the basis of equal treatment....should be offeredappropriate induction and orientation programmes

Fairness questionsOn 4.6, taking measures to ensure migrant

healthpersonnel enjoy opportunities,

incentives...inductionand orientation programmes. Are there some best or promising practices

in the four countries to point to? What are the barriers and facilitators to

establishing such programmes?