Here is our discussion topic for March and April 2015. Last week I attended a meeting at WHO Geneva on the WHO Code on the International Recruitment of Health Personnel. At this meeting, we heard emphatic statements to the effect that taking account of global demographics along with regional economic integration in many parts of the world, Health Workforce Force (HWF) migration will assume mega trends in the coming decades and will impact
the ability of countries and regions to achieve the Post 2015 Sustainable development Goals.
The sooner we all familiarize ourselves with this Code and start to use it the better our chances and hopes of achieving our health goals.
We are discussing this topic now for two reasons which call for urgent action. The first issue is Africa’s performance with respect to actions that were agreed to implement the Code and the second issue is the proposed bilateral agreement between the government of Uganda and the government of Trinidad and Tobago (TT) to recruit Ugandan health workers for TT, which has attracted international press coverage.
The background to this discussion recognizes two facts; firstly that skilled, motivated and supported health workers are essential for access of all people to essential health care or Universal Health Coverage within national and global health systems. Secondly, that the world is faced with a health workforce crisis characterized by widespread shortages of over five million, mal-distribution and poor working conditions. Over years, developed countries recruited health workers from low and middle income countries (LIMC) to fill their HWF gaps; a practice that acquired the name “brain drain".
However following very acrimonious debates over the matter between Ministers of Health from developed and developing countries during a series of annual sessions of the World Health Assembly, a comprehensive voluntary WHO Code on the International Recruitment of Health Personnel was adopted by the World Health Assembly in 2010 to guide the implementation of solutions to the global HWF crisis systematically, ethically and transparently. Article 3 recognizes the Code “as a core component of bilateral, national, regional and global responses to the challenges of health personnel migration and health systems strengthening”…….“safe guards the rights of health personnel … including the right to migrate to countries that wish to admit and employ them”. I have been closely involved in the development and adoption of this Code and recommend it as an excellent tool for global health systems strengthening.
How is the African WHO Region performing with respect to the commitments in the implementation of the Code? This voluntary Code provides an excellent platform for collaboration and ethical sharing of the HWF between countries. The Code encourages Member States to undertake a number of key actions key among which are: designation of national authority to oversee the implementation of the code and periodic reporting to WHO as requested. Others include dissemination and use of the code at country level. In 2012 WHO called upon member states to submit reports on the progress of implementation of the code. The WHO African Region performed dismally with only one country submitting a report out of 47. This compares with 36 countries from the European region. WHO has called for the second round reporting due by July 2015? I would like to call upon Member States from the WHO African Region to ensure that this time round we do not take the last place. What is the best way to get countries to report? Should WHO country offices be doing more to mobilize countries? What about the HealthMinistries?
Let’s now turn to the ongoing and not yet finalized negotiations between the governments of Uganda and T&T to send health workers to T & T. A Uganda based NGO has taken the government of Uganda to court to block the plans for Uganda to send
health professionals to T&T through a bilateral agreement arguing that the health workers are needed more in Uganda than in T & T and the matter has also been raised in the parliament of Uganda. There is currently adverse international media
coverage against the planned recruitment of Ugandan health professionals for T &T. However, the WHO Code was adopted precisely to handle situations such as this; yet I have not seen balanced and holistic references to this code in the current debates!
There are already many bilateral agreements on HWF recruitment between countries such as between South Africa and the UK, Kenya and Namibia; the Philippines leads the way with an elaborate international posting program.
How can we best address the rights of Ugandan health workers to work abroad and the rights of the people of Uganda to access essential health care as well as the needs ofT & T? I suggest the correct place is the negotiating table guided by the Code that was agreed the UN Member States after very extensive debates spanning at least four years. Civil Society actors have a recognized place in the implementation of this Code and I urge them to engage in well informed and constructive dialogue with their respective governments and other stake holders in a spirit of “inform and inspire” and not “name and shame”.
What do you think?