Reviewing the relevance and effectiveness of the WHO Global Code of Practice on the International Recruitment of Health Second meeting of the Expert Advisory Group Effectiveness Synthesis of the evidence from 1st round reporting National Reporting Instrument (NRI) Plus the key recommendations of the JAHWPF Dr. SALEHI ZALANI Gholamhossein DG of HRM office, Ministry of Health and Medical Education (I.R Iran ) April2015

Two sets of data we had A. Joint Action Health Workforce Planning and Forecasting (JAHWPF) (2013 till 2016) - The report on the applicability of the Code in the EU countries (seven best practices plus. Ireland, Germany and Moldova -The (almost) final handbook on planning methodologies across EU. (feasible realization of the methods) - Belgium, Denmark, UK, Finland, Spain and the Netherlands. B. National Reporting Instrument (NRI) 30 th May the data collected through the 1st round reporting on the Code implementation The instrument is distributed among voluntary participants (57 countries) from the WHO regions (EMRO, AFRO,etc) GOALS, FORECASTING MODEL, DATA SOURCES, LINK TO POLICY ACTIONS, ORGANISATION WHO Global Code of Practice on the International Recruitment of Health

The Overall Objectives 1.To synthesize the key recommendations of the JAHWPF in regard to evaluating the Effectiveness of the Code articles 2.To assess the NRI country reports against the Code provisions and to see whether specific elements can be mapped against the Effectiveness concept with specific country examples where possible. Effectiveness: the extent to which implementation of the Code’s objectives, principles and article: -have influenced action and policies concerning the health workforce strengthening (such as those related to health workforce implementation systems, planning education and retention strategies) at country, regional and global levels. - Is there evidence that are changing directives and policies aimed at strengthening human resources for health in line with the intentions of the Code? -What is the success of a voluntary instrument in comparison to other governance initiatives in global health?

Methodology First Stage: ▪Theme Extraction from the Code (10 Articles): 56 Main Themes ▪Theme Extraction from the Instrument: out of 14 questions 22 themes were extracted ▪Theme Extraction from the Handbook (7best practices) & the Applicability Report of the Code in some EU countries (Germany, Ireland and Moldova) Second Stage: ▪Accommodation of the Code themes with the Instrument themes ▪Accommodation of the Code themes with the Handbook & the Applicability Report themes with regard to the five dimensions of HRH planning (GOALS, FORECASTING MODEL, DATA SOURCES, LINK TO POLICY ACTIONS, ORGANISATION) Third Stage: ▪Analysis of the extracted data and their synthesis in Focus Group Discussions 1.1. Precise Translation of the Code to Persian was an essential for better understanding of its articles 2.2. Convened an Expert Committee M. Bayat S.E Mirbahaeddin A. Shokri S. alirezaei F. manafi N. bahmanziari T D

Article code% Frequency Article 1: Objectives50 Article 2 – Nature and scope0 Article 3 – Guiding principles13 Article 4 – Responsibilities, rights and recruitment practices71 Article 5 – Health workforce development and health systems sustainability 29 Article 6 – Data gathering and research50 Article 7 – Information exchange50 Article 8 – Implementation of the Code71 Article 9 – Monitoring and institutional arrangements14 Article 10 – Partnerships, technical collaboration and financial support 67 Total39  In total the instrument covers %39 of the code themes (22 themes out of 56 code themes) ▪The most focus is on article 4 (Responsibilities, rights and recruitment practices) with %71 and article 8 (Implementation of the Code) with %71. ▪the least frequencies respectively belong to article 2 (%0), article 3-Guiding principles (%13) and article 9- Monitoring and institutional arrangements (%14). How far could the instrument themes cover the Code themes? T D

