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The World Health Organization (WHO) has developed a 'global code
of practice' to stem the 'brain drain' of health-care workers from
developing to high-income countries, which weakens health systems
in the countries they quit. (1167 words, English)
Richard Johnson
Worldwide, there are around 60 million health workers. About
two-thirds provide health services; the other one-third is
management and support workers. Without them, prevention and
treatment of disease and advances in health care cannot reach those
in need.
Against this backdrop, WHO -- a directing and coordinating health
authority of the United Nations system -- has drafted a Global Code
of Practice on the International Recruitment of Health Personnel,
which is intended to achieve "an equitable balance of the interests
of health workers, source countries and destination
countries".
According to WHO, health-care workers, like workers in other
sectors of the economy, tend to go where the working conditions are
best. "Income is an important motivation for migration, but not the
only one. Other reasons include: greater job satisfaction; career
opportunities; the quality of management and governance; moving
away from political instability, war, and the threat of violence in
the workplace."
Migration is often stepwise. People tend to move from the poorest
regions to richer cities within a country, and then to high-income
countries. In most countries, there is also movement from the
public to the private sector, particularly if there are
considerable differences in income levels, states a WHO
factsheet.
WHO points out that globalization has helped to trigger
international migration. At the same time, demand for health
workers has increased in high-income countries where not enough
required personnel is being trained locally and where the existing
workforce is ageing. Demand for health services is also increasing
because of ageing populations and the rise of chronic illnesses
like diabetes and heart disease, especially in rural areas.
In a number of middle-income countries with good health education
systems -- such as Fiji, Jamaica, Mauritius and the Philippines --
a significant proportion of students, especially in nursing
schools, begin their education with the intention of migrating,
usually in search of a better income. Some countries, notably the
Philippines, are seeking to capitalize on the demand for imported
health workers by deliberately training graduates for international
careers.
IMPACT OF MIGRATION
The movement of health workers abroad, states WHO, has both
negative and positive consequences.
When significant numbers of doctors and nurses leave, the
countries that financed their education lose the return on their
investment.
Financial loss is not the most damaging outcome, however. When a
country has a fragile health system, the loss of its health
workforce can bring the whole system close to a collapse, with the
consequences measured in lives lost.
"On the positive side, each year, migration generates billions of
dollars in remittances (the money sent back to home countries by
migrants) to low-income countries and has been associated with a
decline in poverty. Health workers also may return and bring
significant skills and expertise back to their home countries," WHO
points out.
SCOPE OF MIGRATION
Exploring the scope of migration, WHO says that health systems in
a number of high-income countries depend heavily on doctors and
nurses who have been trained abroad, in the developing world. Over
the last 30 years, the number of migrant health workers increased
by more than 5 percent per year in many European countries.
In countries of the Organisation for Economic Co-operation and
Development (OECD), around 20 percent of doctors come from abroad.
In some Gulf States, such as Kuwait or the United Arab Emirates,
more than 50 percent of the health workforce is migrants.
Nurses from the Philippines (110,000) and doctors from India
(56,000) account for the largest share of migrant health workforce
in OECD countries. "However, countries with smaller populations
than India and the Philippines may suffer from a larger impact in
terms of expatriation rates," notes the WHO.
Over 50 percent of highly-trained health workers leave for greener
pastures abroad in some low-income countries.
ADDRESSING THE NEGATIVE EFFECTS
Because the number of highly trained and skilled health-care
workers wanting to emigrate from developing to high-income
countries is increasing, thereby weakening health systems in the
countries of origin, WHO proposes following actions to address the
negative effects of migration in source countries:
- Better health workforce retention, especially in rural and
remote areas;
- Stronger protection and fairer treatment of health workers, who
may face difficult and often dangerous working conditions and poor
pay; and
- Improved domestic training of health workers and development of
policies that facilitate the return of migrants.
On the other hand, WHO proposes for the countries of
destination:
- Reduced dependency on migrant health workers notably through
educating and training of more health workers domestically and by
making better use of the existing health workforce; and
- Responsible recruitment policies by destination/receiving
countries and fair treatment of migrant health workers.
As part of an attempt to cope with the situation, the World Health
Assembly requested WHO in 2004 to develop a code of practice on the
international recruitment of health personnel. In response, WHO
initiated a global consultation process. The Code was adopted by
the World Health Assembly in May 2010.
The Code of Practice as adopted is voluntary, global in scope and
applies to all health workers and stakeholders. It sets out
principles and encourages the setting of voluntary standards. The
equitable balance of the interests of health workers, source
countries and destination countries is promoted, with a particular
emphasis on redressing the negative effects of health worker
migration on countries experiencing a health workforce
crisis.
Key components of the Code include:
- Greater commitment to assist countries facing critical health
worker shortages with their efforts to improve and support their
health workforce;
- Joint investment in research and information systems to monitor
the international migration of health workers in order to develop
evidence-based policies;
- Member states should meet their health personnel needs with
their own human resources as far as possible and thus take measures
to educate, retain and sustain their health workforce; and
- Migrant workers' rights are enshrined and equal to
domestically-trained health workers.
Rhee Hetanang, Counsellor at the Permanent mission of Botswana
based in Geneva, who was involved in negotiating a global code,
says that the Southern African country supports introduction of the
new code. In a podcast web posted by WHO, Hetanang said
negotiations for the WHO code of practice are a major milestone for
landlocked Botswana "because we believe it is a delicate balance
following negotiations that were tough".
Supporting the global code, Bjorn Inge Larssen, Norway's chief
medical officer points out: "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. The education of health personnel will probably now be
more important when we are working with other countries to
improving their systems."
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