3.2 Addressing present and expected shortages in the health workforce is crucial to protecting global health. International migration of health personnel can
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WHO Global Code of Practice on the International Recruitment of Health Personnel Preamble The Member States of the World Health Organization, Recalling resolution WHA57.19 in which the Worl d Health Assembly requested the Director- General to develop a voluntary code of practice on th e international recruitment of health personnel in consultation with all relevant partners; Responding to the calls of the Kampala Declaration adopted at the First Global Forum on Human Resources for Health (Kampala, 2Œ7 Marc h 2008) and the G8 communiqués of 2008 and 2009 encouraging WHO to accelerate the developm ent and adoption of a code of practice; Conscious of the global shortage of health personnel and recognizing that an adequate and accessible health workforce is fundame ntal to an integrated and effective health system and for the provision of health services; Deeply concerned that the severe shortage of health personnel, including highly educated and trained health personnel, in many Member States, constitutes a major threat to the performance of health systems and undermines the ability of these countries to achieve the Millennium Development Goals and other internationally agreed development goals; Stressing that the WHO Global Code of Practice on the International Recruitment of Health Personnel be a core component of bilateral, nati onal, regional and global responses to the challenges of health personnel migration and health systems strengthening, THEREFORE The Member States hereby agree on the following articles which are recommended as a basis for action. Article 1 Œ Objectives The objectives of this Code are: (1) to establish and promote voluntary principles and practices for the ethical international recruitment of health personnel, taking into acc ount the rights, obligations and expectations of source countries, destination countries and migrant health personnel; (2) to serve as a reference for Member States in establishing or improving the legal and institutional framework required for the inte rnational recruitment of health personnel; (3) to provide guidance that may be used where appropriate in the formulation and implementation of bilateral agreements a nd other international legal instruments; (4) to facilitate and promote internationa l 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.
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WHO Global Code of Practice on the Intern ational Recruitment of Health Personnel 2 Article 2 ΠNature and scope 2.1 The Code is voluntary. Member States and other stakeholders are strongly encouraged to use the Code. 2.2 The Code is global in scope and is intended as a guide for Member States, working together with stakeholders such as health personnel, recr uiters, employers, health-professional organizations, relevant subregional, regional a nd global organizations, whether public or private sector, including nongovernmental, and all persons concerned with the international recruitment of health personnel. 2.3 The Code provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small island states. Article 3 ΠGuiding principles 3.1 The health of all people is fundamental to th e attainment of peace and security and is dependent upon the fullest cooperation of individuals and states. Governments have a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures. Member States should take the Code into account wh en developing their national health policies and cooperating with each other, as appropriate. 3.2 Addressing present and expected shortages in th e health workforce is crucial to protecting global health. International migration of health personnel can make a sound contribution to the development and strengthening of health systems, if recruitment is properly managed. However, the setting of voluntary international principles and the coordination of national policies on international health personnel recruitment are desirable in or der to advance frameworks to equitably strengthen health systems worldwide, to mitig ate the negative effects of health personnel migration on the health systems of developing countries and to safeguard the rights of health personnel. 3.3 The specific needs and special circumstances of countries, especially those developing countries and countries with economies in transition that are particularly vulnerable to health workforce shortages and/or have limited capacity to implem ent the recommendations of this Code, should be considered. Developed countries should, to the ex tent possible, provide technical and financial assistance to developing countries and countries with economies in transition aimed at strengthening health systems, including h ealth personnel development. 3.4 Member States should take into account the right to the highest attainable standard of health of the populations of source countries, individual righ ts of health personnel to leave any country in accordance with applicable laws, in order to mitigate the negativ e effects and maximize the positive effects of migration on the health systems of the source countries. However, nothing in this Code should be interpreted as limiting th e freedom of health personnel, in accordance with applicable laws, to migrate to countries that wish to admit and employ them. 3.5 International recruitment of health personne l should be conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health systems in developing countries. Member States, in conformity with natio nal legislation and appli cable international legal instruments to which they are a party, should prom ote and respect fair labour practices for all health personnel. All aspects of the employment and treatment of migrant health personnel should be without unlawful distinction of any kind.