Examples for Results from the NRI (effectiveness) ▪Article 8 – Implementation of the Code ▪Article 8 is one of the articles in focus of the instrument as it can be seen in questions 8 and 9 all parts of A, B, C, D, E and concentrates on the effectiveness (strategic plans of education and retention) through the encouragement of informing of code implementation, involving stakeholder by consulting in recruitment decisions, provision and update of recruitment records and utilization of recruitment agencies that comply with the guiding principles of the Code. Article 4 – Responsibilities, rights and recruitment practices ▪This article is covered by questions 1, 2 parts A & B & C and question 3. This article aims at promoting transparency of rights, obligations and expectations of stakeholders as a solution of global challenges (Relevancy) through legal monitoring mechanisms (to assess the benefits and risks, recruiters are obligated to individual right of the employees and provision of equal opportunities of promotion and etc) and also compliance of stakeholders in different professions with the laws as a means of solution for the ultimate goal of implementing strengthened health human resources systems and strategic plans for education and retention of the workforce (Effectiveness) T D

Effectiveness frequency of the code analyzed by the Instrument QuestionsFrequencyPercent Effectiveness % Q2 (mechanism for s ame legal rights ) 815 Q2-a: using mechanisms to assess the benefits and risk 00 Q2-b: promoted and remunerated based on objective criteria 00 Q2-c:same opportunities to strengthen their career progression 00 Q2-d: other mechanism 815 Q Q3: evidence of the legal mechanisms identified in Q(2) 1222 Q Q5:describe the bilateral, regional or multilateral agreements 1426 Q7 47 Q7: details about institutions undertaking research 47 Q Q9-a: communicate and share information on recruitment and migration issues 2852 Q9-b: involve all stakeholders in any decision-making processes 1833 Q9-c: introduce changes to laws or policies on recruitment 1935 Q9-d: recruiters authorized by competent authorities 1222 Q9-e: Good practices are encouraged and promoted among recruitment agencies 1222 Q9-f: other steps have been taken 815 Q Q10: main constraints to the implementation Effectiveness % Effectiveness % Total20 % Effectiveness (1): have influenced action and policies concerning the health workforce strengthening (such as those related to health workforce implementation systems, planning education and retention strategies) at country, regional and global levels. Effectiveness (2): Is there evidence that are changing directives and policies aimed at strengthening human resources for health in line with the intentions of the Code? Effectiveness (3): What is the success of a voluntary instrument in comparison to other governance initiatives in global health?

Key Points ▪The current instrument covers the code content only to some extent (%39); -therefore in order to accurately assess the effectiveness of the code it is highly recommended to utilize a more comprehensive instrument  For example in Article 9 (Monitoring and institutional arrangements) most countries failed to pay attention to it - one of the most important items in any plan and may cause issues for the future plans to be implemented

Key Points ▪Regarding three components of effectiveness there were no specific evidences in change of actions or policies -Hence countries require extensive encouragements to legalize the code imperatives through national laws and policies and also innovative national-specific plans. -in monitoring legal mechanisms they are short of effective measures (Article 4).

Final note ▪While this study examines the Effectiveness of the code to some extent, there are some limitations to results generalization, to name a few: - countries responded some questions in form of Yes or No, therefore theme extraction of these measures was problematic. -it is not determined if the implemented measures of the participating countries are initiated after or before the time when the code was notified. -Only 39 percentage of the Code themes were covered by the instrument, therefore having a comprehensive analysis is unlikely

Handbook Synthesis

How far could the EU HWP measures cover the Code themes? code Total Frequency of the countries Article 1: Objectives 440% Article 2 – Nature and scope 770% Article 3 – Guiding principles 220% Article 4 – Responsibilities, rights and recruitment practices 220% Article 5 – Health workforce development and health systems sustainability 8080% Article 6 – Data gathering and research 440% Article 7 – Information exchange 550% Article 8 – Implementation of the Code 110% Article 9 – Monitoring and institutional arrangements 00% Article 10 – Partnerships, technical collaboration and financial support 880% T

code Total Frequency of the countries percentage Article 1: Objectives 1 %25 Article 2 – Nature and scope 0 %0%0 Article 3 – Guiding principles 2 %100 Article 4 – Responsibilities, rights and recruitment practices 1 %50 Article 5 – Health workforce development and health systems sustainability 6 75% Article 6 – Data gathering and research 4 100% Article 7 – Information exchange 1 20% Article 8 – Implementation of the Code 1 100% Article 9 – Monitoring and institutional arrangements 0 0% Article 10 – Partnerships, technical collaboration and financial support 7 88% total 2356% How far could the EU docs depict the effectiveness of Code themes? T