Transcript HRH workplan 2007

International recruitment of health personnel:
a WHO code of practice
World Health Editors Network
Making Global Health News
Geneva 17-18-May 2009
Jean-Marc Braichet, Coordinator
Health Workforce Migration and Retention Team
Department of Human Resources for Health
World Health Organization, Geneva
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International and internal migration:
complementary but different responses required
 Responses to international migration of HRH
-
bilateral agreements (e.g. South Africa - UK;
Philippines - Japan, etc.)
-
regional codes (e.g. Pacific code)
-
draft global code of practice on the international
recruitment of health personnel
 Responses to internal migration:
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national measures
WHO is developing to major and complementary projects
 Developing a draft global code on the international
recruitment of health personnel
 Implementing a programme which aims to improve the
retention of health workers in rural and remote areas
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Main objectives of a WHO code of practice
 To establish and promote voluntary principles.
 To serve as an instrument of reference.
 To provide guidance.
 To facilitate and promote international discussion and advance
cooperation.
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Process to develop a WHO code of practice on the
international recruitment of health personnel 1/2
Jan08
Mar08
April08
EB Migration
Progress Report
Kampala Forum
May08
PAC – TWG
meeting
Launch of Global
Dialogue on Migration
June08
July08
August08
Sept08
Oct08
Tallinn Euro
Ministerial
Public
Hearings
G8 Summit
Drafting of
the Code
Manila Forum
Draft Outline for a Code
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Draft Code
Process to develop a WHO code of practice on the
international recruitment of health personnel 2/2
Jan09
May09 June09 July09 August09
Sept-October 09
January10
March10
May10
------------ Consultations ---------WHO RCs
Progress Report for EB
Draft Resolution
Draft Code
Progress Report for EB
Global consultation?
Background Paper
Technical Briefing WHA09
Draft Code for the WHA?
Draft Code
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A WHO program on increasing access to health workers
in remote & rural areas through improved retention
For at least three main reasons:
1. needs clearly identified
2. calls for action
3. renewal of PHC
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1- Need has been clearly identified in all countries
Inequitable distribution of health workers
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A programme built on three strategic pillars
 1- Building the evidence base on effective retention strategies
– literature reviews, expert consultations, synthesis of the
evidence, identification of knowledge gaps and commissioning
research
 2- Supporting countries to evaluate and adapt retention
strategies
– work with interested countries to evaluate past and on-going
strategies and to develop and implement country-specific plans
 3- Developing and disseminating global recommendations
on increasing access to health workers in remote and rural areas
through improved retention
– a time-bound participatory process involving all relevant
stakeholders following the steps set out by the WHO Guidelines
Review Committee
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An ongoing calendar
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Thank you for your attention !
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Definitions
 No consensus on a definition for “rural areas” - usually defined as “non-urban”
 Each country has its own definition based on:
–
–
the settlement profile:
• population density
• availability of economic structures
the accessibility from an urban area:
• distance in kilometres or hours drive.
 Remote/underserved = areas where relatively poorer populations reside:
•
•
remote rural areas;
small or remote islands; urban slum areas; areas that are in conflict or post-conflict; refugee camps; areas
inhabited by minority or indigenous groups*
* Not specifically included in the current literature review
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A complex issue
no ‘single bullet’ type of answer
Ministry of
Finance
Health
workers
Ministry of
Labour
Ministry of
Higher
Education
Education
and
regulatory
interventions
Direct and
indirect
financial
incentives
Civil Service
Commission
Ministry of
Transport
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Ministry of
Health
Professional
Associations
Management,
environment and
social support
Ministry of
Public
Administration
Populations/
Communities
Categories of interventions
Category of intervention
Examples
A. Education and regulatory
interventions

Targeted admission of students from rural background

Recruitment from and training in rural areas

Changes / improvements in medical curricula

Early and increased exposure to rural practice during undergraduate studies

Educational outreach programmes

Community involvement in selection of students

Compulsory service requirements (bonding schemes)

Conditional licensing (license to practice in exchange of location in rural areas)

Loan repayment schemes (paid studies in exchange of services in rural areas for 4-6 years)

Producing different types of health workers (mid-level cadres substitution task shifting)

Recognize overseas qualifications

Higher salaries for rural practice

Rural allowances, including installation kit

Pay for performance

Alter the remuneration methods (fee for service, capitation etc)

Loans (housing, vehicle)

Grants for family education

Other non-wage benefits

General improvement in rural infrastructure (roads, phones, water supplies, radio communication)

Improving working and living conditions, ensure adequate supplies of technologies and drugs

Supportive supervision

Support for continuous professional development, career paths

Special awards, civic movement, and social recognition

Flexible new contract opportunities for part-time work

Reduce the feeling of isolation (professional networks, telemedicine, distance learning)

Increase chances for recruitment to civil service
B. Monetary compensation
(direct and indirect financial
incentives)
C. Management, environment
and social support
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How can we measure “success”?
 Disparities in the rural/urban ratio of health workers to population density
 Percentage of health workers to choose to work in rural areas as a
consequence of an intervention
 Vacancy rates
France: General Practitioner density
 Duration in post
 Service utilization rates (before and after)
 Patient satisfaction surveys
 Health workers satisfaction surveys
 Health outcomes (confounding factors!)
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GP
densityper
per
GP density
1000
pop
1,000 pop
Less than 1.43
1.43 - 1.54
1.54 - 1.67
1.67-1.84
1.84 and more
Guiding principles of a WHO code of practice 1/2
 The code is voluntary.
 The individual right "to leave any country, including [one's] own".
 Right of everyone to the enjoyment of the highest attainable standard
of health.
 International recruitment can make a legitimate contribution to the
development and strengthening of a national health workforce.
 The development of voluntary international standards and the
coordination of national policies on international health worker
recruitment.
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Guiding principles of a WHO code of practice 2/2
 International recruitment of health personnel should be conducted in
accordance with the principles of transparency, fairness and mutuality
of benefits.
 The specific needs and special circumstances of countries should be
considered.
 Effective national and international data gathering, research and
information sharing are essential.
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