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WHO Global Code of Practice on the Inte rnational Recruitment of Health Personnel 3 3.6 Member States should strive, to the extent possi ble, to create a sustainable health workforce and work towards establishing effective health workforce planning, educa tion and training, and retention strategies that will reduce their need to recruit migrant health personnel. Policies and measures to strengthen the health workforce should be appropriate for the specific conditio ns of each country and should be integrated within na tional development programmes. 3.7 Effective gathering of nationa l and international data, research and sharing of information on international recruitment of health personnel are needed to achieve the objectives of this Code. 3.8 Member States should facilitate circular migr ation of health personnel, so that skills and knowledge can be achieved to the benefit of both source and destination countries. Article 4 ΠResponsibilities, rights and recruitment practices 4.1 Health personnel, health professional organiza tions, professional councils and recruiters should seek to cooperate fully with regulators, national and lo cal authorities in the interests of patients, health systems, and of society in general. 4.2 Recruiters and employers should, to the ex tent possible, be aware of and consider the outstanding legal responsibility of health personnel to the health system of their own country such as a fair and reasonable contract of service and not seek to recruit them. Health personnel should be open and transparent about any contract ual obligations they may have. 4.3 Member States and other stakeholders should r ecognize that ethical international recruitment practices provide health personnel with the opportunity to assess the be nefits and risks associated with employment positions and to make timely and informed decisions. 4.4 Member States should, to the extent possible unde r applicable laws, ensure that recruiters and employers observe fair and just recruitment and contractual practices in the employment of migrant health personnel and that migran t health personnel are not subjec t to illegal or fraudulent conduct. Migrant health personnel should be hired, promoted and remunerated based on objective criteria, such as levels of qualification, years of experience and degrees of professional responsibility on the basis of equality of treatment with the domestically trained health workforce. Recruiters and employers should provide migrant health personnel with relevant a nd accurate information about all health personnel positions that they are offered. 4.5 Member States should ensure that, subject to a pplicable laws, including relevant international legal instruments to which they are a party, migr ant health personnel enjoy the same legal rights and responsibilities as the domestically trained hea lth workforce in all terms of employment and conditions of work. 4.6 Member States and other stakeholders should take measures to ensure that migrant health personnel enjoy opportunities and in centives to strengthen their professional education, qualifications and career progression, on the basis of equal treatment with the domestically trained health workforce subject to applicable laws. All migrant health pe rsonnel should be offered appropriate induction and orientation programmes that enable them to operate safely and effectively within the health system of the destination country.
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WHO Global Code of Practice on the Intern ational Recruitment of Health Personnel 4 4.7 Recruiters and employers should understand that the Code applies equally to those recruited to work on a temporary or permanent basis. Article 5 Œ Health workforce development and health systems sustainability 5.1 In accordance with the guiding pr inciple as stated in Article 3 of this Code, the health systems of both source and destination countries should derive benefits from the international migration of health personnel. Destination countries are encourag ed to collaborate with source countries to sustain and promote health human resource development and training as appropriate. Member States should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers. 5.2 Member States should use this Code as a guide when entering into bilateral, and/or regional and/or multilateral arrangements, to promote international cooperation and coordination on international recruitment of health personnel. Such arrangements should take into account the needs of developing countries and countries with economies in transition through the a doption of appropriate measures. Such measures may include the provision of effective and appropriate technical assistance, support for health personnel retention, social and professional recognition of health personnel, support for training in source countries that is appropriate fo r the disease profile of such countries, twinning of health facilities, support for capacity building in the development of appropriate regulatory frameworks, access to spec ialized training, technology and skills transfers, and the support of return migration, whether temporary or permanent. 5.3 Member States should recognize the value both to their health systems and to health personnel themselves of professional exchanges between countri es and of opportunities to work and train abroad. Member States in both source and destination countries should encourage and support health personnel to utilize work experience gained ab road for the benefit of their home country. 5.4 As the health workforce is central to sustainable health sy stems, Member States should take effective measures to educate, retain and sustain a he alth workforce that is appropriate for the specific conditions of each country, including areas of gr eatest need, and is built upon an evidence-based health workforce plan. All Member States should strive to meet their health personnel needs with their own human resources for health, as far as possible. 5.5 Member States should consider strengthening edu cational institutions to scale up the training of health personnel and devel oping innovative curricula to address curre nt health needs. Member States should undertake steps to ensure that appropriate tr aining takes place in the public and private sectors. 5.6 Member States should consider adopting a nd implementing effective measures aimed at strengthening health systems, continuous monitori ng of the health labour market, and coordination among all stakeholders in order to develop and retain a sustainable health workforce responsive to their population™s health needs. Member States s hould adopt a multisectoral approach to addressing these issues in national health and development policies. 5.7 Member States should consider adopting measu res to address the geographical maldistribution of health workers and to support their retention in underserved areas, such as through the application of education measures, financial incentives, re gulatory measures, social and professional support.
