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Massive gains on health worker migration could be lost

May 28, 2013  • By Dr. Francis Omaswa (President, ACHEST) and Lord Nigel Crisp (House of Lords, former CEO of NHS)

This post was originally published by the Global Health Workforce Alliance  on their Members’ Platform on May 28, 2013. Learn more about the Health Worker Migration Global Policy Council’s work on health workforce and the WHO Global Code here, including the recent side event at the 2013 World Health Assembly.

In May 2010, we witnessed an incredible victory for global health policy: the 193 member-states of the World Health Organization (WHO) unanimously agreed to adopt a Global Code of Practice on the International Recruitment of Health Personnel, only the second ever of its kind. As members of the Health Worker Migration Global Policy Council, we were particularly moved to see the nations of the world come together in this way, acknowledging that the international migration of health professionals demands the coordination and alignment of international policy.

Now, however, those gains are threatened by lack of follow-up. The WHO, whose executive board  meets this week, has reduced its staffing on human resources and there is a danger that this vital issue will fall further down the list of priorities not just of the WHO but of other agencies and organisations. We all know that without health workers all attempts to improve and strengthen health systems are futile. It is the health worker – of every kind from the village based community worker to the highest trained professional – who ultimately make the difference. We need to renew the 2010 commitment and re-build on the energy and passion of that Assembly to drive forward implementation.

A group of experts from across the global North and South, the Council has been working for years to share best practice, facilitate dialogue, and incentivize policy action to manage the implications of immigration and the global health workforce shortage, respecting the right of health workers to seek a better life while honouring commitments to support the right to health of those who stay in home countries. 

Coming off the first report-out on Code implementation at the 2013 World Health Assembly last week, three years after the Code’s adoption, governments are working to convert the momentum behind the applause that night into country-specific policy solutions. The first report on progress with implementation of the WHO Code is out, highlighting that there has been variable pace of implementation across countries and regions.

Many countries, notably in Africa, have yet to identify a designated national authority to take the lead on national monitoring and reporting of implementation of the Code. The level of awareness of the Code, its key principles and objectives, remains inconsistent and often inadequate, particularly in the countries that have been most impacted by out-migration.   The evidence base on the effect of policies to manage migration and achieve widely positive outcomes, such as bilateral agreements, is still limited and sometimes inaccessible to policy makers.

Achieving the key objectives set out in the WHO Code was never going to be a quick win.   We are only too aware that much work remains to be done. The  continued existence of the Council and learning from the experience of the Code on Breast Milk substitutes confirms that a lot more work remains to be done as a long haul over the coming years.

There is a critical point here that deserves restating.  Our strongly held view is that implementation of the Code is not a box to be checked off. Instead, implementation of the Code represents a national, ongoing commitment to achieving effective health workforce policy and planning in order to support improved population health.

The core aims of the Code are to improve domestic health workforce policy and planning, support a sustainable approach to health worker recruitment, and to assert equal rights for migrant health workers and improving health workforce metrics and monitoring. These aims represent fundamental building blocks to an overall multi-stakeholder approach to effective, responsive national health workforce policy and planning. Accordingly, we call upon all countries, the UN family, Global Health Initiatives and other agencies, civil society, the media and academia to come together and support of the full implementation this Code.

What now needs to be done to take forward implementation of the Code, and support continued momentum towards these key objectives?

Part of the answer lies with the bold leaders and champion countries who have pursued innovative solutions and are committed to more than just “checking the box” on the Code. We have to look to the lessons of countries like Norway and Ghana, who last year won the Health Worker Migration Global Policy Council Innovation Award for innovative exchange programs, progressive and ethical policies. Countries like the Philippines, where the Code has become the catalyst for national multi stakeholder policy dialogue on health worker mobility, have also proven exemplary.

We need to redouble efforts to promote the Code as both a policy instrument and a symbol of commitment to health workforce sustainability.  It was unfortunate that the WHO reduced their internal capacity to address human resources for health (HRH) just after the Code was approved.  This has weakened the ability at a global level to support advocacy and implementation of its objectives, and has constrained the ability of WHO to facilitate national level policy dialogue. We  need to see strengthened capacity at WHO and at the Global Health Workforce Alliance so that the roles that member states entrusted these institutions in the implementation of this code are fully achieved.

We also need to look at the evidence gathering and reporting format for monitoring the Code, to ensure that it is aligned with broader, deeper national health workforce objectives, and supports an implementation that adds policy value, rather than adding an additional data gathering burden.  All countries therefore need to develop effective national health workforce information systems that are integrated with and aligned to national developments plans.


The successful implementation of the Code matters most, but the reporting on such implementation is also critical. The Code is a touchstone, a symbol of commitment towards national and international progress in health workforce sustainability. If the Code is not well implemented, we run a greater risk that these critical objectives are also not being achieved and that the promise of the right to health by all people will remain just that: an unfulfilled promise.