WHO Global Code of Practice on the International Recruitment of Health Personnel – implications for Ireland Professor Ruairí Brugha Dept of Epidemiology and Public Health Medicine Royal College of Surgeons in Ireland (RCSI) The Global Health Workforce: Pathways to Health. Why are health workers important? Irish Forum for Global Health Conference, rd February, 2012, RCSI Dublin,

1.How the Global Code was developed 2.Main recommendations 3.Ireland’s immediate responsibilities under the Code 4.How can we fulfil these responsibilities This presentation 2

Developed, , by a partnership of: o Global Policy Advisory Council – Realizing Rights (M Robinson) + GHWA o WHO (Human Resources Division) see Taylor + Dhillon, 2011 World Health Assembly adopted the Code in May A voluntary instrument that articulates global ethical norms – principles and practices – around the international recruitment and migration of health workers. Political realities of getting agreement from large destination states (US) Non-binding, but includes strong reporting and compliance mechanisms *Taylor + Dhillon argue that the obligation to comply with reporting obligations is of more value than a mandatory code that can be ignored * The WHO Global Code of Practice on the International Recruitment of Health Personnel: The Evolution of Global Health Diplomacy. Taylor + Dhillon Global Health Governance 2011 Global Code: development and form 3

1.Ethical international recruitment Avoid active recruitment from countries facing critical shortages —Ireland recruited its nurses mainly from Philippines and India and now doctors from India and Pakistan – countries with surpluses? ok? 2.Health workforce development and health systems sustainability Member states should train and retain a health workforce appropriate to its needs – HWs central to health systems —Ireland is good at training, but not at retaining its doctors and nurses 3.Fair treatment of migrant health personnel Health workers have rights, including rights to emigrate, Rights to accurate information, and to equal treatment researchable issues – being researched in Global Code: main recommendations

4.International cooperation Destination countries encouraged to collaborate with source countries to maximise mutual benefits —Ireland (donors, practitioners and researchers) collaborating with African countries – but what about our main source countries?? —Support training, technology and skills transfer – best practice is to support in-country training: RCSI COSECSA, COST, Medical Schools 5.Support to developing countries Technical assistance and financial support (as above) Data gathering, reporting, research Establish effective health personnel information systems Research programmes Share information and Report on implementation internationally Global Code: main recommendations

Member states are 1.“encouraged to publicise and implement the code.... consult with stakeholders.... govt depts, employers, recruiters...” 2.“should maintain a record of all recruiters.... and promote good practices in compliance with Code principles” 3.“encouraged to observe and assess the magnitude of active international recruitment of health personnel” 4.“should periodically report to the WHO Secretariat (every 3 years).... initial data report World Health Assembly May 2012 Ireland’s immediate responsibilities

Through partnerships – bringing together policy makers, researchers and practitioners 1.Consultations with stakeholders (Dept of Health, HSE, Medical Council) – initiated by RCSI and TCD researchers + through this conference 2.Maintain record of recruiters + promote Code compliance yet to be determined if this is being done – HRB-funded RCSI-TCD Doctor Migration Study will report 3.Monitor and measure HW immigration trends Nurses: HRB study RCSI ( ), EU study DCU (2010-) – —Later presentations (Humphries and Matthews) Doctors: HRB study by RCSI + TCD ( ) – next presentation RCSI +TCD MoU with Irish Medical Council under discussion How should we fulfil these responsibilities?

4.Reporting Ireland’s Code compliance to WHO / World Health Assembly Policy-relevant research on the health workforce — in Ireland: RCSI, TCD, DCU —In low and middle income countries: all global health partners Communication and Partnerships between researchers, policy makers and practitioners – to —communicate Ireland’s global health achievements – through research and north-south partnerships – to policy makers —build data monitoring capacity and take on new roles in support of policy makers and regulatory bodies. How should we fulfil these responsibilities?

Conclusion 9 Together, through partnerships that bring together policy makers, researchers and practitioners, WE can deliver on Ireland’s Global Health obligations