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WHO Global Code of Practice on the Inte rnational Recruitment of Health Personnel 5 Article 6 ΠData gathering and research 6.1 Member States should recognize that the formul ation of effective policies and plans on the health workforce requires a sound evidence base. 6.2 Taking into account characteristics of national h ealth systems, Member States are encouraged to establish or strengthen and maintain, as appropriate, health personnel information systems, including health personnel migration, and its impact on hea lth systems. Member St ates are encouraged to collect, analyse and translate data into eff ective health workforce policies and planning. 6.3 Member States are encouraged to establish or strengthen research programmes in the field of health personnel migration and coordinate such research programmes through partnerships at the national, subnational, regiona l and international levels. 6.4 WHO, in collaboration with relevant intern ational organizations and Member States, is encouraged to ensure, as much as possible, that comparable and reliable data are generated and collected pursuant to paragraphs 6.2 and 6.3 for ong oing monitoring, analysis and policy formulation. Article 7 ΠInformation exchange 7.1 Member States are encouraged to, as appropriate and subject to national law, promote the establishment or strengthening of information excha nge on international h ealth personnel migration and health systems, nationally and internationally , through public agencies, academic and research institutions, health professional organizations, and subregional, regi onal and international organizations, whether governmental or nongovernmental. 7.2 In order to promote and facilitate the exchange of information that is rele vant to this Code, each Member State should, to the extent possible: (a) progressively establish and maintain an update d database of laws a nd regulations related to health personnel recruitment and migration and, as appropriate, information about their implementation; (b) progressively establish and maintain update d data from health personnel information systems in accordance with Article 6.2; and (c) provide data collected pursuant to s ubparagraphs (a) and (b ) above to the WHO Secretariat every three years, beginning with an initial data report within two years after the adoption of the Code by the Health Assembly. 7.3 For purposes of international communication, each Member State should, as appropriate, designate a national authority responsible for the ex change of information re garding health personnel migration and the implementation of the Code. Me mber States so designating such an authority, should inform WHO. The designated national authority should be authorized to communicate directly or, as provided by national law or regulations, with designated national authorities of other Member States and with the WHO Secretariat and other region al and international organizations concerned, and to submit reports and other information to the WHO Secretariat pursuant to subparagraph 7.2(c) and Article 9.1.
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WHO Global Code of Practice on the Intern ational Recruitment of Health Personnel 6 7.4 A register of designated national authoriti es pursuant to paragraph 7.3 above shall be established, maintained and published by WHO. Article 8 Œ Implementation of the Code 8.1 Member States are encouraged to publicize a nd implement the Code in collaboration with all stakeholders as stipulated in Article 2.2, in acco rdance with national and subnational responsibilities. 8.2 Member States are encouraged to incorporate the Code into applicable laws and policies. 8.3 Member States are encouraged to consult, as a ppropriate, with all stakeholders as stipulated in Article 2.2 in decision-making processes and invol ve them in other activities related to the international recruitment of health personnel. 8.4 All stakeholders referred to in Article 2.2 should strive to work individually and collectively to achieve the objectives of this Code. All stakeholde rs should observe this Code, irrespective of the capacity of others to observe the Code. Recruite rs and employers should cooperate fully in the observance of the Code and promote the guiding principles expressed by the Code, irrespective of a Member State™s ability to implement the Code. 8.5 Member States should, to the extent possibl e, and according to legal responsibilities, working with relevant stakeholders, maintain a record, updated at regular intervals, of all recruiters authorized by competent authorities to operate within their jurisdiction. 8.6 Member States should, to the extent possi ble, encourage and promote good practices among recruitment agencies by only using those agencies th at comply with the guiding principles of the Code. 8.7 Member States are encouraged to observe and assess the magnitude of active international recruitment of health personnel from countries facing critical shortage of health personnel, and assess the scope and impact of circular migration. Article 9 Œ Monitoring and institutional arrangements 9.1 Member States should periodically report the measures taken, results achieved, difficulties encountered and lessons learnt into a single report in conjunction with the provisions of Article 7.2(c). 9.2 The Director-General shall keep under review the implementation of this Code, on the basis of periodic reports received from designated national au thorities pursuant to Articles 7.3 and 9.1 and other competent sources, and periodically report to the World Health Assembly on the effectiveness of the Code in achieving its stated objectives and sugg estions for its improvement . This report would be submitted in conjunction with Article 7.2(c). 9.3 The Director-General shall: (a) support the information exchange system and the network of designated national authorities specified in Article 7; (b) develop guidelines and make recommendati ons on practices and procedures and such joint programmes and measures as specified by the Code; and
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